Past Meetings Highlights
Past Meetings Highlights
Welcome from Scott Urquhart, PA-C, DFAAPA, Chair of MEDS
Scott welcomed the audience of PAs and NPs to the annual Metabolic and Endocrine Disease Summit (MEDS) and discussed his goals for the meeting: to remedy the paucity of education in metabolic and endocrine disease, ease the burden created by the national shortage of endocrinologists, and enhance attendees' ability to treat the growing number of patients with metabolic and endocrine disorders.
Unraveling the Mystery, Part 1: Thyroid Labs and Hypothyroidism
Christine Kessler, MN, CNS, ANP, BC-ADM, CDTC, Co-Chair of MEDS
TSH remains the gold standard in determining abnormal thyroid function and moves in opposition to the primary thyroid secretion of thyroid hormone. Christine also explained what to do with subclinical hypothyroidism: Assess for physical symptoms (fatigue, hyperlipidemia) and thyroid antibodies, perform thyroid ultrasound, and treat only if the patient is symptomatic. Finally, she discussed thyroid replacement hormone, noting that how it is taken–especially with regard to food (eg, soy products) and drugs–can reduce efficacy as much as 50%.
Unraveling the Mystery, Part 2: Hyperthyroidism and Postpartum Thyroiditis
Chris Sadler, MA, PA-C, CDE, Co-Chair of MEDS
Chris concurred with Christine Kessler’s point that TSH is still the best initial screening test for thyroid dysfunction. He added that clinical exam findings can help to guide the diagnostic work-up, and adjunctive labs–including free T4, T3, and thyroid antibodies–help to clarify the diagnosis of hyperthyroidism. Thyroid uptake/scan are helpful when the clinical picture is not clear. Finally, Chris pointed out that postpartum thyroiditis is common; women with +TPO antibodies and other autoimmune diseases are at high risk.
Unraveling the Mystery, Part 3: Thyroid Nodules and Other Forms of Thyroiditis
Chris Sadler, MA, PA-C, CDE
Chris emphasized that the work-up for thyroid nodules is not an emergency; only 5% to 10% are malignant. Furthermore, few malignancies are aggressive; most are slow to grow and slow to spread. He also noted that how the nodule is found does not matter–the risk is the same.
Overview of DM2 and Tackling Current Guidelines
Lucia M. Novak, MSN, ANP-BC, BC-ADM
Lucia’s key point is that patients with diabetes need individualized glycemic goals. Aggressive glycemic control as early in the disease process as possible will continue to convey improved microvascular and macrovascular outcomes for years afterward (known as the "legacy effect" or "metabolic memory"). She also cautioned that older patients with long-standing diabetes and known cardiovascular disease should have less stringent glycemic targets. Finally, she said, prevention is the key: improved diet, increased physical activity, and education, particularly for at-risk groups.
Type 2 Diabetes Agents
Ellen D. Mandel, DMH, MPA, PA-C, CDE
Ellen also highlighted individuality, adding that focusing on the lowering of A1C as the only determinant of patient outcome is no longer key–the overall health of the patient in the context of their lives has gained wider acceptance. Furthermore, she noted, treatment options are increasing and offer prospects for improved clinician-to-patient conversation about what works best. Notably, she added, weight gain is not a "given" with better glucose control, as agents can be selected that are more weight neutral or even result in weight loss in many patients.
Panel Presentation: Case Studies in Type 2 Diabetes
Presenters: Lucia M. Novak, MSN, ANP-BC, BC-ADM, and Ellen D. Mandel, DMH, MPA, PA-C, CDE; Panelist: Scott Urquhart, PA-C, DFAAPA
In this inaugural panel presentation at MEDS, Lucia and Ellen discussed patient cases that illustrate their key point: The patient is the most important focus for the clinician. As Lucia notes, "The level of intimacy, empathy, humanism, and trust that are required to develop a rapport with the patient, and therefore best manage this disease, can be overwhelming. Those who succeed are, not surprisingly, also the most fulfilled and passionate about what they do." Ellen adds, "Patients are not failures: Emphasizing small successes leads to larger wins." She also counseled clinicians that "patients should not hear the A1C talk only–they need to grasp the importance of lipid and blood pressure control as a major determinant of their health."
Davida Kruger, MSN, APRN-BC, BC-ADM
Most patients with type 2 diabetes will eventually require insulin therapy, so Davida emphasized that understanding the physiology of type 2 diabetes will help clinicians to individualize treatment for their patients. She added that self-monitoring of blood glucose helps patients and clinicians to better understand what adjustments are needed with insulin therapy.
Panel Presentation: T2DM Case Studies in the Use of Insulin
Presenters: Davida Kruger, MSN, APRN-BC, BC-ADM, and Lucia M. Novak, MSN, ANP-BC, BC-ADM;
In this panel presentation, Davida and Lucia discussed patient cases that illustrate the challenges of achieving glycemic control. Davida advised that early, intensive intervention is needed to reach glycemic goals and reduce the risk for complications. She added that understanding sequential insulin strategies in type 2 diabetes assists patients in reaching treatment goals. Lucia pointed out that it is often safer to change an insulin regimen than it is to attempt to change lifestyle habits. She also noted that fear of nocturnal hypoglycemia is a significant barrier to optimal diabetes management.
Obesity: The Epidemic and Outcomes
Christine Kessler, MN, CNS, ANP, BC-ADM, CDTC, Co-Chair of MEDS
Christine's lecture focused on the idea that the global obesity epidemic goes beyond the "outdated notion" of "calories in versus calories out." She noted that the cause is multifactorial and may have more to do with the changes to our food supply, enteric signaling, and epigenetics. "We need to change the way we instruct patients on weight loss strategies, with regard to diet and exercise," she said, "to take into account what we now know about entero-endocrine-brain signaling." She also discussed the many anti-obesity agents in the research pipeline, including one recently approved by the FDA (lorcaserin).
Common Causes of Adrenal Dysfunctions
Scott Urquhart, PA-C, DFAAPA, Chair of MEDS
Although adrenal dysfunctions make up a small portion of endocrine-related diseases, Scott said clinicians need to be able to identify the most common and potentially serious conditions–especially when a delay in diagnosis can lead to unfavorable outcomes. Cushing's disease, for example, has such an insidious onset that it might be mistaken for common obesity, metabolic syndrome, or polycystic ovarian syndrome. Clinicians also need to be aware of Addison's disease, which is often associated with other autoimmune disorders. Finally, Scott noted that the "overutilization" of imaging studies has led to an increase in incidental findings of adrenal masses, making it imperative that clinicians know how to evaluate, follow, and/or refer affected patients.
Dyslipidemia and Current Guidelines for Lipid Management
Joyce Ross, MSN, RNC, CRNP, CS, FNLA, FPCNA
Death is the first "symptom" of dyslipidemia for more than 40% of people who have a heart attack, Joyce informed the audience. One in 500 people in the United States have a genetic form of hypercholesterolemia, which when identified can be successfully treated, allowing the patient to have a normal life. "Most people with familial hypercholesterolemia look just like you and me," she said. "The cholesterol that is building up in their bodies cannot be seen, tasted, or otherwise identified without blood tests, which should be completed in all patients by age 20." Children with a family history of coronary artery disease or high cholesterol should be tested at age 2.
PCOS: It's Not Just Infertility–Definition, Diagnosis, and Treatment
Mimi Secor, MS, MEd, APRN, BC, FNP, FAANP
Mimi’s assessment is that clinicians, regardless of specialty, don't fully appreciate the cardiometabolic impact of polycystic ovarian syndrome (PCOS). While the problems of high blood pressure in pregnancy and difficulties in conception receive attention, she noted that clinicians should also be concerned about uterine cancer and "silent" cardiovascular disease. Mimi aimed to educate MEDS attendees on where and how risks are linked to clinical manifestations–for instance, clinicians may think that a woman having a period every few months is "probably OK," when it may signal a serious problem. With early diagnosis, she concluded, preventive strategies can be implemented and clinicians "can help patients live healthier lives."