By Karen Campbell

Front, left to right: Meg Keil, Dr. Tyrrell, Karen Campbell, Louise Pace, Dr. Stratakis, Dr. Findling, Dr. Raff Back, left to right: Dave Campbell, Dr. Schteingart, not shown: Dr. Lacroix

The annual meeting of The Endocrine Society was held June 24-27 at the brand new convention center in Boston. This was the 10th year that the CSRF has exhibited and it was wonderful to have the conference held in the city where the CSRF is headquartered! The , and Karen and Dave Campbell. Booth traffic was excellent and it continues to amaze us that many endocrinologists are still not aware that there is support for Cushing’s, and thanked us for exhibiting.

On Sunday evening, Louise hosted a get together for the CSRF Medical Advisory Board at her and John’s home in Boston. Louise said, “It’s an honor and a privilege to have these wonderful doctors on our Medical Advisory Board. Their support, efforts and encouragement have meant so very much over the years, and I’m thankful that this year we were in some small way able to say “Thank You” in person.”

The technical sessions this year were also excellent, as usual, with a substantial amount of emphasis on Cushing’s and cortisol. While it is impossible summarize all of the various excellent presentations, here are a few highlights.

The preliminary results from a multi-national Phase II clinical trial of SOM 230 (Pasireotide) for treatment of Cushing’s Disease was presented by Dr. Marco Boscaro (Ancona, Italy). (This is the study that was listed in this newsletter and is now closed to enrollment). In 14 patients enrolled in the study, 21% (3) had normal 24 hr urinary free cortisol (UFC) after 15 days of treatment; a decrease of 40% in UFC was observed in another 50% (7) of the patients. One patient had improvement in a visual field test and in general, there were “significant” improvements in Cushing’s symptoms such as weight loss, fatigue, and/or muscle weakness. The largest side effects were gastrointestinal, injection site reactions and primarily transient increases in blood glucose. While SOM 230 was completely or somewhat successful in decreasing UFC in 71% of the patients, further, larger and continuing studies are needed.

Dr. J. Blake Tyrrell (UCSF) presented a talk on the Role of Bilateral Adrenalectomy, concluding that BLA is indeed a treatment option for cases of Cushing’s that cannot be cured by other means. In the same line, a poster presented by Dr. Ed Laws (UVA) discussed the same subject with same conclusion and pointed out that radiation after BLA does not necessarily prevent Nelson’s Syndrome.

Dr. Antoine Tabarin (Bordeaux, France) discussed Looking for Subclinical Cushing’s: Who and How? He emphasized that certain sub-groups, such as diabetics, those with adrenal incidentalomas, and obese subjects should be screened for Cushing’s with greater scrutiny, since the incidence is greater in these groups than the general population.

Dr. Iacopo Chiodini (Milan, Italy) discussed the Prevalence of Subclinical Hypercortisolism in Subjects Screened for Osteoporosis and concluded that in this study, 9.7% (7/72) of those with osteoporosis had sub-clinical Cushing’s. Six of the patients had adrenal tumors and one had a pituitary tumor.

A very interesting talk by Dr. Richard JM Ross (Sheffield, UK) discussed Optimization of Adrenal Glucocorticoid Replacement Therapy and suggested a weight based, 3x daily replacement dose (Mah et.al, Clinical Endocrinology, 61, 367). A particularly interesting note, is that this group mimicked the cortisol circadian rhythm with IV dosing and are working on a delayed and sustained release oral form of hydrocortisone that could also mimic the natural circadian rhythm.

Dr. Martin Fassnacht (Wuerzburg, Germany) discussed the Management of Adrenocorical Carcinoma (ACC), stressing that better treatments will come from a better understanding of this difficult to treat cancer. In another poster, Dr. Fassnacht presented data that supported post-surgical radiation to the ACC tumor location to prevent local recurrence, but did not demonstrate an impact on long term survival in this small patient group of 14.

Again, testing was discussed in many posters and the long and the short still remains, no one single test can completely rule out Cushing’s, even the gold standard, 24hr UFC test. You can view the abstracts yourself at: http://www.endo-society.org/