Diagnose pituitary tumours early as they are largely treatable-Prof. John Wass


 Pakistan Endocrine Society conference proceedings-I

Diagnose pituitary tumours early as they
are largely treatable - Prof. John Wass

Patients on Liraglutide achieved target HbA1c, weight loss and it also
preserves renal function but there is risk of pancreatitis-Prof. Tasnim Ahsan

ISLAMABAD: Prof. John Wass from Oxford UK was the keynote speaker in the first plenary session at the Pakistan Endocrine Society’s 14th annual conference held at Islamabad from November 18-20, 2016. This session was chaired by Prof. Javed Akram Vice Chancellor of SZABMU along with Prof. Najmul Islam from Aga Khan University while Prof. Ali Jawa was the moderator. Prof. John Wass’s presentation was on Pituitary Glands: Not a Wastepipe of the Brain. Prof. John Wass pointed out that one can see the Acromegaly pathology in patients easily. Marrie was the first one to describe Acromegaly. Galen described aneurysm while Geoffery Harris was the founder of neuroendocrinology.  Andrew and Rogers both got Nobel Prize for this.  He also briefly talked about Sheehan Syndrome described by Prof. Sheehan.

Prof. Javed Akram VC SZABMU along with Prof.Najmul Islam and Prof. Ali Jawa
chairing a scientific session during the Pakistan Endocrine Society
conference held at Islamabad from November 18-20, 2016.

Bromocriptine, he said, was discovered and marketed in 1972 for the treatment of prolactinomas and it was used for treatment of acromegaly in 1975.  He then talked about the classification of pituitary tumours and its distribution in various sub-types. Its relapse rate is according to post operative scan classification, He also referred to follow up of NFAs after surgery and radiotherapy. Some of these tumours, Prof. John Wass said are difficult to dissect surgically. Some patients might complain of memory problems after radiotherapy which was one of its side effects. Speaking about epidemiology of prolactinomas, Prof. John Wass said that there is preponderance of female patients, 90% are female and the remaining 10% are male. He then talked about common causes of hyper prolactinaemia and macro prolactinomas.  Dopamine agonist resistance, failure to normalize prolactin, failure to decrease tumour size less than 50% and recurrence of macro prolactinomas were also discussed in detail. He also mentioned about clinical features of acromegaly and pointed out that over the years there has been improvement in life expectancy and reduction in mortality. Acromegaly Registry in UK, he said, was established in 2012 and so far we have registered 2500 patients of which less than 50% are under control. With early treatment there is a success in 60-70% of cases.  At times surgical de-bulking is worthwhile. One should give dopamine agonist first followed by radiation, that is what we practice in UK, he added. Prof. John Wass also discussed anterior pituitary hormone replacement therapy and then showed a few slides of craniophyrangiomas. He concluded is presentation by stating that one should diagnose pituitary tumours early as they are largely treatable.

This was followed by corporate symposia on the potential of GLP-1 Based therapies. Prof. Tasnim Ahsan a noted endocrinologist from Karachi was the guest speaker. This session was moderated by Dr.Amina Riaz. Prof. Tasnim Ahsan discussed in detail how glycaemic control is achieved, the benefits beyond glycaemic control, and clinical trials for practice, safety and practicalities of these therapies. She pointed out that native GLP-1 has limited clinical value because of its short half life. She then talked about  incretin effect in Type 2 diabetes mellitus and said that production of GLP-1 is desired in people with type 2 diabetes. Talking about discovery of GLP-1 therapies she said that various compounds were introduced from 2005-2013. GLP-1 has actions beyond the pancreas, it effects liver, heart,  kidney, GI tract, fat cells, in fact it is everywhere in the blood vessels. Speaking about weight reduction with Liraglutide, she pointed out that it effects on fasting lipid levels. Addition of insulin to Liraglutide results in changes and reduction in HbA1C and there is significant weight reduction as compared to Exenatide. It has beneficial effects on HbA1C and body weight. Studies by Association of British Clinical Diabetologists have showed that there was 1.5% reduction in HbA1c and there was much more reduction in body weight. Using a dose of 1.8mg best results were achieved in a Meta analysis. There was significant reduction in CV events and non-fatal Myocardial Infarcton.

Picture on left shows Prof.Najmul Islam presenting a mementoe to Prof. John Wass. Picture also shows
Prof. Javed Akram presenting mementoes to Prof.Najmul Islam and Prof. Tasnim Ahsan during the
Endocrine Society conference held at Islamabad recently.

Speaking about the side effects, Prof. Tasnim Ahsan mentioned transient nausea but there was no major hypoglycaemia reported with the use of Liraglutide. However, in patients with Type 2 diabetes, there is a risk of pancreatitis and it is reported to be 1.6 per thousand per year. For majority of the patients one can use the dose of 1.2mg for atleast one week and start with 0.6mg. She concluded her presentation saying that we have over fifteen years experience with this drug in Type 2 diabetes mellitus. More patients have achieved target HbA1c and there was significant weight loss. It also preserves renal function but there is risk of pancreatitis. Responding to question from the audience Prof.Tasnim Ahsan said that there are some GI side effects but there is definite weight reduction and no patient on the drug had to be withdrawn from treatment because of side effects.

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