Another great meeting from the Endocrine Society is complete. A variety of presentations were available, and each participant had to choose their favorites, but here are my personal highlights from the lectures that I attended.
Most interesting of all was the presentation of the TRAVERSE trial data that was about the cardiovascular safety of testosterone use in middle-aged or older men with previous cardiac problems or high risk for cardiovascular disease. The results showed that testosterone replacement:
- does not increase the incidence of major cardiac events,
- improves the symptoms of hypogonadism including sexual dysfunction over 1–2 years,
- did not improve glycemic control among patients with diabetes, or decrease the progression of prediabetes to diabetes,
- improved anemia in patients with previous anemia problems as well as showed lower incidence of anemia in patients without previous anemia history,
- did not increase the incidence of prostate cancer,
- increased the incidence of all types of fractures,
All findings were somehow expected and understood, except for the increased fracture risk that, for now, cannot be explained as the study was not designed to answer this particular question. Further studies will be needed to explore the mechanism of this finding.
To avoid confusion about the term “diabetes,” which is primarily connected to sugar problems, the diabetes insipidus conditions are renamed “Vasopressin Deficiency” for the previously known as central diabetes insipidus and as “Vasopressin Resistance” for the previously known as nephrogenic diabetes insipidus.
Patients with posterior pituitary problems might suffer from oxytocin deficiency which has been shown to cause psychopathological issues. A new test using “ecstasy” pills (3,4-methylenedioxymethamphetiamine or MDMA) showed promising results in revealing oxytocin deficiency in patients with vasopressin deficiency, and further studies are now designed to investigate the treatment choices for improving all related symptoms. MDMA use in clinical practice has already shown successful results in research studies when used in combination with psychotherapy for PTSD management.
Last but not least, some preliminary results about new anti-obesity medications were presented, and they are to be discussed in more detail at the upcoming ADA annual meeting later in June. The new medications include a tri-agonist agent called retatrutide that acts as a combined GIP, GLP-1 and glucagon receptor agonist and a combination substance of long-acting amylin analog (cagrilintide) with long-acting GLP-1 analog (semaglutide). Both medications showed quite promising results in phase 3 and phase II studies, respectively, and they might be the next-generation agents approved for obesity management in patients with or without diabetes mellitus comorbidity, something that is so much needed in light of the epidemic of obesity that is a hugely growing burden for medical systems around the world.
Genetic types of obesity, like POMC/LEPR/PCSK1 Biallelic variants and Bardet Biedi syndrome, can be treated with setmelanotide, which is an a-MSH analog already approved and marketed for relevant pediatric patients. Ongoing studies are being conducted for the treatment of hypothalamic obesity and other genetic variants in the MC4R pathway.
Dr. Anastasopoulou has no conflicts of interest to report.
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Illustration by April Brust
