AAES Newsletter
INSIDE
  1. Message from the President
  2. Message from the Secretary-Treasurer
  3. Office of the Recorder
  4. Membership Report
  5. Fellowship Committee Chair Report
  6. Fellowship Accreditation Committee
  7. CESQIP Update
  8. 2015 Annual Meeting
  9. Program Chair Report
  10. AAES Foundation
  11. Community Based Surgeons Committee Update
  12. Endocrine Surgery Quarterly
  13. AAES Job Board
  14. In Memoriam
  15. AAES Marketplace
AVE THE DATES!
Annual Meetings 
April 10-12, 2016

Baltimore, MD
LAC Chair: 
John A. Olson, Jr., MD

Dates TBA

Portland, OR
LAC Chair: 
Mira Milas, MD

IMPORTANT DATES
AAES Council Meeting

May 16, 2015

AAES Fellowship Match: 

June 26, 2015: 

Online application site closes

September 11, 2015: 

Notification of match results

MEETINGS OF INTEREST

AACE
May 13-17, 2015 

IAES
Aug 23-27, 2015

5th ACC Symposium 
Oct 14-16, 2015



Gerard M. Doherty, MD, FACS

In just a few short weeks, we will all be together in Nashville for the 2015 AAES annual meeting.  I am looking forward to seeing each of you.

The preparations for the meeting are in full swing.  Becky Sippel and the Program Committee have solicited and selected an outstanding group of scientific abstracts that is as broad and informative as any that I have ever seen, along with a tremendous group of invited presenters.

We have a wonderful opportunity to interact with our endocrinology colleagues in the American Association of Clinical Endocrinologists, whose meeting immediately precedes ours, and some of whose activities will overlap with us.  I encourage you to attend some of the AACE meeting if you can; they have arranged special daily pricing for us to attend without paying the full registration. 

Carmen Solorzano and her colleagues have prepared a great welcome for us in her home city.  Nashville provides a great cultural backdrop to our meetings.  If you have time, I would encourage you to arrive a day or two early, plan to attend some of the AACE meeting, including a specially priced admission opportunity to arrive late for their Saturday evening Gala - skip the dinner and the talks, but enjoy the music, refreshments and company. Other social activities include the golf and tennis tourneys, the fun run, and many museums and musical venues.

I invite you to join me at the Sunday evening AAES President's Reception.  We will enjoy light hors d'oeuvres and libations at the ACME Feed and Seed near the hotel from 6:00pm to 8:30pm to meet before people head out together for dinner.  We anticipate that this will be the evening that groups of friends and programs will choose to entertain one another over a meal in Nashville.  There are magnificent restaurants nearby, but the time to make reservations for that Sunday evening is now!

I look forward to seeing each of you in Nashville. I have said many times that the AAES meeting is my favorite each year, and I expect that this year will be no exception.

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The AAES enters its 36th year.  We remain busy and are excited about our upcoming combined AAES-AACE meeting, enlarging membership, electronic updates, a busy community-based surgeon (CBS) group, and more.  We have tried to respond to the requests and needs that you have voiced and made it the priority to set a strategic vision of growth and transition for the society. We have employed a solid site for archiving and establishing institutional memory and for consist, transparent communications. Our job has been made easy with management staff, the advice of past officers and hard work of our committee chairs and the exceptional leadership of the officers, especially our president.

 

The AAES has: 

  • responded to stewardship goals
  • transitioned CESQIP to maintenance of certification part 4 status, implement data use agreements and online sign up 
  • transitioned the Foundation website
  • initiated accreditation processes for fellowship
  • transitioned to seamless electronic fellowship application process and match system

We are

  • working to improve online CME during the 2015 meeting
  • looking forward to establishing a higher profile for the society's historical videos
  • establishing a consistent and reproducible committee calendar for meeting time and locations.
  • ensuring that your dollars are supporting our combined values (science, impactful support of trainees, social activity, patient care, Surgery subscription)

Members- please update your membership details online and be on the lookout for Twitter live feeds during the meeting.  I remain grateful for the opportunity to serve you and trust that you will let this office know if we may be of help to you at anytime.  See you in Nashville!

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Cord Sturgeon, MD

I hope everyone enjoyed the December 2014 issue of SURGERY. We are grateful that the journal has allowed the expansion of the December issue to include more AAES podium papers, the "Best Poster Presentation" winner, and the "Best Case Presentation" winner.

We are very excited about the program for the AAES annual meeting in Nashville May 17-19.  All manuscripts are under peer review.  After full peer review, if your manuscript is accepted for publication in SURGERY, you must also complete all revisions and resubmit the manuscript by May 1, 2015. Late submissions of manuscripts may result in non-publication in SURGERY. 

There is no manuscript submission requirement for poster presenters, however poster manuscripts have been very favorably received by ANNALS OF SURGICAL ONCOLOGY in the past.  Therefore, I encourage poster presenters to submit full manuscripts of their work to ANNALS OF SURGICAL ONCOLOGY at the following link:   

https://mc.manuscriptcentral.com/aso.  Please select "AAES manuscript" from the dropdown menu.  As an incentive to submit early, the first 10 submitted papers will not have to pay the manuscript submission fee.

I am always looking for members of AAES and endocrine surgery fellows to review manuscripts for.  Please email me at csturgeo@nm.org if you would like to be an ad hoc reviewer.

Thanks for your support!

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Michael W. Yeh, MDThis year, the AAES welcomed a total of 24 new members. These include 9 Candidate members and 10 Resident/Fellow members. We also welcome 5 members into the new Affiliate Provider membership category. They will all be acknowledged at the 2015 AAES Annual Meeting. Our total membership now lies at  603.

We continue to recruit new members and encourage each of you to share information about membership with colleagues. Resident/Fellow, Candidate and Affiliate Provider categories may apply for membership throughout the year.  The next deadline to apply for Active, Allied Specialist and Corresponding membership is January 31, 2016. Requirements for membership are avaiable at www.endocrinesurgery.org or by contacting our membership director, Wanda Myers at wanda@endocrinesurgery.org.

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MEMBERSHIP

Update Your AAES Contact Information

Please help us to stay connected to you. Login your member account, review and update your contact information, and while you are logged in, we invite Active members to create a profile and opt into the surgeon finder.

Log into your AAES member account by using the link http://www.endocrinesurgery.org/

If you do not have a password, select the "Forgot Your Password" option and a link to create a new password will be sent to your email account.

Have you paid your annual dues?

Log on now to http://www.endocrinesurgery.org and click on "Dues Renewal".

Please contact our office if you have any questions or concerns at (310) 986-6452, ext 138 or membership@endocrinesurgery.org.

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Tracy S. Wang, MD, MPHIn September 2014, the AAES Fellowship Match successfully placed 26 outstanding candidates to the 23 Endocrine Surgery programs across the United States and Canada. Congratulations to the incoming Class of 2015!

The AAES is sponsoring the 2015 Match for clinical fellowship positions for the 2016-2017 academic year. The online application opened March 2, 2015.  Please note the following dates for the 2015 match.

Friday, June 26, 2015: Online application site closes

Monday, August 24, 2015: Online ranking site opens

Thursday, September 3, 2015: Online ranking site closes

Friday, September 11, 2015: Notification of match results

For additional information, please go to www.endocrinesurgery.org or contact the AAES Headquarters Office (match@endocrinesurgery.org), or Dr. Tracy Wang (tswang@mcw.edu).

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Sonia L. Sugg, MD The Fellowship Accreditation Committee has updated and posted on the AAES website the current Fellowship Accreditation Requirements here. We also began the rolling accreditation process, where approximately one third of the programs will undergo the reaccreditation process every 3 years. The next deadline for new fellowship application submission will be September 1, 2015. Please request applications forms and direct any questions regarding the process to Sonia Sugg sonia-sugg@uiowa.edu

 

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CESQIP Update
William B. Inabnet, III, MD, FACS 

William B. Inabnet, III, MD, FACSThe Collaborative Endocrine Surgery Quality Improvement Program has continued to grow at a healthy rate. At the time of this writing, more than 40 institutions and 100 end users have enrolled in CESQIP leading to over 6000 unique case entries.  All 6 modules are fully functioning including the real-time reporting structure.  The web interface was updated to enhance functionality and to facilitate data entry at the point of care with tablets and smartphones. 

Future CESQIP goals include the development of push reporting and data integration with electronic medical records systems to permit direct data extraction. 

For more information or to sign up, please go to https://cesqip.endocrinesurgery.org/cesqip-first-time-signup/

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meeting

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Program Chair Report
Rebecca Sippel, MD

Rebecca Sippel, MDThis year's program committee has worked hard reviewing the almost 200 abstracts that were submitted for this year's meeting.  After a careful review of all the abstracts, they have selected some of the most exciting and innovative work to be presented at the 2015 AAES Annual Meeting in Nashville, Tennessee. The selected program covers the breadth of endocrine surgery and includes a great mix of basic, translational, and clinical topics. The top 34 abstracts will be presented as oral presentations and the poster session will highlight another 50 great abstracts.  We have added some extra time to the meeting schedule this year in order to allow enough time for the dynamic discussion of the presentations and still allow adequate time for breaks and poster viewing.  We know that one of the best parts of this meeting is an opportunity to meet new people and to catch up with old friends and we want to make sure that you don't have to miss any of the exciting program to do that!

The poster session will be opening on Sunday morning immediately after the joint session with AACE, so that they can see some of the remarkable work being presented at our meeting.  The posters will be judged Sunday afternoon during the Poster Walk-Around Session.  The top scoring basic/translational science and clinical poster and presentation will be awarded at the President's Gala Dinner on Monday evening.

 

This year's meeting has several exciting highlights:

  • Interesting Case Session will be a combined session with AACE on Sunday a.m. This session is always interesting and dynamic.  Adding the expertise and experience of our endocrine colleagues should make this an incredible session!
    • Please note that this session will be Sunday morning this year, so please make sure that you are arriving early enough to participate in this great session! 
  • On Sunday from 11-1 pm, the community surgeons committee is putting on a workshop entitled, "How to Build an Endocrine Surgery Practice".  This session will offer advice on developing relationships with endocrinologists and will share advice from colleagues across the country about how they have made it work.  Whether you are just starting out or you are looking to make some improvements, this session is bound to be a worthwhile investment.
  • Dr. Robert Beazley from Boston University is giving the historical lecture on "The Glands of Owen... Who was Owen?"
  • A set of practice guidelines for parathyroidectomy are being put together by the AAES.  Get a first look at their work and see what a valuable resource this will be to our membership.
  • Our nurses and affiliate providers will be sharing their insights and expertise on how to optimize our practices in a special breakout session on Sunday night.  
  • The President's invited guest, Dr. Gary Hammer from the University of Michigan will be presenting an exciting talk on Monday morning, " Translating Adrenal Stem Cells: Implications for Adrenal Disease"
  • The AAES Outcomes Program is planning a special open session on Tuesday am for anyone who is interested in learning more about outcomes research.
     

I hope you have already made plans to attend this year's meeting as it looks to be an amazing program! It has truly been an honor to serve as Program Committee Chair this year and I would like to thank Drs. Doherty, Perrier, Sturgeon and all of the members of the Program Committee for their dedication and hard work to generate a fantastic, high-caliber scientific program I am sure you will enjoy. I look forward to seeing you in Nashville in May!

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AAES Foundation
Geoffrey B. Thompson, MD

Geoffrey B. Thompson, MDI am pleased to report that the AAES Foundation for Education and Research (AAESF) continues to grow. Last year, the AAESF received over $36,000 in contributions. We have 21 Norman Thompson fellows who have given and/or pledged $10,000 to the organization. This past year, the AAESF awarded $24,500 in research grants.

The Paul LoGerfo Research Fund is a part of the AAES Foundation. The mission of the Paul LoGerfo Educational Research Fund is to support education and research in the field of Endocrine Surgery as a tribute to our former President, Dr. Paul LoGerfo, who was interested in education and research in Endocrine Surgery. With Dr. LoGerfo's untimely death during his Presidency of our Association in 2003, the Paul LoGerfo Educational Research Fund was begun in his honor. Beginning this year, there will be $20,000 available for awards. The applicant(s) chosen to receive this year's Paul LoGerfo Research Award(s) will be announced at the upcoming AAES Annual Meeting in Nashville, TN on May 17-19, 2015. Applications for next year's award will be available in the fall. Only surgeons who have completed residency or fellowship training within five (5) academic years of the year of application are eligible to apply for the award. We welcome proposals from the entire spectrum of clinical or basic science research topics pertaining to the field of endocrine surgery. The funds may be used to bridge or supplement research protocols with existing funding. For more information on the Paul LoGerfo Research Award, please visit www.aaesfoundation.org/logerfo-research-award/. Donations to support the Paul LoGerfo Fund are tax deductible to the fullest extent allowed by law.

We encourage every AAES member to give to the AAES Foundation to promote research and education in the field of endocrine surgery. You may make your tax-deductible contribution on our website at www.aaesfoundation.org/donate/. For assistance please contact our Executive Director, Paula Kupiec, at (310) 986-6452 ext.161 or paula@aaesfoundation.org.

I look forward to seeing many of you at the AAES Annual Meeting in Nasvhille.

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Cory L. Foster, MDWe have achieved two major accomplishments since our last meeting. First, thanks to the efforts of committee member, Mark Sneider there will be a luncheon panel presentation about practice development for endocrine surgeons. There will have presentations on various aspects of establishing a community endocrine surgery practice. Second, committee members Mike Starks and Doris Quintana have initiated an endocrine surgery blog through the ACS. All AAES members are welcome to join the discussions. We hope to again gather at the AAES Annual meeting and continue to refine our mission, and plan our next endeavors.

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Endocrine Surgery Quarterly

Castinetti F, Qi XP, Walz MK, et al.  Outcome of adrenal-sparing surgery or total adrenalectomy in phaeochromocytoma associated with multiple endocrine neoplasia type 2: an international retrospective population-based study.


Reviewer:
Diana Ortiz, MD, Fellow, Medical College of Wisconsin

In Brief:
In this issue of Endocrine Surgery Quarterly, we review "Outcomes of adrenal-sparing or total adrenalectomy in phaeochromocytoma associated with multiple endocrine neoplasia type 2: an international retrospective population study" by Castinetti et al.

The article highlights the changing landscape in the management of patients with multiple endocrine neoplasia (MEN) 2. With the advent of prophylactic thyroidectomy for medullary thyroid cancer, these patients are living longer and having to deal with more manifestations of their disease, as well as the repercussions of their treatments. The study tackles the central question of whether adrenal-sparing surgery has comparable outcomes to total adrenalectomy in the treatment of pheochromocytoma in MEN2 patients; for consistency, 'adrenal-sparing' will be referred to as 'cortical-sparing'. This is a retrospective review of 1,210 MEN2 patients in 30 centers across 20 countries in Europe, America, China and India; data were collected from 1968 to 2013 and included 563 patients with pheochromocytomas; 552 patients underwent adrenalectomy. At the time of presentation, 250 (44%) patients had bilateral pheochromocytomas; of the 313 who initially presented with unilateral pheochromocytomas, 95 (30%) subsequently developed a contralateral pheochromocytoma. Total adrenalectomy was performed for 438 (79%) patients and cortical-sparing adrenalectomy in 114 (21%) patients.  Postoperative steroids were started in all patients who had bilateral cortical-sparing adrenalectomy and continuation of steroids was determined by a post-operative ACTH stimulation test, timing of which was investigator-dependent. Steroid dependence occurred in 292 (86%) of the 339 patients with bilateral pheochromocytomas after surgery.  Based on the results of the study, however, it is unclear what timeframe or criteria were used to define steroid dependence. Of patients with bilateral pheochromocytomas, 82 patients had a cortical-sparing procedure for at least 1 adrenal gland; of these 47 (57%) patients, including 39 patients who underwent bilateral cortical-sparing adrenalectomy, did not require long-term postoperative steroids. There was no significant difference in recurrence rate between those that underwent adrenal-sparing surgery; 4 (4%) of the 114 patients, with a mean follow up of 10 years (range, 1-23) compared with 11 (3%) of 438 adrenalectomy patients (p=0.57), with a mean follow up of 13 years (range, 1-40). The authors conclude that cortical-sparing surgery, in experienced centers, should be the favored approach for pheochromocytomas in MEN2 patients.

Critique:
It is essential that thoughtful decisions are made in the treatment of adrenal tumors in MEN2 patients to preserve quality of life, as 30% of patients who initially present with unilateral disease eventually develop contralateral disease, requiring surgery. Total bilateral adrenalectomy requires lifelong glucocorticoid and mineralocorticoid replacement. In 1996, Lee et al first looked at cortical-sparing techniques to preserve adrenal function in MEN2 and von Hippel-Lindau patients with bilateral pheochromocytoma. Cortical-sparing adrenalectomy was successful in 14 of 15 patients, where 93% (13) patients did not require postoperative steroid supplementation. Of the patients that required steroids, 1 patient required daily supplementation, while 2 patients with a borderline response to cosyntropin stimulation testing required only stress dose steroids.  In that cohort, recurrence occurred in 3 (21%) patients, with a median follow-up of 138 months [1]. In a subsequent follow-up study from the same institution that reviewed 30 patients undergoing cortical-sparing adrenalectomy, 21 (78%) did not require steroid replacement at a follow-up of 3 years; 4 (7%) patients had recurrence within the adrenal remnant [2]. These numbers are not congruent with the findings in Castinetti study, which had a greater rate of steroid dependence, while having a lower recurrence rate, possibly suggesting that more adrenal cortex was removed by the surgeons in the Castinetti study. While the Castinetti study includes a larger cohort of patients, the number of institutions and surgeons that the study included also introduced many confounding variables.  First, indications for cortical-sparing surgery and surgeon experience with adrenalectomy varied among the sites and it is not possible to adjust for the differences in management, techniques and experience. Also, the study did not establish a standard definition for what was considered cortical-sparing. It was however noted that at least 1/3 of an adrenal gland needed to be viable in order to preserve adrenal function. Finally, changes in surgical treatment over the period of the study have been drastic, making comparisons between the earlier and later time periods difficult. Despite these limitations, the authors show that adrenal-sparing techniques can be successful in preserving adrenal function in greater than 50% of cases, and as we have seen, in experienced hands 78-93% of the time [1,2].  This study adds value by providing an overview of adrenal management in MEN2 across a wide scope of centers internationally and stresses the importance of referral of patients with rare and complex diseases, such as MEN2, to high-volume centers.

Future directions:
While it seems intuitive that steroid dependence may decrease quality of life, this was not addressed in this study and provides an opportunity for further investigation. Also, with minimally invasive approaches becoming more prevalent and accepted, determining how these different techniques will affect outcomes could be an ongoing focus of study. 

References:

  1. Castinetti F, Qi XP, Walz MK, Maia AL et al. Outcomes of adrenal-sparing surgery or total adrenalectomy in phaeochromocytoma associated with the multiple endocrine neoplasia type 2: an international retrospective population-based study. Lancet Oncology 2014; 15; 648-655.
  2. Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC. Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 1996;120:1064-1071
  3. Grubbs EG, Rich TA, Ng C, Bhosale PR, Jimenez C, Evans DB, Lee JE, Perrier ND. Long Term Outcomes of Surgical Treatment of Hereditary Pheochromocytoma. Journal of the American College of Surgeons 2013; 216: 280-289

Additional high-yield reading:

Oswald A, et al.  Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease.  Eur J Endocrinol. 2014 171:209-15.

 

Terzolo M, et al. Surgical remission of Cushing's syndrome reduces cardiovascular risk.  Eur J Endocrinol. 2014 171:127-36.

 

Monticone S, et al.  Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure response after adrenalectomy.  J Clin Endocriol Metab. 2014 99:4158-66.

 

Lenders JWM, et al.  Pheochromocytoma and paraganglioma: An Endocrine Society clinical practice guideline.  J Clin Endocrinol Metab. 2014 99:1915-42.

 

Lim V, et al.  Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism.  J Clin Endocrinol and Metab. 2014 99:2712-19.

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Please visit jobs.endocrinesurgery.org/ today to post a job opening or peruse the current listings.

Michael Brauckhoff, M.D.
Haukeland University Hospital
Department of Surgery
Bergen, Norway

Colin G. Thomas, Jr., MD
University of North Carolina at Chapel Hill 
Division of Surgical Oncology 
Chapel Hill, NC

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  • If you have an endocrine training opportunity, research survey, or job listing that would be relevant to the AAES Membership and want to pay to have an email blast sent to the full membership, please contact information@endocrinesurgery.org to find out more about pricing.

  • Need that special fashion forward endocrine system accessory to complete your look? Or a gift for a special endocrine someone? Please visit the AAES Store https://store.endocrinesurgery.org/  to purchase an endocrine system themed scarf or tie!

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