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The Endocrine Society’s Annual Meeting offers an unparalleled opportu...
The Endocrine Society’s
                                          Clinical Endocrinology Update

We’re on the frontlines against this century’s plague.
Maybe that’s why you should consider joining our             escala...
The Endocrine Society
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Upcoming International Symposium on

                                   Integrated Approach to Disease Management:
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  1. 1. JCEM TM THE JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Volume 94 • Number 4 • April 2009 • jcem.endojournals.org
  2. 2. ENDO09 REGISTER EARLY FOR ENDO 09 and save up to 30% The Endocrine Society’s Annual Meeting offers an unparalleled opportunity to learn about the latest advances in endocrine research and clinical care. Don’t miss the world’s premier medical and scientific meeting of endocrinologists, featuring over 200 scientific sessions, 150 exhibits and over 2,000 poster presentations. Receive the lowest registration rates by registering early. Register now for ENDO 09 and save up to 30%. Visit www.endo-society.org/endo09 ANNOUNCING THE 2009 ELECTION RESULTS The Endocrine Society’s Nominating Committee is pleased to announce the results of the 2009 Election that concluded on March 9, 2009. Congratulations to the following Society leaders who will assume Drum Roll. their new positions at the Society’s Annual Business Meeting on June 13, 2009, during ENDO 2009 in Washington, DC. President-Elect (Basic Scientist) Kelly E. Mayo, Ph.D. Vice President (Clinical Scientist) Nannette F. Santoro, M.D. Secretary Treasurer-Elect John C. Marshall, M.D., Ph.D. Council (Physician-in-Practice seat) Susan J. Mandel, M.D. Council (At Large seat) Jennifer L. Larsen, M.D.
  3. 3. The Endocrine Society’s Clinical Endocrinology Update AMA PRA Category 1 Credits™ THE JOURNALS of The Endocrine Society World leaders in diabetes, endocrinology & metabolism Renew Now or Begin Your Free Trial! Endocrine Reviews An In-Depth, Enduring Resource Free Trial Offer for New Institutional Subscribers— Each issue presents in-depth reviews on clinical and Get 3 months of free online access to any of our four journals. research topics in endocrinology, including diabetes, Offer expires June 30, 2009. Available to new institutional thyroid disorders, pediatric endocrinology, growth subscribers and qualified former institutional subscribers. factors and reproductive medicine. Its impact factor Two-for-One Offer for Institutional Subscribers— of 18.493 was the highest among all endocrinology and Endocrinology and Molecular Endocrinology are sold as a metabolism journals in 2007. bundle, giving you the value of two high impact journals at a discounted rate. Endocrinology & Molecular Endocrinology Essential Resources for Researchers Tailor-Made Pricing for Institutional Subscribers— Endocrinology has defined the science of endocrinology for y Subscription prices for institutional and multi-site subscribers over 90 years, publishing a broad spectrum of the highest will be based on the type of organization (tiered pricing). quality basic research related to the endocrine glands and For more information about these offers or a tailor-made price their hormones. quote, contact societyservices @ endo-society.org. Molecular Endocrinology focuses on how receptors and hormones signal to regulate gene expression, The Journal of Clinical Endocrinology development, physiological function and disease. & Metabolism With impact factors of 5.045 and 5.337, both The Must-Read Clinical Journal in the Field Endocrinology and Molecular Endocrinology are y In-depth coverage of the latest developments in diabetes, ranked among the top 5% of all biomedical journals. obesity, thyroid disorders, reproductive endocrinology, growth hormone therapy and other critical areas of endocrinology and metabolism. © 2009 The Endocrine Society ® View subscription information at www.endo-society.org/journals
  4. 4. We’re on the frontlines against this century’s plague. Maybe that’s why you should consider joining our escalating volumes of outpatients with diabetes and other fight. At UPMC, we’re dedicated to overcoming the endocrine disorders; $70 million in extramural funding, 21st century’s plague: more than 1.5 million new cases of mostly from NIH; and generous compensation packages, diabetes mellitus in the United States each year. We’re offer our recruits a unique level of professional support. expanding what is already one of the largest endocrinology Plus, a rounded faculty offers support for endocrinologists divisions in the nation — 30 faculty, including 10 with clinical and research interests including thyroid cancer, full-time clinicians. Powerful resources, such as the pituitary disease, osteoporosis, and basic endocrine largest registry of unselected diabetes patients in the science. Contact us and find out why UPMC may be the United States, containing 107,000 patients; large and next step up for your career. upmc.com | 1-800-533-UPMC Affiliated with the University of Pittsburgh School of Medicine, UPMC is ranked among the nation’s best hospitals by U.S.News & World Report.
  5. 5. The Endocrine Society 8401 Connecticut Avenue, Suite 900 Chevy Chase, Maryland 20815-5817 USA Phone: 301-951-2617 / Fax: 301-951-2617 Mission Statement of The Endocrine Society The mission of The Endocrine Society is to advance excellence in endocrinology and promote its essential role as an integrative force in scientific research and medical practice. THE ENDOCRINE SOCIETY 2008-2009 ROBERT M. CAREY, President CAROLE R. MENDELSON, Vice-President—Basic ROBERT A. VIGERSKY, President-Elect Science MARGARET A. SHUPNIK, Past President LYNNETTE K. NIEMAN, Vice-President—Clinical LISA H. FISH, Vice-President—Physician in Practice Science ANDREW F. STEWART, Secretary-Treasurer PUBLICATIONS CORE COMMITTEE—WILLIAM ROSNER, Chair COUNCIL—ROBERT M. CAREY, LISA H. FISH, VALERIA CUNHA GUIMARAES, JAN-ÅKE GUSTAFSSON, DONALD P. MCDONNELL, CAROLE R. MENDELSON, MARK E. MOLITCH, LYNNETTE K. NIEMAN, ALVIN C. POWERS, SUSAN ANN SHERMAN, MARGARET A. SHUPNIK, ANDREW F. STEWART, PETER TRAINER, ROBERT A. VIGERSKY, TERESA K. WOODRUFF. EX OFFICIO: SCOTT HUNT, JOY Y. WU, WILLIAM F. YOUNG, JR. SCOTT HUNT, Executive Director and CEO INSTRUCTIONS TO AUTHORS AND ETHICAL GUIDELINES: These appear in the first issue of each volume and at http://jcem.endojournals.org. The online versions of these documents should be treated as the most current. CHANGE OF ADDRESS: Notify The Endocrine Society 60 days in advance using the contact information above. DISCLAIMER: The statements and opinions in Endocrine Society journal articles are solely those of the authors and not of The Endocrine Society. Advertisements are solicited and placed without knowledge of the particular order of articles in any issue. The Editors are not permitted to engage in discussions about Journal content for forthcoming issues with agencies involved in soliciting advertisements, or companies purchasing advertising space. The Endocrine Society does not evaluate advertised products or services nor assess advertising claims. The appearance of advertising in The Endocrine Society’s publications, or reference to a product or service within a paper published by The Endocrine Society, do not constitute endorsements by The Endocrine Society. The Endocrine Society reserves the right to decline any advertisement in its discretion. CLASSIFIED ADVERTISING: Contact The Endocrine Society Placement and Classified Advertising, c/o Christine Whorton, 12366 N. Red Mountain Drive, Tucson, AZ 85737 USA. Phone: 800-361-3906 or 520-544-2760; Fax: 520-297-4466; Email: placement@endo-society.org DISPLAY ADVERTISING: Contact Scherago International, Inc., 525 Washington Blvd., Suite 3310, Jersey City, NJ 07310 USA. Phone: 201-653-4777; Fax: 201-653-5705 The Journal of Clinical Endocrinology & Metabolism Email: sherman@endo-society.org Website: http://jcem.endojournals.org 14A
  6. 6. NEWS E N D O C R I N O L O G Y & M E T A B O L I S M N E W S Endocrine Discovery proved disease-free survival. (N Engl J Med [Feb- ruary 12, 2009] 360(7):679) A retrospective cohort study of more than 800 patients with and nearly 7000 without A survey of 20,211 overweight or obese in- HIV beginning lipid-lowering therapy for el- dividuals younger than 75 years and 7764 evated LDL-cholesterol or triglyceride levels smokers found that new diagnoses can revealed that dyslipidemia, particularly hy- serve as a window of opportunity to pertriglyceridemia, is more difficult to treat prompt older adults to lose weight and stop in patients with HIV infection than in the smoking. (Arch Int Med [February 9, 2009] general population. However, patients with 169(3):237) HIV infection receiving NNRTI-based antiretrovi- ral therapy and gemfibrozil had triglyceride Continuation of statin treatment provided responses similar to those in patients without HIV an ongoing reduction in all-cause mortality infection. (Ann Intern Med [March 3, for up to 9.5 years among patients with and 2009]150(5):301) without a history of cardiovascular heart disease, according to a retrospective cohort Regardless of smoking status, overweight study of 229,918 adult participants in a health and obesity in late adolescence increased maintenance organization. (Arch Int Med [Feb- the risk of adult mortality in a record linkage ruary 9, 2009] 169(3):260) study of the Swedish military service conscription register. Obesity and overweight were found to Systematic delivery of IGF-1 significantly be as hazardous as heavy and light smoking, re- improved physiological behavior and sur- spectively, but no interaction between BMI and vival and partially rescued immature syn- smoking status was discovered. (BMJ [March 14, aptic function and organization in methyl 2009] 338(7695):b496) CpG-binding protein 2 (MeCP2) mutant mice, suggesting the use of IGF-1 in the treat- In a meta-analysis of 108 randomized trials ment of Rett Syndrome and other central nervous involving 299,310 participants at risk of car- system disorders caused by delayed synapse mat- diovascular events, the change in HDL-cho- uration. (Proc Natl Acad Sci USA [February 10, lesterol explained little to none of the 2009] 106(6):2029) change in outcomes, whereas a 10 mg/dl reduction in LDL cholesterol led to a relative Another Src family kinase, Lyn, has been risk reduction of 7.2% for coronary heart found to affect osteoclast function by mod- disease deaths. (BMJ [February 28, 2009] ulating differentiation, in a manner anti- 338(7693):b92) thetical to c-Src, which regulates bone resorp- tion by these cells, thus underscoring the Increased risk of breast cancer declined necessity of specific targeting of these family markedly soon after discontinuation of members in designing antiresorptive agents. combined estrogen plus progestin therapy (Proc Natl Acad Sci USA [February 17, 2009] and was unrelated to changes in mammog- 106(7):2325) raphy use. (N Engl J Med [February 5, 2009] 360(6):573) A prospective study of 1,295 women and men aged 60 years and over found that all In 1803 premenopausal women with endo- low-trauma fractures were linked to in- crine-responsive early breast cancer, after a NEWS creased mortality risk for 5–10 years, with 47.8 month median follow-up, goserelin subsequent fractures associated with increased plus anastrole resulted in clinical outcomes mortality risk for an additional 5 years. (JAMA similar to those treated with goserelin plus [February 4, 2009] 301(5):513) Tamoxifen. The addition of zoledronic acid to adjuvant endocrine therapy significantly im- Low-income pregnant women with diabe- tes were twice as likely as those without Readers are encouraged to suggest items for Endocrinology and Metabolism News by email (sherman@endo-society.org). Sub- diabetes to be diagnosed with depression missions will be considered based on their significance and during and after their pregnancy. (JAMA timeliness. [February 25, 2009] 301(8):842) J Clin Endocrinol Metab, April 2009, 94(4):17A–20A jcem.endojournals.org 17A
  7. 7. E N D O C R I N O L O G Y & M E T A B O L I S M N E W S “Calories count. You In 746 patients with early type 2 diabetes, with prandial doses of insulin lispro, com- liraglutide was found to be safe and effec- pared to basal doses of NPH, showed lower can lose essentially tive as initial pharmacological therapy and postprandial blood glucose, higher fasting led to greater decreases in weight, blood blood glucose, similar levels of A1c, and no the same amount of pressure, HbA1c, and hypoglycemic events difference in risk for future cardiovascular weight with any than glimepiride. (Lancet [February 7, 2009] event rates. (Diabetes Care [March 2009] 373:473) 32(3):381) combo of macronutrients if you Body mass index above and below the op- A study of 2955 participants aged 12–19 timum range of 22.5–25 kg/m2 was a strong years found that black teens were twenty adhere to the predictor of overall mortality—from vascular times more likely to be vitamin D deficient disease at above this range and from smoking- than white teens and that females were at program,” said related diseases at below this range—according double the risk than males. (Pediatrics [March George Bray, M.D., to a meta-analysis of 57 studies involving 894, 2009] 123(3):797) 576 adults. People with a body mass index at about his study that 40 – 45 lost about 8 –10 years of their lifespan, while those with a body mass index at 30 –35 lost A genome-wide association study involving compared four heart- 30,000 subjects identified four rare gene about 2– 4 years. (Lancet [published online healthy diets of March 18, 2009]) variants that lowered type 1 diabetes risk in IFIH1, a gene encoding a cytoplasmic helicase various Mouse models of diabetes revealed that that mediates the induction of interferon re- downregulation of -arrestin-2 contribute sponse to viral RNA. (Science [published ahead of macronutrients. print March 5, 2009]) to insulin resistance and disturbance of in- sulin signaling, such that -arrestin-2 cannot scaffold Akt and Src to the insulin receptor. In- Diet Comparisons Find Calories Count sight into this signaling pathway may provide More Than Macronutrients new preventive and treatment strategies against Diet fads may come and go, but which one is insulin resistance and type 2 diabetes. (Nature the most effective? Turns out any diet that re- [February 26, 2009] 457:1146) duces caloric intake will do as long as people stick to it, according to a recent research article pub- Sphingosine-1-phosphate, a lipid mediator lished in The New England Journal of Medicine. enriched in blood, was found in vitro and in “Calories count. You can lose essentially the vivo to induce chemotaxis and regulate the same amount of weight with any combo of ma- migration of osteoclast precursors, thus con- cronutrients if you adhere to the program,” said tributing to bone homeostasis. (Nature [pub- George Bray, M.D., chief of the division of clinical lished ahead of print February 8,2009]) obesity and metabolism at the Pennington Bio- medical Research Center in Baton Rouge, Loui- FTO-/- mice had a reduction in adiposity and siana, and one of the coauthors of the study were protected from diet-induced obesity, article. suggesting that variants in the human FTO gene In the article, researchers from the Preventing might render individuals more susceptible to Overweight Using Novel Dietary Strategies obesity. (Nature [published ahead of print Feb- (POUNDS LOST) study found similar weight loss ruary 22, 2009]) after 6 months and 2 years among participants assigned to four heart-healthy diets that differed NEWS While low to moderate alcohol consump- in their proportions of three major nutrients— tion in a study of 1,280,296 middle-aged fats, proteins, and carbohydrates. The group as- women increased the risk of certain cancers signed 811 overweight and obese adults to one such as breast cancer, the risks for other of four diets that ranged in fat content and per- cancers were decreased, such as thyroid can- centages of energy derived from these macro- cer and renal cell carcinoma. (J Natl Cancer Inst nutrients: a low-fat, average protein diet (20% [March 4, 2009] 101(5):296) fat, 15% protein, 65% carbohydrate); a low-fat, high protein diet (20% fat, 25% protein, 55% Treating patients with type 2 diabetes who carbohydrate); a high-fat, average protein diet had survived an acute myocardial infarction (40% fat, 15% protein, 45% carbohydrate); and 18A jcem.endojournals.org J Clin Endocrinol Metab. April 2009, 94(4):17A–20A
  8. 8. NEWS E N D O C R I N O L O G Y & M E T A B O L I S M N E W S a high-fat, high-protein diet (40% fat, 25% pro- cians, friends, and family. (N Engl J Med [February tein, 35% carbohydrate). 26, 2009] 360:859) “We want people to The team gave the participants personalized calorie goals, ranging from 1,200 to 2,400 cal- be aware of the risk Thyroid Cancer Linked to Two Common ories a day and required them to participate in Gene Variants of disease but not at moderate exercises of 90 minutes per week such Researchers have narrowed in on two com- the risk of scaring that the overall caloric intake was lower than mon gene variants— on chromosomes 9 and their daily energy requirement. Additionally, par- them,” explained Kari ´ 14 —that show an increased susceptibility for ticipants recorded their food intake in a diary or thyroid cancer, paving the way for future genetic Stefansson, M.D., ´ an online tool and attended group and individual testing screens for this disease. instructional sessions for 2 years. “The risk of thyroid cancer has a greater ge- about his group’s On average, participants shed 13 pounds at 6 netic component than the risk of any other can- months and maintained a 9-pound loss at 2 cer, and the effect has been shown to extend finding of two gene years. They also whittled their waistlines by 1 to beyond the nuclear family,” said Julius Gud- variants that show an 3 inches by the end of the study. Across all four mundsson at deCODE Genetics in Reykjavık, Ice-´ diets craving, fullness, hunger, and diet satisfac- increased land, and co-authors in their recent online article tion were all similar. Additionally, 14%-15% of in Nature Genetics. susceptibility for the participants had a reduction of at least 10% The team conducted a genome-wide associa- of their initial body weight, which previous stud- tion study on an Icelandic study population of thyroid cancer. ies have shown to help lower risk factors for heart 192 thyroid cancer cases and approximately disease and other medical conditions. 37,000 controls, followed by a replication study As the largest diet comparison study per- of two case-control groups of European descent formed to date, diet specialists hail the study as (342 cases and 348 controls in the United States, seminal to the field. and 90 cases and 1,343 controls in Spain). The “This study shows that doctors and their pa- first study identified nine single nucleotide poly- tients should spend more time on the amount of morphisms (SNPs), which were then genotyped food consumed and less attention to the macro- in an additional 241 thyroid cancer cases and nutrient composition,” said Gary Foster, Ph.D., resulted in the two SNP candidates, located on Director of the Center for Obesity Research and 9q22.33 and 14q13.3. Education at Temple University in Philadelphia, Their research shows that close to 4% of indi- Pennsylvania. “Essentially, whatever you’re eat- viduals of European descent are homozygous for ing, eat a little less of it instead of going through both high risk alleles, which increases their risk of the mental gymnastics of counting fats and thyroid cancer by nearly 6-fold compared with non- carbs.” carriers. The incidence of thyroid cancer is 4.9 and Others in the field point out that this study 14.1 per 100,000 in the U.S. for males and females indicates a diet can be custom-made for the pa- of European ancestry, respectively. Iceland has a tient to better their chances for long-term similar incidence rate, at 4.6 and 12.1 per 100,000 success. for males and females, respectively. “To improve adherence in individual patients, Biologically, the locations of each of these clinicians can learn to match up patients with an SNPs are of interest to thryoidologists as each fall appropriate strategy based on lifestyle, medical close to two genes that are involved in thyroid history, and specific food preferences,” said Mi- development—the chromosome 9 SNP is close to chael Dansinger, M.D., Principal Investigator of FOXE1 and the chromosome 14 SNP is near the Tufts Popular Diet Trial, and weight loss and NEWS NKX2-1. Both variants contribute to a height- nutrition advisor for the primetime TV weight loss ened risk of papillary and follicular thyroid can- series “The Biggest Loser,” adding that his pre- cer, two of the most common forms of thyroid viously published study also found that adher- cancer. Furthermore, both SNPs are associated ence level, rather than diet type, was the key de- with a decrease in serum levels of thyroid stim- terminant of weight loss and health benefits. ulating hormone, potentially causing less thyroid He suggested that the best approach would be differentiation and more susceptibility to malig- to get patients to commit to a dieting plan and nancy. Additionally, the chromosome 9 SNP is make sure that they have numerous external sup- linked to increased levels of free triiodothyronine ports such as doctors, personal trainers, dieti- and decreased levels of free thyroxine. J Clin Endocrinol Metab, April 2009, 94(4):17A–20A jcem.endojournals.org 19A
  9. 9. E N D O C R I N O L O G Y & M E T A B O L I S M N E W S Kari Stefansson, M.D., president and CEO of ´ ´ HbA1c by 0.7% in patients with type 2 dia- deCODE and one of the paper’s coauthors, indi- betes. (Diabetes Care [February 2009] 32(2):234) cated that genetic tests for these candidate genes could be made available to the public Adult Treatment Panel III (ATP III) guidelines within weeks. are relatively cost-effective and would have Dr. Stefansson claimed that the tests hold ´ a large public health impact if implemented some value. fully in the United States, according to an “We want people to be aware of the risk of assessment of their cost-effectiveness and disease but not at the risk of scaring them,” he public health impact. Alternate strategies may said. “We want to make people aware of their be preferred, however, depending on the cost of risk of disease because we hope it helps to mo- statins and how much society is willing to pay for tivate them to change their behavior such as eat- better health outcomes. (Ann Intern Med [Feb- ing better.” ruary 17, 2009]150(4):243) However, most thyroidologists and geneticists question whether the public will fully understand the clinical implications of these tests. Milestones in Endocrinology “This is not quite ready for clinical prime 100 years ago, MacCallum and Voegtlin time—yet. More research needs to be done to showed that post-parathyroidectomy tetany bring clinical context to genomic content,” said and hypocalcaemia can be controlled by cal- Charis Eng, M.D., Ph.D., chairperson of the cium administration. Genomic Medicine Institute and Director of the Center for Personalized Genetic Healthcare at the Cleveland Clinic in Ohio, adding that the pub- In the Journal 25 Years Ago lic and caregivers need to be educated on the Orbital cobalt irradiation combined with systemic broad topic of variant-related risks for disease, corticosteroids for Graves’ ophthalmopathy: and in this context, exactly what is their chance Comparison with systemic corticosteroids alone. for developing thyroid cancer. The population Bartalena L, Marcocci C, Chiovato L, Laddaga M, lifetime risk of thyroid cancer is generally at 1% Lepri G, Andreani D, Cavallacci G, Baschieri L, or less, with higher rates for females than males, Pinchera A. J Clin Endocrinol Metab [June she said, explaining that even if a person was 1983]56(6):1139. found to carry these variants, the six-fold in- creased risk for thyroid cancer would just raise the lifetime risk from 1% to 6%. (Nat Gen “The present study indicates that both orbital co- [published ahead of print February 6, 2009]) balt irradiation combined with systemic methyl- prednisolone treatment and systemic methyl- prednisolone therapy alone are valuable Endocrine Practice methods of treatment for Graves’ ophthalmop- Web-based collaborative care of diabetes athy, but the combined therapy proved to be with a shared medical record decreased more effective.” NEWS 20A jcem.endojournals.org J Clin Endocrinol Metab. April 2009, 94(4):17A–20A
  10. 10. Upcoming International Symposium on Integrated Approach to Disease Management: Endocrinology and Metabolic Disorders Madrid, Spain - June 26-27, 2009 Scientific Organizers Gianluca Aimaretti Endocrinology, University of Piemonte Orientale Novara, Novara, Italy Jorgen Isgaard Dept. of Internal Medicine, University of Gothenburg, Gothenburg, Sweden George J. Kahaly Dept. of Medicine I, Gutenberg University Medical Center, Mainz, Germany Aim of the Symposium The symposium will provide participants with an excellent overview on some of the most debated topics in metabolic disorders, thyroid diseases and growth disorders. Relationships between endocrine system and other systems will be highlighted, addressing multi-systemic disorders like type 2 diabetes, obesity, autoimmune thyroiditis and Short Stature Syndromes. “Meeting the Experts” sessions will offer the possibility to exchange knowledge and experience among top-level experts and a highly qualified audience Learning objectives Attending this symposium, participants will achieve an up-to-date knowledge on: Pathophysiology and management of obesity and type 2 diabetes - Etiology, pathophysiology and management of frequent thyroid disorders - Management, follow-up and prevention of complications of growth hormone deficiency in children and adults Target audience Clinicians interested in endocrinology, paediatrics, diabetes, obesity, genetics, oncology, thyroid and autoimmune diseases could be interested in this symposium S Session I Metabolism - The complexity of central mechanism of eating behaviour Pharmacological approach to diabetes: new options versus cornerstones - Bariatric C Surgery in Type 2 Diabetes and obese patients I Session II Thyroid - Genetics of autoimmune thyroid diseases - New guidelines for the management of thyroid cancer - New guidelines for the management P of Graves’ orbitopathy O Meeting The Experts Metabolic disorders - Insulin introduction in For further information or to register to upcoming Symposium, visit type 2 diabetes: to whom and when - Changing life style in Type 2 Diabetes: www.seronosymposia.org T from theory to practice Scientific Secretariat Serono Symposia International Foundation Meeting The Experts Thyroid disorders - Management of thyroid nodules Salita di San Nicola da Tolentino, 1/b 00187 Rome, Italy Subclinical thyroid disease Senior Project Manager: Annamaria Nesticò N Tel.: +39-06-420413 591 - Fax: +39-06-420413 677 E-mail: annamaria.nestico@seronosymposia.org Session III Growth hormone deficiency - Rare Short Stature Syndromes in Serono Symposia International Foundation I children - Transition of pediatric patients to adulthood - Growth hormone is a Swiss Foundation with headquarters in 14, rue du Rhône, 1204 Geneva, Switzerland therapy and Quality of life A Meeting The Experts Growth disorders - Controversies in GH replacement Serono Symposia International Foundation M therapy - Adherence to treatment Your Continuing Medical Education Partner
  11. 11. The Journal of Clinical Endocrinology & Metabolism Affirmation of Originality and Assignment of Copyright Fax this form to: Paul W. Ladenson, M.D., Editor-in-Chief Manuscript No.: The Journal of Clinical Endocrinology & Metabolism 8401 Connecticut Avenue, Suite 900 Chevy Chase, MD 20815-5817 USA Fax: 301-951-2617; Phone: 301-951-2615 The author(s) hereby affirms that the manuscript entitled: is original, that all statements asserted as facts are based on author(s) careful investigation and research for accuracy, that the manuscript does not, in whole or part, infringe any copyright or violate any right of privacy or other personal or property right whatsoever, that it has not been published in total or in part and is not being submitted or considered for publication in total or in part elsewhere, and that author(s) has full power and authority to enter into this copyright assignment and to make the grants herein contained. In signing this form, each author acknowledges that he/she participated in the work in a substantive way and is prepared to take public responsibility for the work. If the above statement cannot be certified, justification for duplicate publication and permission to republish copyrighted material must be included with the covering letter. Please include a statement declaring any commercial relationships that may pertain to this paper. In signing this form, each author further affirms that he or she has read and understands the “Ethical Guidelines for Publication of Research” and consents to the investigation of any improprieties or violations thereof that may be alleged. Each author further releases and holds harmless The Endocrine Society from any claim or liability that may arise therefrom. The author(s), in consideration of the acceptance of the above work for publication, does hereby assign and transfer to The Endocrine Society all of the rights and interest in and to the copyright of the above titled work in its current form and in any form subsequently revised for publication and/or electronic dissemination and does hereby appoint The Endocrine Society to obtain all right, title, and interest to the copyright for the above titled work. Publication Charge Agreement: The undersigned agree to honor publication charges as outlined in the Instructions to Authors if the manuscript is published. The Journals are copyrighted by The Endocrine Society to protect The Society and authors from unauthorized use of its contents. The Society grants to authors the royalty-free right of republication in any work of which they are the author or editor, subject only to giving proper credit in the work to the original publication of the article by The Endocrine Society. Therefore, authors do not need to contact The Endocrine Society office to request permission to reproduce their work. All authors must sign in the order in which each is listed in the authorship. Authors may submit copies of this document independently if they are located at different institutions, but authors signing independently must sign on the line that reflects their authorship placement. Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature ______Check here if this article exists in the public domain because it was written as part of the official duties of any of the authors as employees of a government. A signature confirming authorship is still required for each author. Full Instructions to Authors and Ethical Guidelines for Endocrinology can be found in the first issue of each volume and http://endo.endojournals.org/. The online versions of these documents should be treated as the most current. 22A