112年秋季會(嘉義長庚)

FNA代檢 Why chose Thinpreps? 通過美國CAP能力試驗認證

We are the only ThinPrep pathology lab in Taiwan with a professional team

擁有TAF細胞病理能力試驗證明 醫學中心醫師與顧問強強聯手 報告數位化打破時間區域框架

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112 年秋季學術研討會

目

錄

雙會理監事名單.............................................................................. 3 嘉義長庚醫院交通及平面資訊...................................................... 4 內分泌學會理事長致詞.................................................................. 6 糖尿病學會理事長致詞.................................................................. 7 節目表.............................................................................................. 8 講者 CV 摘要 ................................................................................ 11 口頭發表注意事項........................................................................ 27 論文口頭報告 Oral-DM................................................................ 28 論文口頭報告 Oral-ENDO ........................................................... 34

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中華民國內分泌暨糖尿病學會

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112 年秋季學術研討會

社團法人中華民國內分泌暨糖尿病學會 理監事名單 社團法人中華民國內分泌學會第 15 屆理監事名單 理 事 長 劉鳳炫 常 務 理 事 王治元、陳涵栩、蔡克嵩、簡銘男 理

事 王舒儀、呂介華、李亭儀、周振凱、施翔蓉、陳沛隆、 陳思達、黃兆山、歐弘毅、盧介祥

常 務 監 事 曾芬郁 監

事 林宏達、張慶忠、張宏猷、郭錦松

秘 書 長 陳維健 副 秘 書 長 李宇璇、林冠宇、姜和均、陳思綺、黃峻偉、陳瑜忻

社團法人中華民國糖尿病學會第 15 屆理監事名單 理 事 長 黃建寧 常 務 理 事 陳榮福、胡啟民、杜思德、蔡世澤 理

事 李弘元、陳清助、曾慶孝、林慶齡、楊偉勛、李建興、 洪乙仁、張恬君、林嘉鴻、朱志勳

常 務 監 事 許惠恒 監

事 莊立民、楊純宜、何橈通、葉振聲

秘 書 長 楊宜瑱 副 秘 書 長 沈峰志、郭仁富、沈宜靜、范綱志、蘇聖強、曾耀賢

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中華民國內分泌暨糖尿病學會

會場交通及平面圖資訊 長庚醫療社團法人─嘉義長庚紀念醫院 地址：嘉義縣朴子市嘉朴路西段 8 號 電話：(05)362-1000

【自行前往交通資訊】 ◎高鐵： A. 學會接駁公車於 2 號出口集合。 B. 快捷公車 7211：高鐵嘉義站─崙仔頂站─ 東勢寮站─縣政府站─長庚醫院 （頭班車 06：00 約 20 分鐘一車次） ◎嘉義縣公車處： 嘉義─水上─太保─長庚 （頭班車 5：50 約 30 分鐘一車次） 朴子─大糠榔─長庚 （頭班車 6：10 約 30 分鐘一車次） 布袋─朴子─長庚 （頭班車 6：20 約 60 分鐘一車次） 嘉義─蒜頭─雙溪口─長庚 （頭班車 8：45 嘉義市發車）

◎嘉義客運： 朴子─大糠榔─長庚 （頭班車 7：00 約 30 分鐘一車次） 布袋─朴子─長庚 （頭班車 7：30 約 60 分鐘一車次） 塭港─朴子─長庚 （頭班車 7：00 約 60 分鐘一車次）） ◎停車場： 西側停車場、綜合大樓地下停車場、 北側停車場。

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112 年秋季學術研討會

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中華民國內分泌暨糖尿病學會

社團法人中華民國內分泌學會 理事長致詞 各位女士先生會員們大家好： 社團法人中華民國內分泌暨糖尿病學會共同籌劃的秋季會今年選擇在嘉義長 庚舉行，秘書處對這次大會的主軸擬定以年輕、多元、國際、科技的方向來呈現。 會員們期待睽違已久的秋季會旅遊活動安排，也在秘書處的精心規劃下出爐。 這次的秋季會由內分泌學會主辦，感謝糖尿病學會黃建寧理事長的大力支 持，讓秘書處得以安排許多精彩的學術節目，本次上午的口頭論文報告計有 9 篇 涵蓋內分泌暨糖尿病的病例報告及臨床研究分享，下午場邀請韓國內分泌學會的 李是勳博士專題演講，國科會研究計畫的跨領域對談則邀請陳沛隆、藍昇輝、吳 家兆三位專家教授主講，最新的 AI 領域在醫學職場上的影響與運用則由三位深 具研究功力的蔡昆原、曾耀賢、曹心怡醫師幫我們解析與引導。中午午餐會報也 有三場引人入勝的話題由資深醫師群擔綱以及一場延續斜槓人生的輕鬆話題來探 討職涯規劃，內容必定精彩可期，值得您的蒞臨。也感謝兩會理監事們的熱心支 持擔任主持人，讓討論度熱絡更加提升可看性。 嘉義是個地靈人傑的地方，有好山好水值得我們再來尋幽訪勝，而嘉義長庚 醫院更是具有相當優越的會議場所，在此再度感謝楊仁宗院長、林俊良副院長與 何正主任的全力配合與協助，讓我們主辦方無後顧之憂。 最後，感謝秘書處同仁的付出、全體會員的支持、廠商對於學術活動的不遺 餘力，讓秋季會能夠順利圓滿成功。同時這次秋季會也將學會策劃完成的甲狀腺 消融專刊印製成書，用大會設計製作的提袋包裝呈現，希望也能讓會員們裝回滿 滿的豐收。 祝大家身體健康，平安喜樂！ 社團法人中華民國內分泌學會 理事長 敬上 中華民國 112 年 9 月 16 日 6

112 年秋季學術研討會

社團法人中華民國糖尿病學會 理事長致詞 親愛的會員們，大家好： 感謝各位蒞臨內分泌暨糖尿病學會 2023 年秋季學術研討會，我們欣然歡迎 您的參與，共同探討糖尿病與內分泌學的新知。 回顧過去疫情期間，我們曾專注於糖尿病在疫情背景下的影響，此次會議則 安排透過口頭報告，瞭解最新的研究成果和治療進展，其中包括糖尿病人 BC 型 肝炎篩檢，以及高齡糖尿病治療的相關議題等。其他大家很有興趣的糖尿病患者 接種帶狀疱疹疫苗的成效，杜思德院長將分享醫師的建議與挑戰。 這次學會特別舉辦跨領域對談，其中之一是探討分泌型細胞自噬於調控 胰島素釋放之新策略；另外題目則包括代謝內分泌疾病之基因體醫學，以及 Melatonin、Circadian 和 Autoimmune Membranous Nephropathy 等範圍。 此外，AI 在醫療實際應用的議題也將是今年秋季會的亮點之一。我們將探討 人工智能在醫療領域的創新應用，這不僅是當下熱門的話題，更是引領未來醫療 發展的重要方向。 本次秋季會由內分泌學會籌辦，特別選擇在嘉義長庚醫院舉行。除了豐富多 彩的學術課程外，大會也安排了健康休閒活動，讓您的家人一同享受愉快的時光。 這也是學會自疫情後首次的旅遊規畫，希望您能充分放鬆身心，感受愉快的氛圍。 最後，祝福本次研討會順利圓滿成功，為各位帶來豐富的學術交流和難忘的 體驗。讓我們共同攜手探索新知，提出困難問題之解方，為內分泌糖尿病醫學領 域的進步和發展作出貢獻。謝謝大家！

社團法人中華民國糖尿病學會 理事長 敬上 中華民國 112 年 9 月 16 日 7

中華民國內分泌暨糖尿病學會

社團法人中華民國內分泌暨糖尿病學會 2023 年秋季學術研討會節目表 課程時間：2023 年 9 月 16 日（六）10:20-17:30 課程地點：嘉義長庚醫院（第二國際會議廳、第三～四會議室）

節目總表 教室 / 時間

內容 第三會議室

第二國際會議廳

【Oral Presentation-DM】 10:20-12:00

主持人： 胡啟民、朱志勳、黃峻偉

臨床新知 -LS1 AZ The latest evidence postADA: Insights of SGLT2i therapy to deliver MECARE 12:00-13:00 (MEtaboli-Cardio-Renal care) management in T2D 主持人：黃建寧 演講者：廖國盟

第四會議室

【Early Career 系列】 【Oral Presentation-ENDO】 去藥廠的醫師都在做什麼？ 11:20-12:00 主持人： 主持人：蔡克嵩 王治元、盧介祥、姜和均 演講者：黃萬均 臨床新知 -LS2 GSK 糖尿病患者接種帶狀疱疹 疫苗：醫師的建議與挑戰

臨床新知 -LS3 諾華 New treatment choice for thyroid cancer patients: how to optimize BRAF V600E thyroid cancer patients

主持人：陳清助 演講者：杜思德

主持人：蕭璧容 演講者：姜和均

13:10-13:20

Opening 致詞（第二國際會議廳） 內分泌學會劉鳳炫理事長、糖尿病學會黃建寧理事長

13:20-13:25

嘉義長庚紀念醫院 楊仁宗院長致詞（第二國際會議廳）

13:25-13:55

【Plenary Lecture】（第二國際會議廳） The parathyroid glands and parathyroid hormone: Insights from PTH gene mutations 主持人：施翔蓉 演講者：Sihoon Lee

13:55-15:25

【跨領域對談】（第二國際會議廳） 1. 代謝內分泌疾病之基因體醫學 2. 分泌型細胞自噬：調控胰島素釋放之新策略 3. 褪黑激素、晝夜週期與自體免疫膜性腎病變 主持人：楊偉勛、許惠恒、林俊良 演講者：陳沛隆、藍昇輝、吳家兆

15:25-15:40

大合照

15:40-15:50

Break

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112 年秋季學術研討會 教室 / 時間

15:50-17:20

17:20-17:30 17:30~18:10 18:30~20:00

內容 【AI 與醫療實際應用】（第二國際會議廳） 1. 生成式人工智慧 2. 運用 ChatGPT 提升糖尿病病患的照護品質 3. 人工智慧與醫療系統演進 主持人：歐弘毅、王舒儀、簡銘男 演講者：蔡昆原、曾耀賢、曹心怡 Closing 致詞及 Oral Presentation 頒獎（第二國際會議廳） 內分泌學會劉鳳炫理事長 糖尿病學會黃建寧理事長 接駁車前往高鐵 長榮文苑 晚餐會議

★ 各教室節目內容 ★ 【主會場】第二國際會議廳 時間

主題

Early Career 系列

11:20-12:00 去藥廠的醫師都在做什麼？ 臨床新知 GSK 糖尿病患者接種帶狀疱疹疫苗： 12:00-13:00 醫師的建議與挑戰 Plenary Lecture 13:25-13:55

The parathyroid glands and parathyroid hormone: Insights from PTH gene mutations

演講者

主持人

GSK 醫藥顧問 黃萬均醫師

遠東診所 蔡克嵩教授

彰化基督教醫院 杜思德教授

中國附醫 陳清助主任

Gachon University College of Medicine Prof. Sihoon Lee

臺大醫院 施翔蓉副教授

跨領域對談 臺大醫院 陳沛隆教授 陽明交大生命科學系 14:25-14:55 分泌型細胞自噬：調控胰島素釋放之新策略 暨基因體科學研究所 藍昇輝教授 國防醫學院 14:55-15:25 褪黑激素、晝夜週期與自體免疫膜性腎病變 吳家兆教育長 AI 與醫療實際應用 重心診所 15:50-16:20 生成式人工智慧 蔡昆原醫師 童綜合醫院 16:20-16:50 運用 ChatGPT 提升糖尿病病患的照護品質 曾耀賢主任 國泰醫院 16:50-17:20 人工智慧與醫療系統演進 曹心怡醫師 13:55-14:25 代謝內分泌疾病之基因體醫學

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臺大醫院 楊偉勛教授 國家衛生研究院 許惠恒副院長 嘉義長庚醫院 林俊良副院長 成大醫院 歐弘毅主任 彰化基督教醫院 王舒儀主任 馬偕醫院 簡銘男主任

中華民國內分泌暨糖尿病學會

第三會議室 時間

主題

演講者

主持人

臺北榮總 李佩娟醫師

臺北榮總 胡啟民主任

Oral Presentation-DM 10:20-10:40 糖尿病人之 BC 型肝炎篩檢：臺北榮總經驗 10:40-11:00

老年第二型糖尿病人過度治療與嚴重低血糖及全 因死亡率的相關性

11:00-11:20 血糖控制對高齡第 2 型糖尿病患者的益處 11:20-11:40

台灣論質計酬對第二型老年糖尿病病人血糖過度 治療的影響

中國附醫 邱依婷醫師 臺北榮總 葉雲凱醫師 中國附醫 蔡依靜醫師

高雄榮總 朱志勳主任 禾馨醫療 黃峻偉醫師

臨床新知 AZ

The latest evidence post-ADA: Insights of SGLT2i 臺北市立聯合醫院 12:00-13:00 therapy to deliver MECARE (MEtaboli-Cardio-Renal 忠孝院區 care) management in T2D 廖國盟醫師

糖尿病學會 黃建寧理事長

第四會議室 時間

主題

演講者

主持人

Oral Presentation-ENDO 10:20-10:40

北台灣哺乳婦女之母乳碘濃度、尿液碘濃度、 和甲狀腺功能相關性之研究

臺北榮總 蘇冠伃醫師

以 NP-59 輔以單光子放射斷層攝影術併斷層掃描 融合技術在腎上腺靜脈取樣顯示雙側醛固酮抑制 10:40-11:00 的原發性高醛固酮症患者正確分側：三例病例報 告及文獻回顧

成大醫院 梁祐誠醫師

Ga68-DOTATE PET / CT 於甲狀腺髓質癌的應用― 11:00-11:20 案例報告

臺北榮總 潘立昕醫師

11:20-11:40 胰臟神經內分泌瘤之低血糖：長期追蹤案例報告

臺大醫院 蔡元祐醫師

11:40-12:00 兩例困難定位的異位性庫欣氏症

臺北榮總 潘立昕醫師

臺大醫院 王治元主任 高雄基督教醫院 盧介祥院長 義大醫院 姜和均主任

臨床新知 諾華 12:00-13:00

New treatment choice for thyroid cancer patients: how to optimize BRAF V600E thyroid cancer patients

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義大醫院 姜和均主任

義大醫院 蕭璧容教授

講者 CV 摘要

黃萬均 Erick Huang GSK 醫藥學術部門 醫學顧問 學歷 年份 2018 – 2022 2016 2015 – 2016 2001 – 2008

學校 / 系所

學位

Woolcock Institute of Medical Research/University PhD in Medicine of New South Wales, Australia

London School of Hygiene and Tropical Medicine, Diploma in Tropical Medicine and UK Hygiene Imperial College London, UK

Master of Public Health MD

臺北醫學大學醫學系

經歷 年份 2021 – 至今 2019 – 2021

2017 – 2018 and 2013 – 2015 2008 – 2013

機構 / 單位

職務

GSK

Medical Advisor

雙和醫院胸腔內科

主治醫師

嘉義基督教醫院胸腔暨重症科

主治醫師

萬芳醫院內科部

內科住院醫師、胸腔內科 fellow

研究領域 1 Chronic respiratory diseases

論文 1 Huang WC, Fox GJ, Pham NY, Nguyen TA, Vu VG, Nguyen VN, Jan S, Negin J, Ngo QC, Marks GB. Stepped treatment algorithm using budesonide-formoterol for chronic respiratory diseases: A single arm interventional study. PLOS ONE. 2022; 17(7): e0271178.

2 Huang WC, Marks GB, Pham NY, Nguyen TA, Nguyen TA, Vu VG, Nguyen VN, Jan S, Negin J, Ngo QC, Fox GJ. A smoking quitline integrated with clinician counselling at outpatient health facilities in Vietnam: a single-arm prospective cohort study. BMC Public Health. 2022; doi: 10.1186/s12889-022-13203-y 3 Tabyshova A, Hurst JR, Soriano JB, Checkley W, Huang WC, Trofor AC, Flores-Flores O, Alupo P, Gianella G, Ferdous T, Meharg D, Alison J, de Sousa JC, Postma MJ, Chavannes NH, van Boven JFM. Gaps in COPD guidelines of low- and middle-income countries: a systematic scoping review. Chest. 2020; doi: 10.1016/ j.chest.2020.09.260 4 Sun KS, Tsai CF, Chen SC, Chen YY, Huang WC. Galactomannan Testing and the Incidence of Invasive Pulmonary Aspergillosis: A 10-Year Nationwide Population-Based Study in Taiwan. PLOS ONE. 2016;11(2):e0149964.

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中華民國內分泌暨糖尿病學會

PHYSICIANS IN PHARMACEUTICAL INDUSTRY: WHAT ARE WE DOING? 去藥廠的醫師都在做什麼？ Erick Huang 黃萬均 Medical Affairs, GSK Taiwan 荷商葛蘭素史克藥廠 醫藥學術部門

Most physicians in Taiwan work in clinical settings and are often unfamiliar with the variety of career paths within the pharmaceutical industry. In this session, I will discuss the general structure of pharmaceutical companies and the roles of Medical Affairs department. I will also share my personal experience transitioning from clinical practice to the pharmaceutical industry. Apart from Medical Affairs department, career opportunities within the pharmaceutical industry for physicians will be discussed. Finally, I will talk about skills and characteristics that allow a physician to have a successful career in the pharmaceutical industry.

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講者 CV 摘要

李是勳 Sihoon Lee

Gachon University College of Medicine Professor of Medicine Educational background & professional experience (in sequence of the latest year) Year

Department/Organization

2016-2017

Endocrine Unit/ Massachusetts General Hospital/ Visiting Associate Professor of Harvard Medical School Medicine

2023-

2016 2006-2008 2000-2005 1992-1998

Position

Division of Endocrinology, Diabetes and Bone Disease/ Adjunct Professor Icahn School of Medicine at Mount Sinai

Graduate Program for Leaders in Life Innovation/ The Visiting Faculty University of Tokyo Diabetes Unit/ National Institutes of Health

Postdoctoral Fellow

Yonsei University College of Medicine

M.D

Yonsei University Graduate School

Ph.D

Research Interests

1 Genomics and Translational Research of Adult and Pediatric Endocine diseases 2 Gene editing using CRISPR-CAS and its therapeutic application 3 Animal model development of human diseases

Publications

1 In-depth proteomic signature of parathyroid carcinoma. Eur J Endocrinol 188:385-394, 2023 2 Inherited Disorders of Thyroid Hormone Metabolism Defect caused by Selenoprotein Dysregulation. Front Endocrinol 12:803024. doi: 10.3389/fendo.2021.803024, 2022 3 Rare PTH Gene Mutations Causing Parathyroid Disorders: A Review. Endocrinol Metab 35:64-70, 2020 4 Incidence of hypoparathyroidism after thyroid cancer surgery in South Korea, 2007-2016. JAMA 322:2441-2443, 2019 5 Ca2+ allostery in PTH-receptor signaling. Proc Natl Acad Sci U S A 116:3294-3299, 2019

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中華民國內分泌暨糖尿病學會

THE PARATHYROID GLANDS AND PARATHYROID HORMONE: INSIGHTS FROM PTH GENE MUTATIONS Joon-Hyop Lee, Sihoon Lee Laboratory of Genomics and Translational Medicine, Gachon University College of Medicine, Incheon, Korea

Nine mutations have been discovered in the parathyroid hormone (PTH) gene since it was initially sequenced in 1983. An autosomal dominant C18R mutation in the signal peptide was first reported in 1990, followed by an exon skipping mutation, leading to loss of exon 2 in 1992; the latter mutation prevents PTH biosynthesis, as exon 2 contains the initiation codon. The S23P and S23X mutations affecting the same residue were reported in 1999 and 2012, respectively, while in 2008, the somatic mutation, R83X, was detected in a parathyroid adenoma tissue sample from a patient with overt hyperparathyroidism. In 2013, the heterozygous p.Met1_Asp6del mutation was discovered incidentally in a case-control study, while another heterozygous mutation, M14K, was detected in the signal peptide 4 years later. In 2015, a homozygous R56C mutation was reported, and was the first hypoparathyroidism-causing mutation identified that affects the mature bioactive portion of PTH; this mutation has significantly contributed to the understanding of the molecular mechanisms involved in signal transduction through the PTH receptor. Recently, a novel homozygous S32P mutation was identified, which is also situated in the bioactive portion of PTH. The discovery of these nine mutations in the PTH gene and determination of the molecular mechanisms underlying their effects has provided deep insights into the synthesis, processing, and secretion of PTH. Future attempts to discover other such mutations will help elucidate as yet unknown functions of PTH, with potential clinical implications.

14

講者 CV 摘要

陳沛隆 Pei-Lung Chen 臺大醫學院基因體暨蛋白體醫學研究所 教授兼所長 學歷 年份 2003 – 2009 2000 – 2002 1988 – 1995

學校 / 系所 學位 Human Genetics and Molecular Biology Program, Johns Hopkins Ph.D. degree School of Medicine Graduate Institute of Clinical Medicine, NTU Master degree College of Medicine, NTU M.D. degree

經歷 年份 2023 – 至今 2016 – 2023 2009 – 至今 2011 – 2016

機構 / 單位 Graduate Institute of Medical Genomics and Proteomics, NTU Graduate Institute of Medical Genomics and Proteomics, NTU Departments of Medical Genetics and Internal Medicine, NTU Hospital (NTUH) Graduate Institute of Medical Genomics and Proteomics, NTU

職務 Professor Associate Professor Attending Physician Assistant Professor

研究領域 1 Genetics/Genomics 2 Endocrinology and metabolism 3 Bioinformatics

論文 1 Mao-Jan Lin, Yu-Chun Lin, Nae-Chyun Chen, Allen Chilun Luo, Sheng-Kai Lai, Chia-Lang Hsu, Jacob Shujui Hsu, Chien-Yu Chen, Wei-Shiung Yang, Pei-Lung Chen (2022, Sep). Profiling genes encoding the adaptive immune receptor repertoire with gAIRR Suite. Frontiers in Immunology, 13:922513. (Corresponding author) 2 Ta-Ching Chen, Ding-Siang Huang, Chao-Wen Lin, Chang-Hao Yang, Chung-May Yang, Victoria Y Wang, JouWei Lin, Allen Chilun Luo, Fung-Rong Hu, Pei-Lung Chen (2021, Feb). Genetic characteristics and epidemiology of inherited retinal degeneration in Taiwan. npj Genomic Medicine, 6(1):1-8. (Co-corresponding author) 3 Pei-Lung Chen, Cathy Shen-Jang Fann, Shyang-Rong Shih, Wei-Shiung Yang and Tien-Chun Chang (2016, Jun) First step towards precision medicine for antithyroid drug-induced agranulocytosis. The Lancet Diabetes & Endocrinology. 4:473. (Corresponding author) 4 Pei-Lung Chen, Shyang-Rong Shih, Pei-Wen Wang, Ying-Chao Lin, Chen-Chung Chu, Jung-Hsin Lin, Szu-Chi Chen, Ching-Chung Chang, Tien-Shang Huang, Keh Sung Tsai, Fen-Yu Tseng, Chih-Yuan Wang, Jin-Ying Lu, Wei-Yih Chiu, Chien-Ching Chang, Yu-Hsuan Chen, Yuan-Tsong Chen, Cathy Shen-Jang Fann, Wei-Shiung Yang and Tien-Chun Chang (2015, Jul) Genetic determinants of antithyroid drug-induced agranulocytosis by human leukocyte antigen genotyping and genome-wide association study. Nature Communications. 6:7633.

5 Pei-Lung Chen, Cathy Shen-Jang Fann, Chen-Chung Chu, Chien-Ching Chang, Su-Wei Chang, Hsin-Yi Hsieh, Marie Lin, Wei-Shiung Yang and Tien-Chun Chang (2011, Jan) Comprehensive genotyping in two homogeneous Graves’ disease samples reveals major and novel HLA association alleles. PLoS ONE 6: e16635.

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中華民國內分泌暨糖尿病學會

GENOMIC MEDICINE FOR ENDOCRINE AND METABOLIC DISORDERS 代謝內分泌疾病之基因體醫學 Pei-Lung Chen 陳沛隆 1 Division of Endocrinology and Metabolism, Department of Internal Medicine.

2 Department of Medical Genetics, National Taiwan University Hospital, Taiwan.

3 Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taiwan.

1 台大醫院內科部新陳代謝科 2 台大醫院基因醫學部 3 台灣大學基因體暨蛋白體醫學研究所 1,2,3 1,2,3

Genomic medicine is an approach for disease diagnosis, treatment and prevention that takes into account individuals’ genomic compositions. Under this approach, diagnostic testing is often employed for diagnosis and/or for selecting appropriate therapies based on the patient’s genetic content. Given that the genetic models of diseases (for example, single gene disease vs. complex disease) can vary from diseases to diseases, the most appropriate method for genetic testing therefore will also keep evolving. In addition to traditional platforms (such as Sanger sequencing, multiplex ligation-dependent probe amplification (MLA), array CGH, etc.), next-generation sequencing (NGS) has been revolutionizing the field of genetic testing during the latest years.

In this presentation, the principles of genomic medicine and the state-of-the-art methodologies of clinical genetic testing will be illustrated. Several important endocrine diseases will be covered, including multiple endocrine neoplasia (MEN) type 1, MEN type 2, pseudohypoparathyroidism (PHP) type 1a and type 1b, pheochromocytoma/paraganglioma (PPGL), primary aldosteronism, thyroid cancer, mitochondrial disease, antithyroid drug-induced agranulocytosis, congenital adrenal hyperplasia (CAH), diabetes mellitus, Graves’ disease, etc.

However, genetic diagnosis is far from perfect and NGS is no panacea. Several critical challenges need to be addressed. In this talk, the speaker will present his views and experience in clinical genetic testing, especially focusing on the challenges and possible solutions.

16

講者 CV 摘要

藍昇輝 Sheng-Hui Lan 國立陽明交通大學生命科學系暨基因體科學研究所 助理教授 學歷 年份 2007/08 – 2013/10 2005/08 – 2007/07

學校 / 系所

學位

國立成功大學 / 基礎醫學研究所 中國醫藥大學 / 營養所

博士 碩士

經歷 年份 2019/02 – 至今

2018/08 – 2019/01 2017/08 – 2018/07 2017/02 – 2017/07 2013/12 – 2017/01

機構 / 單位

職務

國立陽明交通大學 / 生命科學系暨基因體科學研 中國醫藥大學 / 生科系

助理教授 助理教授

國立成功大學 / 生物化學暨分子生物研究所 美國耶魯大學 / 細胞生物學研究所

國立成功大學 / 微生物及免疫學研究所

博士後研究員 訪問學者 博士後研究員

研究領域 1 癌症分子醫學 2 細胞自我吞噬 3 分子及細胞生物學

論文 1 Shan-Ying Wu, Jia-Wen Chen, Hsi-Yu Liu, Yi-Ching Wang, Yeh-Shiu Chu, ChiYing Huang, Kai-Ying Lan, HsiaoSheng Liu*, and Sheng-Hui Lan* (2022, Dec). Secretory autophagy promotes Rab37-mediated exocytosis of tissue inhibitor of metalloproteinase 1. Journal of Biomedical Science.

2 Shan-Ying Wu, Hung-Tsung Wu, Yi-Ching Wang, Chih-Jen Chang, Yan-Shen Shan, Shang-Rung Wu, Yen-Chi Chiu, Chia-Lang Hsu, Hsueh-Fen Juan, KaiYing Lan, Chi-Wen Chu, Ying-Ray Lee, Sheng-Hui Lan* & HsiaoSheng Liu* (2022, Sep). Secretory autophagy promotes RAB37- mediated insulin secretion under glucose stimulation both in vitro and in vivo. Autophagy.

3 Sheng-Hui Lan, Shu-Ching Lin, Wei-Chen Wang, Yu-Chan Yang, Jenq-Chang Lee, Pei-Wen Lin, Man-Ling Chu, Kai-Ying Lan, Roberto Zuchini, Hsiao-Sheng Liu, * and Shan-Ying Wu* (2021, Oct). Autophagy Upregulates miR-449a Expression to Suppress Progression of Colorectal Cancer. Frontiers in Oncology, 11: p. 738144.

4 Shan-Ying Wu *, Sheng-Hui Lan*, Hsiao-Sheng Liu (2019, Jan). Degradative autophagy selectively regulates CCND1 (cyclin D1) and MIR224, two oncogenic factors involved in hepatocellular carcinoma tumorigenesis.

Autophagy, 2019; 15(4).

5 Shan-Ying Wu *, Sheng-Hui Lan *, Shang-Rung Wu, Yen Chi Chiu, Xi-Zhang Lin, Ih-Jen Su, Ting-Fen Tsai, Chia-Jui Yen, Tsung-Hsueh Lu, Fu-Wen Liang, Chung-Yi Li, Huey-Jen Su, Chun-Li Su and Hsiao-Sheng Liu. Hepatocellular carcinoma-related cyclin D1 is selectively regulated by autophagy degradation system. Hepatology, 2018; 68(1):141- 154.

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中華民國內分泌暨糖尿病學會

SECRETORY AUTOPHAGY PROMOTES RAB37-MEDIATED INSULIN SECRETION IN PANCREATIC BETA CELL 分泌型細胞自噬：調控胰島素釋放之新策略 Sheng-Hui Lan 藍昇輝 Department of Life Sciences and Institute of Genome Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan 國立陽明交通大學生命科學系暨基因體科學研究所

High blood glucose is one of the risk factors for metabolic disease and INS (insulin) is the key regulatory hormone for glucose homeostasis. Hypoinsulinemia accompanied with hyperglycemia was diagnosed in mice with pancreatic β-cells exhibiting autophagy deficiency; however, the underlying mechanism remains elusive. The role of secretory autophagy in the regulation of metabolic syndrome is gaining more attention. Our data demonstrated that increased macroautophagic/autophagic activity leads to induction of insulin secretion in β-cells both in vivo and in vitro under high-glucose conditions.

Moreover, proteomic analysis of purified autophagosomes from β-cells identified a group of vesicular transport proteins participating in insulin secretion, implying that secretory autophagy regulates insulin exocytosis. RAB37, a small GTPase, regulates vesicle biogenesis, trafficking, and cargo release. We demonstrated that the active form of RAB37 increased MAP1LC3/LC3 lipidation (LC3-II) and is essential for the promotion of insulin secretion by autophagy, but these phenomena were not observed in rab37 knockout (rab37-/-) cells and mice. Unbalanced insulin and glucose concentration in the blood was improved by manipulating autophagic activity using a novel autophagy inducer niclosamide (an antihelminthic drug) in a high-fat diet (HFD)-obesity mouse model. In summary, we reveal that secretory autophagy promotes RAB37-mediated insulin secretion to maintain the homeostasis of insulin and glucose both in vitro and in vivo.

18

講者 CV 摘要

吳家兆 Chia-Chao Wu 國防醫學院院本部 教育長 學歷 年份 2003 – 2007 1988 – 1995

學校 / 系所

學位

國防醫學院醫學研究所

博士

國防醫學院醫學系

醫學士

機構 / 單位

職務

腎臟醫學會

理事

國防醫學院教務處

教務長

國防醫學院內科學

教授

三軍總醫院腎臟科

主任

經歷 年份 2022/12 – 至今

2020/10 – 2022/06 2018/07 – 至今 2016 – 2020/10

研究領域 1 腎絲球腎炎 2 腎臟免疫 3 臨床透析

論文 1 Yen-Sung Huang, Kuo-Cheng Lu, Hsu-Wen Chao, Ann Chen, Tai-Kuang Chao, Cheng-Yi Guo, Hsin-Yi Hsieh, Hsiu-Ming Shih, Huey-Kang Sytwu, Chia-Chao Wu*. The MTNR1A mRNA is stabilized by the cytoplasmic hnRNPL in renal tubular cells. J Cellular Physiol 2021;236(3):2023-2035 2 Yen-Sung Huang, Kuo-Cheng Lu, Tai-Kuang Chao, Jin-Shuen Chen, Ann Chen, Cheng-Yi Guo, Hsin-Yi Hsieh, Hsiu-Ming Shih, Huey-Kang Sytwu, Chai-Chao Wu*. Role of melatonin receptor 1A and pituitary homeobox-1 coexpression in protecting tubular epithelial cells in membranous nephropathy. J Pineal Res 2018;65(1):e12482 3 Chia-Chao Wu*, Kuo-Cheng Lu, Gu-Jiun Lin, Hsin-Yi Hsieh, Pauling Chu, Shih-Hua Lin, Huey-Kang Sytwu.

Melatonin enhances endogenous heme oxygenase-1 and represses immune responses to ameliorate experimental murine membranous nephropathy. J Pineal Res. 2012 ;52(4):460-9.

4 Chia-Chao Wu*, Kuo-Cheng Lu, Yuh-Feng Lin, Jin-Shuen Chen, Ching-Feng Huang, Chun-Chi Chen, Shih-Hua Lin, Pauling Chu, Huey-Kang Sytwu. Pathogenic role of effector cells and immunoglobulins in cationic bovine serum albumin-induced membranous nephropathy. J Clin Immunol. 2012;32:138-149.

5 Chia-Chao Wu, Jin-Shuen Chen, Shyi-Jou Chen, Shih-Hua Lin, Ann Chen , Li-Chien Chang, Huey-Kang Sytwu and Yuh-Feng Lin. Kinetics of adaptive immunity to cationic bovine serum albumin-induced membranous nephropathy. Kidney Int. 2007; 72:831-40.

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中華民國內分泌暨糖尿病學會

MELATONIN, CIRCADIAN AND AUTOIMMUNE MEMBRANOUS NEPHROPATHY 褪黑激素、晝夜週期與自體免疫膜性腎病變 Chia-Chao Wu 吳家兆 Division of Nephrology, Department Medicine, Tri-Service General Hospital, Taipei, Taiwan 三軍總醫院 腎臟科

Membranous nephropathy (MN), a type of glomerular nephritis, is one of the most common causes of nephrotic syndrome in adults. Initially, our results suggest that melatonin treatment ameliorates experimental MN via multiple pathways, including by its anti-oxidative, anti-apoptotic, and immunomodulatory effects. Although it is known that melatonin plays a protective role in MN, the role of melatonin receptors in the pathophysiology of MN is unclear. Following, we found that melatonin receptor 1A (MTNR1A) expression was significantly downregulated in renal tubular epithelial cells.

Molecular studies showed that in MN kidney tissue, decreased PITX1 expression at the MTNR1A promoter regions leads to decreased levels of MTNR1A in renal tubular epithelial cells, which increases the future risk of MN. However, knowledge of the mechanism underlying MTNR1A expression has been limited and identified cytoplasmic hnRNPL as a novel player in the upregulation of MTNR1A expression in renal tubular epithelial cells, and as a potential therapeutic target. We further provide the molecular basis of c-Fos in transcriptionally downregulating expression of AANAT and melatonin, and elucidate the protective role of AANAT in preventing renal tubular cells death in albumin-injury cell model and MN progression. Melatonin, circadian and MN are linked together. We know smoking and sleeping disorder have been associated with chronic kidney disease (CKD). We showed that sleeping pill use was related to an increased risk of CKD and ESRD. There are interactions of smoking and sleep on the renal function.

The effects of sleep duration on eGFR levels varied with smoking status. Normal sleep duration was a protective factor and more crucial for non-smokers than for smokers.

Sleep disorder is bi-directionally associated with chronic kidney diseases (CKD). We also analyze the interaction between sleep duration on weekdays/weekends, catch-up sleep on weekends, and kidney functions to elucidate the missing link.

20

講者 CV 摘要

蔡昆原 Kun-Yuan Tsai 重心診所新陳代謝科 主治醫師 學歷 年份 2012 2001

學校 / 系所

學位

臺北醫學大學醫學資訊所

碩士

臺北醫學大學醫學系

學士

機構 / 單位

職務

署立雙和醫院新陳代謝科

主治醫師

臺北市萬芳醫院新陳代謝科

總醫師

經歷 年份 2008 – 2017 2006 – 2008

研究領域 1 糖尿病 2 資訊

論文 1 蔡昆原，劉見祥，劉建財，我國電子病歷發展現況與展望，醫療品質雜誌 2 Kun-Yuan Tsai, Samuel Chen, Chien-Wen Chou, Thing-Fong Tzeng, Yau-Jiunn Lee, Min-ling Chen. Quality of care and prescription patterns among patients with diabetic kidney disease—a large-scale cohort study from Taiwanese clinics. PeerJ . 2022 Jul 27;10 3 Anne Chang, Chung-Ze Wu, Jiunn-Diann Lin, Chun-Nin Lee, Kun-Yuan Tsai, Pin-Hao Wu, An-Tsz Hsieh.

Prevalence and risk factors for latent tuberculosis among diabetes patients in Taiwan: A cross-sectional study. J Infect Dev Ctries 2022 Apr 30;16(4):644-649.

4 Yi-Hao Peng , Yu-Sheng Lin, Chia-Hung Chen, Kun-Yuan Tsai, Yi-Chih Hung, Hsuan-Ju Chen, Wei-Chih Liao, Wen-Chao Ho. Type 1 diabetes is associated with an increased risk of venous thromboembolism: A retrospective population-based cohort study. PLoS One 2020 Jan 14;15(1):e0226997.

5 Ming-Song Hsieh, Tai-Guang Wu, Chein-Shyong Su, Wen-Jing Cheng, Namik Ozbek, Kun-Yuan Tsai, ChingYu Lin. Comparison of an electrochemical biosensor with optical devices for hemoglobin measurement in human whole blood samples. Clin Chim Acta 2011 Nov 20;412(23-24):2150-6.

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中華民國內分泌暨糖尿病學會

INTRODUCE TO AI-GENERATED CONTENT 生成式人工智慧 Kun-Yuan Tsai 蔡昆原 Chong-Shin Clinic, New Taipei City, Taiwan. 重心診所

Machine learning stands as the cornerstone technology within the field of artificial intelligence. It leverages algorithms to autonomously identify patterns and regularities within extensive datasets, propelling advancements across a spectrum of application domains.

In the realm of image recognition and generation, deep learning has registered momentous strides. Models like Stable Diffusion have the capacity to craft multimedia content based on natural language descriptions. However, technological advancements within natural language processing (NLP) have been constrained by hardware and neural network architecture, yielding steady yet not revolutionary progress. The advent of the Transformer architecture in 2017, embodied by the renowned BERT neural network model, propelled rapid advancements in NLP models. BERT, founded on an expanded neural network architecture and pre-training, adeptly captures linguistic structures and contextual nuances, markedly enhancing the model's grasp of natural language and yielding remarkable outcomes. The subsequent GPT series similarly captures language structures through pre-training. As model scales continuously expand, large-scale models like GPT-3 astonishingly unveil emergent capabilities in reasoning and logic, tackling open-domain question-answering tasks. These expansive language models possess the prowess to process text, thereby amplifying the proficiency of other intelligent processing tasks. Their pioneering semantic comprehension abilities lay a robust foundation for applications such as knowledge extraction, information retrieval, and sophisticated dialogues, profoundly shaping the trajectory of diverse fields.

In summation, with computational power and neural network models evolving apace, machine learning and deep learning technologies have charted astonishing progress across multifarious domains. Nonetheless, challenges pertaining to quality, transparency, and cost containment persist. Navigating these challenges necessitates collaborative endeavors in both technological innovation and management, fostering the sustained and healthful evolution of artificial intelligence.

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講者 CV 摘要

曾耀賢 Yao-Hsien Tseng 童綜合醫院 新陳代謝科 主任 學歷 年份 2017 2002

學校 / 系所

學位

台灣大學 職業醫學與工業衛生研究所

博士

中山醫學大學

學士

機構 / 單位

職務

童綜合醫院新陳代謝科

主任

台中榮總新陳代謝科

主治醫師

經歷 年份 2019 – 至今 2009 – 2019

研究領域 1 糖尿病 2 內分泌疾病

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中華民國內分泌暨糖尿病學會

UTILIZING CHATGPT FOR IMPROVED CARE IN PATIENTS WITH DIABETES 運用 ChatGPT 提升糖尿病病患的照護品質

Yao-Hsien Tseng 曾耀賢 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tungs Metroharbor Taichung Hospital, Taiwan 童綜合醫院 新陳代謝科

Diabetes, a chronic disease affecting millions of people worldwide, requires constant monitoring, precise management, and long-term support. The rise of artificial intelligence (AI) has paved new ways in healthcare, and the breakthrough language model developed by OpenAI, ChatGPT, has the potential to revolutionize diabetes management.

Combining advanced natural language processing techniques and machine learning capabilities, ChatGPT brings a range of benefits to diabetes management, from personalized assistance and data analysis to a deeper understanding of oneself, helping diabetic patients more effectively control their condition.

For people with diabetes, continuous support and monitoring is one of the main challenges they face. In this respect, ChatGPT’s availability provides ongoing help and guidance. Patients can ask questions about their symptoms, medication plans, or dietary issues, and ChatGPT can provide timely and reliable responses.

In addition to understanding and managing the disease, diabetics need to maintain a balanced diet. ChatGPT can serve as a “virtual nutritionist”, planning their meals based on individual dietary needs and preferences. In diabetes team care, it provides decision-making support for all team roles, including physicians, health educators, pharmacists, nutritionists, and others.

The massive amount of data produced by diabetics, such as blood glucose readings, insulin doses, exercise logs, and dietary information, can be difficult to interpret and analyze. ChatGPT excels at handling and understanding these complex data, making it a valuable tool in managing diabetes. ChatGPT can analyze and identify continuous blood glucose data and provide analysis and graphical results.

The utilization of ChatGPT in diabetes management and a deeper discussion of the various advantages it provides, including its value in personalized counseling, data analysis and academic research, as well as its importance in continuous support and monitoring. Fully leveraging AI, ChatGPT is an excellent auxiliary tool in clinical practice.

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講者 CV 摘要

曹心怡 Shin-Yi Tsao 汐止國泰綜合醫院內分泌新陳代謝科 主治醫師 學歷 年份 2015 /06 2001 /06

學校 / 系所

學位

臺北醫學大學 / 醫學資訊所

碩士

中山醫學大學 / 醫學系

學士

機構 / 單位

職務

汐止國泰綜合醫院

主治醫師

經歷 年份 2007/4 – 至今

研究領域 1 內科學 2 醫學資訊學

論文 1 Hui-Chuan Hsu, Shin-Yi Tsao*, Shaw-Min Hou, Shu-Wei Hsieh, and Yee-Chia Yeo. Cardiac Papillary Fibroelastoma in a Patient with Diabetic Ketoacidosis: A Case Report. Journal of Internal Medicine of Taiwan 內 科學誌 2017：28：41-46. DOI：10.6314/JIMT.2017.28(1).07 2 Chih-Hsuan Hsia, Thanasekaran Jayakumar, Joen-Rong Sheu, Shin-Yi Tsao, Marappan Velusamy, Chih-Wei Hsia, Duen-Suey Chou, Chao-Chien Chang, Chi-Li Chung, Themmila Khamrang* and Kao-Chang Lin*. StructureAntiplatelet Activity Relationships of Novel Ruthenium (II) Complexes: Investigation of Its Molecular Targets.

Molecules 2018, 23, 477; doi:10.3390/molecules23020477 3 Eng-Thiam Ong, Shin-Yi Tsao, Chao-Chien Chang. Sesamol, a phenolic antioxidant, acts as regulator of NF-kB and MAPKs-mediated antiplatelet ef- fects. Fu-Jen Journal of Medicine 20(1): 21-31, 2022. DOI: 10.53106/181020932022032001003

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中華民國內分泌暨糖尿病學會

人工智慧與醫療系統演進 曹心怡 汐止國泰綜合醫院內分泌新陳代謝科

人工智慧（AI）在醫療資訊系統中的演進已引起廣泛關注。隨著科技的進步， AI 在醫療領域的應用持續發展。根據台灣智慧醫療相關研究，AI 在醫療照護產 業中的應用具有巨大潛力。這些應用包括數據分析、影像辨識、臨床決策輔助等。 然而，智慧醫療領域仍然面臨多方面的挑戰，例如資訊系統整合不足。 在生成式 AI 如 ChatGPT 出現之前，AI 已被廣泛用於影像辨識、診斷輔助、 病歷管理等，但缺乏生成式對話能力。生成式 AI（AIGC）如 ChatGPT 在醫療領 域引起巨變。它被用來產生 FAQ、協助患者解答問題，但也可能面臨內容品質和 準確性挑戰。AI 在糖尿病治療中具有展望。它可幫助監測血糖、個人化治療、預 測低血糖事件，改善病人生活品質。導入 ChatGPT 到醫療系統可提升患者溝通、 教育、FAQ 解答等。但是產生的諸多內容仍需後端求證、隱私保護，以確保安全 有效的運用。在未來，透過數位化、健康資料整合以及產業合作，智慧醫療有望 成為主流趨勢，並提供更精準的照護和治療方案。

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112 年秋季學術研討會

口頭發表注意事項

發表時間：112 年 9 月 16 日（星期六）上午 10:20-12:00 地 點：嘉義長庚紀念醫院 B1 第三、四會議室 說明： 1. 投稿獎勵：內分泌與糖尿病口頭報告各有評比，第一名將頒發獎狀、獎金， 頒獎時間為當日 Closing 時段。 2. 若要更換報告者，請務必提早告知學會，報告者需為會員作者群，若非會員作 者群，將不列入評比。 3. 報告方式：每題有 15 分鐘報告 +5 分鐘提問討論，為維持節目順暢，第 1 次響 鈴提醒為 10 分鐘，第 2 次響鈴為 15 分鐘。 4. 報告投影片建議 15-18 頁內，請於當日 10 點前交至前台工作人員。

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中華民國內分泌暨糖尿病學會

Oral-DM 01

SCREENING OF HEPATITIS B AND HEPATITIS C VIRUS INFECTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: THE EXPERIENCE IN TAIPEI VETERANS GENERAL HOSPITAL Pei-Chuan Lee, 1 Ting-Yu Chen, 1 Tsung-Hui Wu, 1,3 Chen-Ta Chi, 1,3 Yi-Hsiang Huang, 1,3 Chii-Min Hwu 1,2

Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

2 Section of Endocrinology and Metabolism, Department of Medicine, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital.

3 Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.

1

Purpose Type 2 diabetes mellitus and hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are serious health problem worldwide. The aim of the study is to screen the seroprevalence of HBV and HCV infection in patients with diabetes mellitus and to analyze the potential associations of HBV and HCV infections with clinical factors in this population.

Method We conducted a retrospective analysis by enrolling 3199 patients with diabetes mellitus who visited Taipei Veterans General Hospital between March 2022 and February 2023. Each patient underwent serology testing to identify HBV and HCV infection by checking HBsAg and anti-HCV antibodies. We collected clinical characteristics, including age, sex, body mass index(BMI), blood pressure and blood samples were taken to measure fasting glucose and HbA1c level.

Result Of the total 3199 patients with type 2 diabetes mellitus, 252(7.9%) patients tested positive for HBsAg and 81(2.5%) tested positive for anti-HCV antibodies. Among these patients, 7(0.2%) were found to have both HBsAg and anti-HCV. Regarding HCV infection, 44(54.2%) patients were newly diagnosed and 33 patients(75%) were referred to our Gastroenterology outpatient clinics. Among these 33 patients, 13 were found to have detectable HCV RNA and 12 of them received treatment with direct-acting antivirals(DAAs). Patients with hepatitis B infection were found to be younger compared to those without hepatitis B infection and patients with HCV infection were older and lower body weight compared to those without hepatitis C infection.

Conclusion This study provides the importance of screening of HBV and HCV infection among patients with type 2 diabetes mellitus.

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論文口頭報告 Oral-DM Oral-DM 02

GLYCEMIC OVERTREATMENT, SEVERE HYPOGLYCEMIA AND ALL-CAUSE MORTALITY IN OLD ADULTS WITH TYPE 2 DIABETES MELLITUS 1,2

Yi-Ting Chiu, 3,4 Sung-Chen Liu, 3,4 Chun-Chuan Lee, 1,5 Ching-Chu Chen

Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taiwan.

2 Department of Medicine, China Medical University, Taiwan.

3 Division of Endocrinology and Metabolism, Department of Medicine, Mackay Memorial Hospital, Taiwan.

4 Department of Medicine, Mackay Medical College, Taiwan.

5 School of Chinese Medicine, China Medical University, Taiwan.

1

Purpose Intensive glycemic control can potentially increase the risk of hypoglycemia especially using glinides, sulfonylureas and/or insulin in elderly persons with multiple chronic diseases. This study aimed to evaluate the impact of glycemic overtreatment on severe hypoglycemia and all-causes mortality among old adults with type 2 diabetes mellitus (T2DM).

Method Participants were T2DM, age ≥65 years old, being treated with glinides, sulfonylureas and/or insulin in 2006, 2011, and 2016. Glycemic overtreatment was defined as healthy patients with HbA1c <6.5%, intermediate health with HbA1c <7.0%, and poor health with HbA1c <7.5%. Severe hypoglycemia was ≥ 1 hypoglycemic hospitalization or emergency department visit after index HbA1c within one year. All-cause mortality was death after index HbA1c within one year. The Student’s t test and the chi-square test were used to compare continuous and categorical variables, respectively. Hazard ratios (HRs) for severe hypoglycemia and all-cause mortality within one year were estimated using Cox proportional hazard models. A proportional hazards model for the subdistribution of a competing risk was used to weigh competing risk of death with severe hypoglycemia. The time-dependent Cox proportional hazard model was used to evaluate the association of severe hypoglycemia with all-cause mortality.

Result A total of 30,195 patients were included (mean age 73±6.5 years), of whom 8,671 (28.7%) patients was overtreated. Higher proportion of patients developed severe hypoglycemia in overtreated patients (5.3% vs 3.1%, P<0.001). The hypoglycemic risk (HR) of overtreated patients was 1.25 [1.04- 1.51], P=0.020. More patients died in overtreated patients (10.8% vs 5.8%, P<0.001). The all-cause mortality risk (HR) of overtreated patients was 1.14 [1.00- 1.31], P=0.055. The effect of severe hypoglycemia within 30 days on all-cause mortality within 1 year (HR) was 3.64 [2.50- 5.29], P<0.001.

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中華民國內分泌暨糖尿病學會

Conclusion Glycemic overtreatment is harmful to old patients with T2DM, with higher hypoglycemic and all-cause mortality risk. Individualized goal of glycemic target needs to be emphasized in our clinical practice.

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論文口頭報告 Oral-DM Oral-DM 03

THE BENEFITS OF GLYCEMIC CONTROL IN AMBULATORY VERY ELDERLY PATIENTS WITH TYPE 2 DIABETES- PRELIMINARY REPORT 1

Yun-Kai Yeh, 1,2 Harn-Shen Chen,

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

2 Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

1

Purpose That intensive glucose control decreases the risk for multiple complications in patients with diabetes compared with moderate glucose control has been well documented by several trials over the last 15 years. However, most of these trials have either excluded patients aged >80 years or recruited too few to establish the benefit-to-risk ratio in the elderly. The benefits of glucose control remain uncertain for the heterogeneous population of older diabetic patients due to a lack of clinical trial data evaluating the benefits of long-term intensive glucose control in older patients. This study is designed to provide reliable evidence on the balance of benefits and risks conferred by glucose control in elderly patients with type 2 diabetes(T2DM).

Method This is a prospective, randomized, open-labeled, controlled design to assess the benefits of treating elderly patients with type 2 diabetes. Patients with type 2 diabetes who are older than 80 years and able to walk by themselves were recruited. The goal in the standard therapy group is to maintain glycated hemoglobin below 7%, as compared with the conservative-therapy group which is to maintain glycated hemoglobin below 9%. The primary study outcomes are biochemical data was assessed during follow up period for at most 5 years.

Result After 5 years of follow-up, the mean glycated hemoglobin level was lower in the standard care group (7.5%) than in the conservative-therapy group (7.9%). Follow up biochemical data revealed no significant difference of estimated Glomerular filtration rate, total cholesterol, high-density lipoprotein, uric acid, urine microalbumin to creatinine ratio , and between 2 groups. Significantly elevated fasting glucose and triglycerides level was found in conservative-therapy group.

Conclusion Implementing a strategy of standard glucose control in elderly patients with T2DM can yield benefits in terms of fasting glucose and triglyceride levels. Further analysis of its impact on T2DM complications will be conducted in subsequent studies 31

中華民國內分泌暨糖尿病學會

Oral-DM 04

THE IMPACT OF PAY-FOR-PERFORMANCE PROGRAM ON GLYCEMIC OVERTREATMENT IN OLD PATIENTS WITH TYPE 2 DIABETES MELLITUS IN TAIWAN 1,2

Yi-Ching Tsai, 3,4 Sung-Chen Liu, 3,4 Chun-Chuan Lee, 1,5 Ching-Chu Chen

Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.

2 Department of Medicine, China Medical University, Taichung, Taiwan.

3 Division of Endocrinology and Metabolism, Department of Medicine, Mackay Memorial Hospital, Taipei, Taiwan.

4 Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.

5 School of Chinese Medicine, China Medical University, Taichung, Taiwan.

1

Introduction In 2001, the Bureau of Nation Health Insurance (NHI), Taiwan implanted a pay-for-performance (P4P) program for diabetes mellitus care to promote regular follow-up visits and exams/tests for better monitoring and glycemic control. In 2006, the NHI launched the “Personal Annual Incentive by Performance” which includes the proportion of enrollees with HbA1c <7% as one of the four performance indicators. It is unclear the effect of annual incentive on glycemic control. In this study, we aimed to evaluate the impact of annual Incentive on glycemic overtreatment and characteristics of glycemic overtreatment in old patients with type 2 diabetes mellitus (T2DM).

Materials and Methods Data of patients with T2DM in 2006, 2011, and 2016 were collected from 2 tertiary referral medical centers. The inclusion criteria were age ≥65 years old, using insulin, sulfonylureas, or glinides. The definition of glycemic overtreatment were healthy patients with HbA1c <6.5%, intermediate health with HbA1c <7.0%, and poor health with HbA1c <7.5%. The mean and standard deviation (SD) of continuous variables and number and percentage for categorical variables were used to describe the distributions of the cohorts. The Student’s t test and the chi-square test were used to compare continuous and categorical variables, respectively.

Results A total of 30,195 patients (7,029 patients in 2006, 10,742 patients in 2011, and 12,424 patients in 2006) were included, of whom 8,671 (28.7%) patients was overtreated with an increasing rate overtime (27.0% in 2006, 28.2% in 2011, and 30.2% in 2016).

The overtreated trend was similar overtime in both P4P participants and non-P4P participants. P4P participants had lower overtreated rate than non-P4P participants. The older the age has the higher overtreated rate, highest 37.3% in age ≥80 years old. The lower

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論文口頭報告 Oral-DM

the estimated glomerular rate (eGFR) has the higher overtreated rate, highest in eGFR <15 mL/min/1.73m2 63.5%. Nephrologist had the highest overtreated rate (38.1%); similar rate between endocrinologist and family physician, 24% vs 23.8%.

Conclusions The glycemic overtreatment is increasing overtime in old patients with T2DM. P4P program lowered overtreatment rate. Different specialty education of individualized treatment goal to avoid glycemic overtreatment is needed.

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中華民國內分泌暨糖尿病學會

Oral-ENDO 01

BREAST MILK IODINE CONCENTRATION AND URINARY IODINE CONCENTRATION AS BIOMARKERS FOR THE ASSESSMENT OF IODINE NUTRITIONAL STATUS OF LACTATING WOMEN IN NORTHERN TAIWAN Guan-Yu Su1, Jia-Zhen Li1,2, Chang-Ching Yeh 3,4,5, Fan-Fen Wang2,6, Chen-Chang Yang7,8,9, Chun-Jui Huang2,9

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

2 Department of Food Safety and Health Risk Assessment Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan.

3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.

4 Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.

5 Department of Obstetrics and Gynecology, Faculty of Medicine, School of Medicine, National YangMing University, Taipei, Taiwan.

6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan.

7 Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

8 Institute of Environmental & Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.

9 Faculty of Medicine, School of Medicine, National Yang-M Chiao Tung University, Taipei, Taiwan.

1

Objective: Adequate iodine nutritional status has been defined by a median urinary iodine concentration (UIC) ≥100 μg/L in a population of lactating women. However, studies have shown that breast median iodine concentration (BMIC) can be completely different in groups of exclusively breastfeeding women with similar median UIC. Whether BMIC or UIC serves as an accurate biomarker for the assessment of iodine nutritional status in lactating women in Taiwan, an area with borderline iodine adequacy, is unknown. The study aims to evaluate the relationship between maternal UIC, BMIC, and thyroid function in lactating women and assess the influence of dietary habits on iodine nutritional status in northern Taiwan.

Methods: This cross-sectional hospital-based study enrolled breastfeeding women aged 20 years or above who visited Taipei Veterans General Hospital for routine post-partum checkups from August 2021 to February 2023. Each participant provided a random spot urine sample for measurement of UIC and two random breast milk samples including one sample from each breast for determination of BMIC. A blood sample was taken for measurement of thyroid profiles including TSH, free T4, anti-thyroglobulin antibodies, and anti-thyroid peroxidase antibodies. A food frequency questionnaire was completed at the time of sample collection. Iodine measurements were performed using inductively coupled plasma mass spectrometry.

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論文口頭報告 Oral-ENDO

Results: A total of 75 women with a mean age of 34.0 ± 4.1 years old (range: 24-43 years) were enrolled. The median UIC of the studied women was 87.7 μg/L (IQR: 42.6 - 125.9 μg/L), and this suggests insufficient iodine status (recommended median UIC ≥100 µg/L). However, the overall median BMIC was 168.4 μg/L, which means that the amount of iodine delivered to the infants is sufficient (recommended median BMIC ≥100 µg/L). The positive predictive value for detecting iodine insufficiency using UIC alone was only 22.0% because 42.7% (n=32) of the studied women would be misclassified. There was a positive correlation between UIC and BMIC (Pearson correlation coefficient: 0.608); the correlation between UIC, BMIC, and thyroid function was weak.

The most commonly consumed iodine-containing food type was dairy products (66.6% ingesting dairy products ≥3 days/week). Seaweed, fish, and seafood were less frequency eaten (median intake frequency: one day per week). More than 80% of the women either took multivitamin frequently every day or never took multivitamin (everyday: 29.3%, never: 52.0%). Women not taking multivitamin had a higher likelihood of having BMIC <100 μg/L (adjusted OR: 13.65, 95% CI:1.48 -125.92, p =0.02).

Conclusions: The result of the current study suggests that BMIC is an important biomarker to determine iodine nutritional status in lactating women. The iodine nutritional status may be incorrectly classified based on measuring UIC alone.

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中華民國內分泌暨糖尿病學會

Oral-ENDO 02

NP-59 SPECT/CT CORRECTLY GUIDED LATERALIZATION IN PATIENTS WITH PRIMARY ALDOSTERONISM AND BILATERAL ALDOSTERONE SUPPRESSION IN ADRENAL VENOUS SAMPLING: A REPORT OF THREE CASES AND A REVIEW OF LITERATURE 1

Yu-Cheng Liang, 2 Hung-Tsung Wu, 1,2 Horng-Yih Ou

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

2 Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

1

Purpose In patients with primary aldosteronism, adrenal venous sampling (AVS) is a gold standard for subtype classification. Even with successful cannulation of bilateral adrenal veins, AVS is thought to be failed when bilateral aldosterone suppression (BAS) is found, and repeating AVS is usually suggested. In our center, our successful cannulation rate of AVS was relatively low. Thus, we used NP-59 SPECT/CT to subtype the patients with BAS rather than repeating AVS. In addition, we conducted a review of the related literature with similar cases.

Method We report a retrospective observational study of patients receiving AVS in a medical center in Southern Taiwan.

Result From 2012 to 2022, twenty-seven patients received sequential cosyntropin-stimulated AVS, and thirteen of twenty-seven (48%) had bilateral successful cannulation.

Three of thirteen (23%) patients had BAS. All of them had discordant findings with CT. Thereafter, they received unilateral adrenalectomies according to the findings on NP-59 SPECT/CT, followed by complete clinical and biochemical success.

Conclusion Our results emphasized that the results of AVS were not reliable in the presence of BAS. In contrast, NP-59 SPECT/CT is a less technically dependent procedure and correctly guided lateralization in our cases with complete clinical and biochemical success.

Our experiences suggest NP-59 SPECT/CT might have a lower false negative rate in patients with BAS than those without BAS. The role of NP-59 SPECT/CT in patients with BAS requires further study.

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論文口頭報告 Oral-ENDO Oral-ENDO 03

APPLICATION OF GA68-DOTATE PET/CT IN PATIENTS WITH MEDULLARY THYROID CANCER---A CASE REPORT Li-Hsin Pan, 1,2Liang-Yu Lin

1

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

2 Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

1

Purpose Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor of the C cells of thyroid gland. After total thyroidectomy, regular follow-up of tumor markers for detection of persistent or recurrent disease is important. 18F-FDOPA PET is first choice of imaging study in patients with persistent/ recurrent MTC. However, commercial product of FDOPA is not available in many countries including Taiwan. 68Ga-DOTATE PET may be helpful for monitoring disease status when cross-sectional images fail to locate the source of elevated calcitonin or carcinoembryonic antigen (CEA).

Method We reported a case with recurrent MTC identified by 68Ga-DOTATE PET/CT. Result A 77-year-old woman had MTC, stage I diagnosed in 2003 and underwent total thyroidectomy at that time. A progressive increase in calcitonin and CEA was detected from 2008 to 2022. However, neck ultrasonography, computed tomography, bone scan and whole body 18F-FDG PET all failed to locate the recurrent tumors. 68Ga-DOTATE PET was performed and showed an enhancing lesion over the right thyroid bed. The patient underwent right neck dissection and several black lymph nodes were excised. The pathologic report of the lymph nodes confirmed metastatic MTC. Conclusion 68 Ga-DOTATE PET is more sensitive in identifying recurrent or metastatic MTC than 18F-FDG-PET. The sensitivity increases with elevation of calcitonin and CEA. 68 Ga-DOTATE PET should be considered if conventional imaging study is not able to detect persistent or recurrent disease.

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中華民國內分泌暨糖尿病學會

Oral-ENDO 04

HYPOGLYCEMIA OF PANCREATIC NEUROENDOCRINE TUMOR: LONG JOURNEY CASE REPORT Y-Y Tsai, W-C Wu, W-Y Chiu, J-Y Lu, S-R Shih, P-L Chen, C-Y Wang

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Purpose Insulinoma, insulin autoimmune syndrome and nesidioblastosis are rare diseases which manifest hypoglycemia in adult patients.

Method We presented an 84-year-old man, being diagnosed with pancreatic neuroendocrine tumor with coexistence of insulin autoimmune syndrome and nesidioblastosis.

Result The patient presented with symptoms of consciousness change three times within three months. In the latest episode, he had consciousness disturbance with a fingerstick blood glucose of 36 mg/dL (reference 70-140 mg/dL). The symptoms relieved soon after glucose water infusion. He was sent to the emergency department of National Taiwan University Hospital and was admitted to survey recurrent episodes of severe hypoglycemia. There were neither intracranial lesion by neuroimaging nor cardiac origin problems by ultrasound cardiography and 24-hour Holter electrocardiogram. 72-hour fasting test was performed. 7 hours later, serum glucose of 42 mg/dL (reference 70-100 mg/dL) developed, with C-peptide of 3.10 ng/mL (reference 0.78-5.19 ng/mL), insulin level of > 600 μIU/mL (reference < 28.8 μIU/mL), and insulin-to-C-peptide ratio > 1.

Moreover, chromogranin A level of 95.4 ng/mL (reference < 101 ng/mL) and auto-insulin Ab of 80.8 % (reference > 10 %) were detected. Other autoimmune screening tests were negative, but insulin autoimmune syndrome was highly suspected biochemically.

Possible culprit medication of clopidegrol was changed to cilostazol. Abdomen MRI revealed no significant pancreatic lesion. Endoscopic ultrasound demonstrated a 0.9 mm pancreatic body tumor. Medical therapy rather than operation was preferred by his family due to old age, thus endoscopic ultrasound with aspiration cytology was performed.

Biopsy-proven neuroendocrine tumor with SSTR 5/2a focally positive was noted. Ethanol injection therapy was carried out. However, hypoglycemia events with persistent hyperinsulinemia were noticed in the following days. Sequential endoscopic ultrasound disclosed a 2.9 mm nodule at pancreatic neck and a biopsy-proven pancreatic tail nesidioblastosis. Sandostatin LAR 30 mg was given monthly as maintenance therapy. Frequent meals were still educated to avoid hypoglycemia.

Conclusion Insulinoma with concomitant insulin autoimmune syndrome and nesidioblastosis is rare.

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論文口頭報告 Oral-ENDO Oral-ENDO 05

DIFFICULT CASES OF ECTOPIC CUSHING SYNDROME Jui-Hsiang Sung, 1,2Chin-Sung Kuo（臺北榮總潘立昕醫師代為報告）

1

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

2 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

1

Purpose Cushing syndrome is a disease of the hypothalamic-pituitary-adrenal axis characterized by an excess of circulating glucocorticoids. Once the diagnosis of Cushing syndrome is confirmed, it is important to determine the cause. Ectopic Cushing syndrome refers to non-pituitary tumors that secrete ACTH. CT and MRI are typically the initial modalities used to localize ectopic Cushing syndrome. However, in some cases, such as pulmonary neuroendocrine tumors, diagnosing them with cross-sectional imaging can be challenging due to their small size or proximity to vasculature. Additionally, imaging fails to identify the cause in up to 20% of ectopic Cushing syndrome cases. Functional imaging modalities, such as 68Ga-DOTATATE, have now been introduced for the survey of ectopic Cushing’s syndrome. In this report, we present two difficult cases of ectopic Cushing syndrome failed to be localized using 68Ga-DOTATATE PET/CT. Method We present two difficult cases of ectopic Cushing syndrome failed to be localized using 68Ga-DOTATATE PET/CT. Result A 63-year-old man is referred to our hospital for Cushing syndrome survey. His presentations are resistant hypertension, body weight gain, general edema, moon face, buffalo hump, proximal muscle weakness for months and osteoporosis of L spine. Loss diurnal change of serum ACTH and cortisol, elevated saliva cortisol, elevated 24-hr urine free cortisol, DDAVP test positive, but the results of high-dose dexamethasone test and bilateral inferior petrosal sinus sampling (BIPSS) indicate ectopic Cushing syndrome. However, brain MRI, chest CT and whole body 18F-FDG PET fails to locate the origin. 68Ga-DOTATE PET is performed but still reveals no specific findings.

Another case is a 74-year-old woman whose initial presentation is progressive lower legs pitting edema, body weight gain, polyuria, blurred vision, moon face, buffalo hump and pendulous abdomen. As previous case, series survey including DDAVP, high dose dexamethasone test and BIPSS indicate ectopic Cushing’s syndrome. However, in this case, pituitary MRI found a 4.5 x 5.4 mm nodular lesion in right posterior pituitary gland. A pulmonary nodule over LUL is found on Chest CT, and abdominal CT reveals hyperplasia of bilateral adrenal glands. Whole body 18F-FDG PET reveals high function

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中華民國內分泌暨糖尿病學會

of adrenal glands. Because it fails to locate the origin of cortisol secretion, 68Ga-DOTATE PET is performed which results no specific findings.

Conclusion 68 Ga-DOTATE PET is reported as a better tool in localizing ectopic Cushing syndrome than 18F-FDG-PET and should be considered if conventional imaging study is not able to detect persistent or recurrent disease. However, the experience of 68Ga-DOTATE PET to localize ectopic Cushing syndrome will be further explored in our clinical practice.

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