The glass podium: Gender representation within the American Association of Endocrine Surgeons (AAES) from 2010 to 2019.

BACKGROUND: Despite increasing numbers of women in surgery, female underrepresentation in surgical societies remains an ongoing issue. We sought to determine the gender composition of presenters at the American Association of Endocrine Surgery annual meetings. METHODS: Utilizing previous meeting data, we collected gender information for presenters from 2010 to 2019, including first/senior author combinations. Awards winners and invited lecturers were also reviewed. We performed binomial testing to analyze proportions of male to female presenters, with significance set at P < .05. Temporal trends were analyzed via linear regression. RESULTS: Fifty-six percent of American Association of Endocrine Surgery fellows and 36% of members are female. Of 354 podium and 477 poster presentations, women were listed less often as first (42.7%, P = .007) and senior (30.6%, P < .0001) podium authors and less often as first (42.8%, P = .002) and senior (29.8%, P < .0001) poster authors. The most common combination of first/senior authors was male-male (43.1%), followed by female-male (26.8%), female-female (16.1%), and male-female (14.0%). Less than 15% of invited lecturers were women, and women represented a minority in nearly all award categories. We observed a positive trend in female first authorship over time (slope = 0.766, 95% confidence interval, 0.70%-2.23%, P = .26) but no change in female senior authorship over time (slope = 0.03348, 95% confidence interval, 1.086%-1.153%, P = .95). CONCLUSION: Women are underrepresented as American Association of Endocrine Surgery presenters and less likely to receive awards or deliver invited lectures. Although female first authorship increased over time, women continued to lag behind men as senior authors and mentors to trainees and junior faculty. Opportunities to improve speaker and awardee representation should be explored.

Endocrine surgery is at the forefront of gender diversity.

BACKGROUND: The purpose of this study is to assess gender diversity across surgical subspecialties, with a focus on endocrine surgery. METHODS: We collected publicly-reported data from Association of American Medical Colleges (AAMC) and American Association of Endocrine Surgeons (AAES) during the 2017 data period. Student's t-test and Analysis of Variance (ANOVA) were used to compare percentages of female surgeons. We analyzed data by geographical regions, excluding states where data was unreported/unavailable. RESULTS: During this period, there were 25,022 general surgeons. Of these, 5157 (20.6%) were female. There were 513 endocrine surgeons, of which 179 (34.8%) were female (p < 0.001). Across the US, endocrine surgery had the greatest percentage of female surgeons (34.8%) compared to other surgical subspecialties (p < 0.001). When comparing geographical regions, the Northeast (22.8%) and West (22.8%) contained the highest percentages of female general surgeons, while the South comprised the greatest proportion of female endocrine surgeons (38.7%). CONCLUSIONS: Endocrine surgery has the most gender diversity of all studied surgical subspecialties. The Southern US has the greatest proportion of female endocrine surgeons.

Neurodevelopmental and Mental Health Screening for Patients with Turner Syndrome in Pediatric Endocrine Clinics: Results of a Pediatric Endocrine Society Survey.

INTRODUCTION: International Turner syndrome (TS) Clinical Practice Guidelines recommend screening for neurodevelopmental (ND) and mental health (MH) concerns in girls with TS; however, it remains unclear whether this is implemented in current practice. The objective of this mixed methods study was to assess screening practices for ND and MH in girls with TS from the perspective of pediatric endocrinologists. METHODS: Pediatric Endocrine Society members who provide care for girls with TS were invited to complete an electronic survey on screening practices. Descriptive statistics were used to summarize quantitative results concurrently with thematic analysis of free-text survey responses. RESULTS: A total of 124 surveys were completed (86% attending pediatric endocrinologists, 81% at academic institutions). Overall, 25% of providers reported their patients with TS received both ND and MH screenings. Only 9 (9%) respondents endorsed screening for ND concerns themselves, while more providers (26%) reported they screen for MH concerns. Multiple barriers to screening for ND and MH concerns within the clinical setting were endorsed. Nearly all providers (>93%) reported they would consider using a short, validated screening tool for ND and MH concerns if such tools were available. DISCUSSION: A minority of pediatric endocrinologists currently perform ND or MH screening for patients with TS, however, many would be interested in implementing a brief screening tool into their clinical practice. Given almost all girls with a TS diagnosis receive care from pediatric endocrinologists at least annually, this may be an effective method to increase the proportion of girls with TS who receive recommended screenings.

How academically productive are endocrine surgeons in the United States?

BACKGROUND: Many surgical departments in the United States lack endocrine surgery faculty. Although endocrine surgeons can provide worthwhile clinical services, it is unclear how they contribute to the overall academic mission of the department. The present study aims to evaluate the academic productivity of endocrine surgeons, as defined by the American Association of Endocrine Surgeons (AAES) membership, when compared with other academic surgical faculty. MATERIALS AND METHODS: An established database of 4081 surgical department faculty was used for this study. This database includes surgical faculty of the top 50 National Institutes of Health (NIH) funded universities and faculty from five outstanding hospital-based surgical departments. Academic metrics including publication, citations, H-index, and NIH funding were obtained using publically available data from websites. The AAES membership status was gathered from the online membership registry. RESULTS: A total of 110 AAES members were identified in this database, accounting for 2.7% of this population. Overall, the AAES members outperformed other academic surgical faculty with respect to publications (66 ± 94 versus 28 ± 91, P < 0.001), publication citations (1430 ± 3432 versus 495 ± 2955, P < 0.001), and H-index (19 ± 18 versus 10 ± 13, P < 0.001). In addition, the AAES members were more likely to have former/current NIH funding and hold divisional or departmental leadership positions than their non-AAES member colleagues. CONCLUSIONS: Based on these data, the AAES members excelled with respect to publications, citations, and research funding compared with nonendocrine surgical faculty. These results demonstrate that endocrine surgeons can contribute enormously to the overall academic mission. Therefore, more surgical departments in the United States should consider establishing an endocrine surgery program.

Diagnostic Evaluation, Comorbidity Screening, and Treatment of Polycystic Ovary Syndrome in Adolescents in 3 Specialty Clinics.

STUDY OBJECTIVE: A polycystic ovary syndrome (PCOS) diagnosis in adolescence can have significant long-term health implications. The criteria for its diagnosis in adolescents have been subject to much debate. In this study we aimed to characterize the variability in diagnosis and management among different pediatric specialties. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: This was a retrospective review of electronic medical records of female patients (11-21 years old) who presented to 3 specialties (adolescent medicine [ADO], pediatric endocrinology [ENDO], and gynecology [GYN]), with a postvisit diagnosis of PCOS, menstrual disorders, or hirsutism, at a large tertiary care center, from November 1, 2011 to October 31, 2012. Demographic, clinical, laboratory, and treatment data were abstracted. MAIN OUTCOME MEASURES: Testing for diagnosis of PCOS and its comorbidities, and treatment strategies in the 3 pediatric specialties. RESULTS: One hundred forty-one patients (50 ADO, 48 ENDO, and 43 GYN) were eligible. Testing for hyperandrogenemia (17-hydroxy-progesterone, dehydroepiandrosterone, estradiol), thyroxine, and use of pelvic ultrasound differed among specialties. Providers failed to document weight concerns in 28.3% (29 of 101) of overweight or obese patients. Patients seen by ENDO were most likely, and GYN least likely, to be identified as having elevated weight, and to be tested for glucose abnormalities, dyslipidemia, and liver disease. ENDO providers prescribed metformin more often and hormonal therapy less often than ADO and GYN. CONCLUSION: There is considerable variability across pediatric specialties in the evaluation of PCOS, with significant underassessment of comorbidities. Use of unified guidelines, including for the evaluation of comorbidities, would improve evidence-based management of adolescent PCOS.

Retirement Age Ranges from Clinical Practice of Maternal-Fetal Medicine Physicians.

Objectives Retirement of "baby boomer" physicians is a matter of growing concern in light of the shortage of certain physician groups. The objectives of this investigation were to define what constitutes a customary retirement age range of maternal-fetal medicine (MFM) physicians and examine how that compares with other obstetrician-gynecologist (ob-gyn) specialists. Study Design This descriptive study was based on American Medical Association Masterfile survey data from 2010 to 2014. Data from the National Provider Identifier were used to correct for upward bias in reporting retirement ages. Only physicians engaged in direct patient care between ages 55 and 80 years were included. Primary outcomes involved comparisons of retirement ages of male and female physicians with other ob-gyn specialties. Results Interquartile ranges of retirement ages were similar between specialists in MFM (64.1-71.1), gynecologic oncology (62.1-68.9), reproductive endocrinology and infertility (64.1-71.7), and general ob-gyn (61.5-67.9). In every specialty, women retired earlier, while males in MFM were most likely to retire at the oldest age (median 70.0). Conclusion MFM physicians usually retired from clinical practice between ages 64 and 71 years, which is similar to other ob-gyn specialists. Females retired earlier, however, which may impact the overall supply as more females pursue MFM careers.

Management of gestational hypothyroidism: results of a Brazilian survey

Objectives Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. Materials and methods In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. Results Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. Conclusion The recommendations of the consensus statements are incorporated into the respondents’ clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening.

Radiology reporting of adrenal incidentalomas - who requires further testing?

Adrenal incidentalomas (AIs) are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in several investigations that are usually conducted in the endocrinology clinic. In 2011, we audited the prevalence and management of AIs identified on computed tomography (CT) imaging of abdomen over 1 calendar month. Consequently, a decision pathway for adrenal lesions was introduced in the radiology department of the Royal Free London Hospital. One year later, we re-audited the local practice. In total, 690 CT scans were reviewed in 2011 compared with 1,264 in 2012. In 2011, 17 (2.46%) patients with AIs were identified, and 26 (2.01%) in 2012. Of those, 1.01% in 2011 and 0.95% in 2012 had newly identified AIs. Only a few patients had been tested to exclude a functional lesion and there was inconsistent terminology in reporting adrenal lesions. Therefore, we support comprehensive reporting of AIs and a selective testing strategy.

Polycystic ovary syndrome and diabetes screening: a survey of gynecologists and reproductive endocrinologists.

OBJECTIVES: Women with polycystic ovary syndrome (PCOS) are at high risk of developing type 2 diabetes mellitus. The purpose of this study was to assess self-reported methods used by specialists in obstetrics and gynecology (OB/GYN) and in reproductive endocrinology and infertility (REI) to screen for type 2 diabetes in women with PCOS. STUDY DESIGN: We analyzed responses to a web-based survey of from 123 OB/GYN and 223 REI physician members of the American Society for Reproductive Medicine. RESULTS: Initial diabetes screening of all women with PCOS was performed by fewer OB/GYNs (57%) than REIs (71%). Approximately 1/3 of both groups reported initial screening only for those with additional risk factors, and 3% reported no screening. Re-screening for diabetes was reportedly performed by similar numbers of OB/GYNs (49%) and REIs (53%). Re-screening was reportedly not performed by the remaining 51% of OB/GYNs and 47% of REIs. For initial screening, the 2h glucose tolerance test (GTT) was reportedly used by fewer OB/GYNs than REIs (59% vs 72%), fasting plasma glucose (FPG) by more OB/GYNs (22% vs 8%), and hemoglobin A1c (HbA1c) by a similar number (19% vs 20%). For re-screening, GTT was reportedly used by a similar proportion of OB/GYNs and REIs (27% vs 32%), FPG was used more by OB/GYNs (43% vs 23%), and HbA1c was used less (30% vs 45%). CONCLUSIONS: Not all OB/GYN and REI respondents followed diabetes screening guidelines for women with PCOS. Screening rates for women with PCOS might be increased by continued educational efforts concerning their high risk for diabetes, and by the recent recommendation to use HbA1c for diabetes screening in high-risk populations.

Radiological reports: a comparison between the transmission efficiency of information in free text and in structured reports.

INTRODUCTION: This work proposes to improve the transmission of information between requiring physicians and radiologists. OBJECTIVES: Evaluate the implementation of a structured report (SR) in a university hospital. METHODS: A model of a structured report for thyroid sonography was developed according to information gathered from radiologists and endocrinologists working in this field. The report was based on a web platform and installed as a part of a Radiological Information System (RIS) and a Hospital Information System (HIS). The time for the report generation under the two forms was evaluated over a four-month period, two months for each method. After this period, radiologists and requiring physicians were questioned about the two methods of reporting. RESULTS: For free text, 98 sonograms were reported to have thyroids with nodules in an average time of 8.71 (+/-4.11) minutes, and 59 sonograms of thyroids without nodules were reported in an average time of 4.54 (+/- 3.97) minutes. For SR, 73 sonograms in an average time of 6.08 (+/-3.8) minutes for thyroids with nodules and 3.67 (+/-2.51) minutes for thyroids without nodules. Most of the radiologists (76.2%) preferred the SR, as originally created or with suggested changes. Among endocrinologists, 80% preferred the SR. DISCUSSION: From the requiring physicians' perspective, the SR enabled standardization and improved information transmission. This information is valuable because physicians need reports prepared by radiologists. CONCLUSIONS: The implementation of a SR in a university hospital, under an RIS/HIS system, was viable. Radiologists and endocrinologists preferred the SR when compared to free text, and both agreed that the former improved the transmission of information.

Aftercare in patients with Cushing's disease and acromegaly: is there room for improvement?

PURPOSE: Evaluation of aftercare, medical therapy and remission rate for Cushing's disease (CD) and acromegaly (AC). METHODS: Fifty-eight CD and 83 AC patients operated on over 10 years were carefully evaluated. The patients received a disease-related questionnaire and were invited for a follow-up at the outpatient clinic of the Department of Neurosurgery. Thirty-three CD and 52 AC patients returned the questionnaire; 25 CD and 37 AC patients participated personally. CD patients underwent a dexamethasone suppression test, and IGF-1 levels were assessed in AC patients. Data on postoperative therapy were assessed. RESULTS: 84.8% of those with CD and 75.0% of those with AC had been followed by endocrinologists; 9.1% of CD and 1.9% of AC patients had been under no aftercare; 96% of CD patients were in remission. A recurrence occurred in four patients, two were newly detected by our study. IGF-1 was postoperatively normalized in 25 of 37 AC patients (67.6%). Twenty patients remained in remission, five relapsed. One patient received medical therapy upon recurrence and presented normal IGF-1; four patients with relapse had not been treated yet. Ten of 12 patients with elevated early postoperative IGF-1 received medical therapy that was commenced within 6 months in nine cases. The mean duration of medical therapy was 36 months (range 2-92). IGF-1 was still elevated at the last follow-up in eight of these ten patients, all of them receiving monotherapy. In four patients, the dose had been increased once. CONCLUSIONS: The postoperative transfer back to the endocrinologist after operative treatment is achieved well in both groups. In uncured AC, medical therapy is initiated early, but options of therapy offer room for improvement. Therapy of recurrence is delayed in both pathologies.

Radiological reports: a comparison between the transmission efficiency of information in free text and in structured reports

Introduction: This work proposes to improve the transmission of information between requiring physicians and radiologists. Objectives: Evaluate the implementation of a structured report (SR) in a university hospital. Methods: A model of a structured report for thyroid sonography was developed according to information gathered from radiologists and endocrinologists working in this field. The report was based on a web platform and installed as a part of a Radiological Information System (RIS) and a Hospital Information System (HIS). The time for the report generation under the two forms was evaluated over a four-month period, two months for each method. After this period, radiologists and requiring physicians were questioned about the two methods of reporting. Results: For free text, 98 sonograms were reported to have thyroids with nodules in an average time of 8.71 (+/-4.11) minutes, and 59 sonograms of thyroids without nodules were reported in an average time of 4.54 (+/- 3.97) minutes. For SR, 73 sonograms in an average time of 6.08 (+/-3.8) minutes for thyroids with nodules and 3.67 (+/-2.51) minutes for thyroids without nodules. Most of the radiologists (76.2 percent) preferred the SR, as originally created or with suggested changes. Among endocrinologists, 80 percent preferred the SR. Discussion: From the requiring physicians' perspective, the SR enabled standardization and improved information transmission. This information is valuable because physicians need reports prepared by radiologists. Conclusions: The implementation of a SR in a university hospital, under an RIS/HIS system, was viable. Radiologists and endocrinologists preferred the SR when compared to free text, and both agreed that the former improved the transmission of information.

A questionnaire survey on the management of Graves' orbitopathy in Europe.

OBJECTIVE: To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe. DESIGN AND METHODS: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians. RESULTS: A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P<0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P<0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P<0.05) and surgical decompression (from 20.9 to 52.9%, P<0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P<0.01). CONCLUSION: Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.

A workshop on pubertal hormone replacement options in the United States.

BACKGROUND: The optimal pubertal hormone replacement therapy in females and males is unclear. OBJECTIVE: To review hormone replacement options for hypogonadal teenagers and to determine the relevant attitudes and practices of pediatric endocrinologists in the United States. DESIGN/METHODS: A workshop on pubertal hormone replacement options was held during the Lawson Wilkins Pediatric Endocrine Society meeting in 2004. A questionnaire was distributed to investigate the audience's attitudes and practices in inducing puberty. RESULTS: The majority of respondents used conjugated estrogens to treat hypogonadal girls with the primary aim of treatment being attainment of maximal adult height. The majority of respondents used depot testosterone to treat hypogonadal boys with the primary aim of treatment being pubertal development and virilization. CONCLUSIONS: The use of physiological sex hormone replacement to optimize the induction of puberty in hypogonadal adolescents was recommended. The workshop revealed striking differences between US and European pediatric endocrinologists regarding their practices and attitudes regarding the induction of puberty in hypogonadal females. Detailed studies are necessary to develop more uniform guidelines.

Effective and accurate screening for diabetic retinopathy using a 60 degree mydriatic fundus camera.

UNLABELLED: OBJECTIVES. To establish whether an experienced endocrinologist could screen accurately for diabetic retinopathy using mydriatic 60 degree fundus photographs compared with a reference standard, viz. the combined highest scores of two experienced ophthalmologists. DESIGN: Retrospective review of 60 degree colour transparency photographs taken over a 6-year period. Retinopathy was graded in a standardised way. SETTING: Patients attending the diabetic clinic at Johannesburg Hospital, South Africa. SUBJECTS: Fifteen hundred and seventeen patients (2446 eyes) formed the basis for the study. Patients were included if there was more than 50% readability of the fundus photographs. OUTCOME MEASURES: Outcome measures were prevalence of any retinopathy and presence of referable (severe) retinopathy. Interobserver agreement was measured using the kappa statistic, and sensitivity and specificity of the screener were evaluated. RESULTS: The prevalence of retinopathy at the clinic was approximately 30%, but only about 12% was severe enough to warrant referral to the ophthalmology outpatient department. The endocrinologist was very accurate in determining cases requiring referral; there was 97% agreement with the reference standard, viz. the combined highest score of two experienced ophthalmologists (gold standard). Correlation on the determination of any retinopathy was less accurate (80% agreement), mostly owing to the endocrinologist reporting more isolated microaneurysms than the ophthalmologists. The screening method used gave a sensitivity of 83% and specificity of 99% which are within recommended standards. CONCLUSIONS: The screening strategy using a mydriatic fundus camera at the diabetic clinic was found to be effective and accurate and greatly reduced the number of possible referrals to the ophthalmology outpatient department.

Who performs endocrine operations in the United States?

BACKGROUND: Endocrine surgery is a discipline that is dedicated to high-quality care of patients with endocrine surgical disease. The relationship between its "identity" as a separate field and clinical practice patterns is not known. METHODS: The National Inpatient Sample was searched by the International Classification of Diseases-9th revision-Clinical Modification codes for parathyroidectomy, thyroidectomy, and adrenalectomy for the years 1988 through 2000. The surgeons who performed these operations were profiled by 2 methods: Method A, by the percentage of the total primary International Classification of Diseases-9th revision-Clinical Modification procedure codes that were the selected endocrine procedures; method B, by absolute number of index endocrine procedures performed per year. Only patients with complete coding data for the surgeons were included. RESULTS: In this sample, surgeons whose practice was comprised of 25% or less of these endocrine procedures performed 11,071 parathyroidectomies (78% of total), 46,210 thyroidectomies (82% of total), and 4209 adrenalectomies (94% of total). In contrast, surgeons whose practice was comprised of more than 75% of these endocrine procedures performed 769 parathyroidectomies (5% of total), 1560 thyroidectomies (3% of total), and 128 adrenalectomies (3% of total). CONCLUSION: If these data can be extrapolated to indicate generalized practice patterns, the majority of common operations for endocrine disease are performed by surgeons whose practice is not focused on endocrine surgery. However, much of this effect is due to the fact that non-endocrine surgeons far outnumber endocrine surgeons. This understanding of clinical practice patterns will be important to consider during future studies that seek to determine the relationship between surgeon volume and patient outcomes.

The management of subclinical hyperthyroidism by thyroid specialists.

Subclinical hyperthyroidism is a relatively common condition for which prospectively derived evidenced-based management guidelines do not exist. We have conducted a case-based mail survey to solicit opinions from members of the American Thyroid Association (ATA) about various issues that arise in the management of patients with this disorder. The survey was completed and returned by 185 of 300 (62%) of the original survey recipients. Four hypothetical cases varying in age, thyrotropin (TSH) level and underlying etiology were presented. The majority of respondents recommended further evaluation of all cases, most commonly choosing a radioactive iodine uptake (42%-71%), thyroid scan (39%-68%) and antithyroid (TPO/Tg) antibodies (49%-55%) as the additional tests to be ordered. The large majority (84%) recommended observation rather than active treatment for a young patient with a low but detectable serum TSH level. A small majority also recommended observation alone for a young woman with an undetectable serum TSH level (58%) and for an older woman with a low but detectable serum TSH value (63%). However, the majority (66%) favored treating an older woman with an undetectable serum TSH. When treatment was advised in the patients with subclinical hyperthyroidism, the respondents strongly favored anti-thyroid drugs when the etiology was Graves' disease and radioactive iodine when the etiology was toxic nodular thyroid disease. In the absence of adequate evidence-based guidelines, it is hoped that this survey of expert opinions may provide useful guidance for physicians providing care for patients with subclinical hyperthyroidism.