Graves’ orbitopathy (GO) is an autoimmune disease affecting the orbit and the retro-ocular tissues. GO pathogenesis involves multiple complex mechanisms, including the contribution of many inflammatory cytokines, such as interleukin-6 (IL-6). GO severity ranges from mild to severe and sight-threatening cases, with the latter affecting only a small percentage of patients. A considerable number of these patients do not respond to first-line immunosuppressive therapy with weekly intravenous pulses of corticosteroids and therefore, there is an unmet need for a second-line treatment, based on immunosuppressive drugs. In recent years tocilizumab (TCZ), an IL-6 inhibitor, has emerged as an effective and safe alternative option for the treatment of active, moderate-to-severe, refractory to steroids cases of GO. This review focuses on the up-to-date concepts regarding TCZ administration for the management of these patients.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background Graves’ orbitopathy (GO) is an autoimmune disorder affecting the orbital fat and muscles. A significant role of IL-6 in the pathogenesis of GO has been described and tocilizumab (TCZ), an IL-6 inhibitor targeting IL-6R has been given in some patients. The aim of our case study was to evaluate the therapeutic outcome of TCZ in non-responders to first line treatments with corticosteroids. Methods We conducted an observational study of patients with moderate to severe GO. Twelve patients received TCZ in intravenous infusions at a dose of 8mg/kg every 28 days for 4 months and followed up for additionally 6 weeks. The primary outcome was improvement in CAS by at least 2 points, 6 weeks after the last dose of TCZ. Secondary outcomes included CAS <3 (inactive disease) 6 weeks after TCZ last dose, reduced TSI levels, proptosis reduction by > 2mm and diplopia response. Results The primary outcome, was achieved in all patients 6 weeks after treatment course. Furthermore all patients had inactive disease 6 weeks after treatment cessation. Treatment with TCZ reduced significantly median CAS by 3 units (p=0.002), TSI levels by 11.02 IU/L (p=0.006), Hertel score on the right eye by 2.3 mm (p=0.003), Hertel score on the left eye by 1.6 mm (p=0.002), while diplopia persisted in fewer patients (25%) after treatment with TCZ (not statistically significant, p=0.250). After treatment with TCZ, there was a radiological improvement in 75% of patients, while 16.7% showed no response, and in 8.3% of patients deterioration was established. Conclusion Tocilizumab appears to be a safe and cost effective therapeutic option for patients with active, corticosteroid-resistant, moderate to severe Graves’ orbitopathy.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Objectives: The rate of morbid obesity among women of reproductive age continues to rise worldwide. Surgical treatment remains the most effective mean to face it. Anatomical, physiological and nutritional modifications lead to several challenges for pregnancy after bariatric procedures. In spite of routine supplementation after bariatric surgery, vitamin and mineral deficiency frequently appear in bariatric pregnancies. The aim of this review is to summarize the existing data on the prevalence and management of nutritional deficiencies in pregnancy after bariatric surgery. Methodology: A comprehensive search of Pubmed Database was conducted for English-language studies using a list of key words. Results: The most common post-operative deficiencies in pregnancy include iron, vitamin B12, folate, vitamin D and magnesium deficiency. Less common are selenium, vitamin A, vitamin B6 and vitamin C deficiency. Finally, copper, vitamin K, vitamin B1, vitamin E and albumin deficiencies are considered to be relatively rare. Conclusions: Pregnancy after bariatric surgery has been proven to be safe for both the mother and the fetus. However, there is still the risk of significant nutritional deficiencies with adverse effects on pregnancy and lactation. As a result, a thorough customized nutritional assessment is mandatory for every woman in reproductive age who has undergone a bariatric operation, with strict regular follow-up during pregnancy and lactation.

Introduction: Parathyroid hormone (PTH) determines calcium homeostasis and may contribute to the development of postmenopausal osteoporosis as serum PTH levels and bone mineral density (BMD) seem to be inversely correlated. However, the role of PTH in the modulation and support of bone mass has not been thoroughly defined. This review focuses on PTH determinants and its effect on BMD.