下垂体性成長ホルモン分泌亢進症

The 13th Annual EndoBridge Meeting took place in Antalya, Türkiye, from October 23 to 26, 2025. Accredited by the European Council, the congress delivered a comprehensive scientific program combining state-of-the-art lectures with interactive small-group case discussions led by internationally recognized experts in endocrinology and metabolism. The meeting drew a diverse audience and provided an in-depth review of major areas within the field. Core subjects included disorders of the pituitary, thyroid, adrenal glands, and bone metabolism, as well as neuroendocrine tumors, diabetes, obesity, clinical nutrition, and lipid abnormalities. Clinical case abstracts presented in oral and poster sessions were subsequently published in JCEM Case Reports. This report highlights the principal themes and clinical insights shared during the congress. Key discussions addressed contemporary approaches to acromegaly management, therapeutic strategies for subclinical thyroid dysfunction, goal-oriented treatment models in osteoporosis, adjunctive options in type 1 diabetes management, and the evolving concept of obesity phenotyping. Additional updates covered hormonal treatment strategies for menopause and premature ovarian insufficiency, along with recent developments in male hypogonadism and infertility. Overall, the sessions reflected current advances in endocrine science while offering practical guidance for the management of common and complex endocrine disorders. The 14th Annual EndoBridge Meeting will be held in Antalya, Türkiye, from October 22 to 25, 2026.

Acromegaly is a severe endocrine disease, and growth hormone receptor antagonist B2036 constitutes the core protein backbone of pegvisomant. Conventional B2036 production based on inclusion bodies or periplasmic expression suffers from low yield, complicated refolding, and multi-step purification. Herein, we developed a highly efficient, refolding-free bioprocess for soluble expression of B2036 in Escherichia coli using SUMO fusion technology. The entire fermentation cycle was controlled within 24 h, and fermentation optimization via response surface methodology enabled a high-yield soluble yield of 0.95 g/L. For downstream processing, an industrial-scalable, affinity-tag-free strategy using only two chromatography steps (anion-exchange and mixed-mode chromatography) was established, producing 498.47 mg/L B2036 with 97.12% purity, representing a 20-fold improvement over previous reports. The obtained B2036 showed correct sequence, precise disulfide pairing, and strong biological activity with an IC₅₀ of 0.67 nmol/L. By removing protein refolding and metal-affinity chromatography, this simplified and robust workflow remarkably improves productivity and product quality, offering a cost-effective and scalable technical platform for large-scale manufacturing of pegvisomant biosimilars. Collectively, these findings provide a valuable reference for developing efficient soluble expression and downstream purification processes of other intrachain disulfide-bonded proteins in E. coli.

OBJECTIVE: To evaluate the relationship between MRI-derived proximal humeral cortical bone thickness and dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) parameters in patients with acromegaly. METHODS: This retrospective study included 22 patients with acromegaly and 20 age- and sex-matched controls. Proximal humeral cortical bone thickness (CBTavg) was measured on coronal T1-weighted MRI images as the mean of four standardized cortical measurements. Lumbar spine DXA T-scores were recorded in the acromegaly cohort. Group comparisons, Spearman correlation analyses, and exploratory receiver operating characteristic (ROC) analysis were performed. RESULTS: Mean CBTavg did not differ significantly between patients with acromegaly and controls (5.86 ± 1.83 mm vs 6.38 ± 1.33 mm, P = 0.294). Within the acromegaly cohort, CBTavg demonstrated a strong positive correlation with lumbar DXA T-scores (ρ = 0.906, p < 0.001). No significant associations were observed between CBTavg and disease duration or body mass index. Patients with active disease demonstrated lower mean CBTavg values compared with those in remission; however, this difference was not statistically significant. Exploratory ROC analysis demonstrated discriminative performance of CBTavg for identifying low BMD (AUC = 0.946). CONCLUSION: MRI-derived proximal humeral cortical thickness is associated with DXA-derived BMD parameters in acromegaly and may provide opportunistic structural information from routine MRI examinations that include the proximal humerus. However, CBTavg did not significantly differ between patients with acromegaly and healthy controls and therefore should not be interpreted as a disease-specific skeletal biomarker.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a rare condition characterized by increased cerebrospinal fluid pressure without an intracranial mass, mainly affecting overweight women of reproductive age. It commonly presents with headache, visual disturbance, and papilledema. Acromegaly is an uncommon endocrine disorder caused by a growth hormone-secreting pituitary adenoma. CASE PRESENTATION: A 24-year-old female presented to an ophthalmology clinic complaining of blurred vision and generalized headache. Clinical examination revealed coarse facial features and a deep voice, raising suspicion of an underlying endocrine disorder. Fundoscopic examination showed bilateral papilledema (grade II in the right eye, grade I in the left). Laboratory investigations showed elevated IGF-1 (508 ng/mL) and unsuppressed GH levels during an oral glucose tolerance test. Brain magnetic resonance imaging (MRI) demonstrated a 1.5 × 1.3 cm pituitary adenoma extending into the left cavernous sinus. These results led to the diagnosis of acromegaly with a pattern of raised intracranial pressure resembling IIH. Notably, headache and visual problems continued after surgery, requiring acetazolamide medication (250 mg twice daily) to control intracranial pressure. CONCLUSION: Even in the absence of optic chiasm compression, papilledema and symptoms of raised intracranial pressure can occur in patients with acromegaly. Management of IIH generally aims to reduce intracranial pressure through weight optimization, medical therapy, or surgical intervention when indicated.