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Open access

Violeta Iotova, Jerome Bertherat, George Mastorakos, Olaf Hiort, and Alberto M Pereira

Open access

Violeta Iotova, Camilla Schalin-Jäntti, Petra Bruegmann, Manuela Broesamle, Natasa Bratina, Vallo Tillmann, Olaf Hiort, and Alberto M Pereira

Objective

The European Reference Network on Rare Endocrine Conditions (Endo-ERN), operational since 2017, consists of 71 health care providers (HCPs) in 19 EU member states. Our objective was to assess education and knowledge on rare endocrine conditions.

Design and methods

A survey was developed and sent through the DIGIT-EUROSURVEY system to all Endo-ERN HCPs.

Results

Response rate was 55% (n = 146), 95% physicians, 58% >20 years of experience, 96% academics. Largest knowledge gaps were reported for the transition and neonatal ages, and for the GPs. Less than 50% of HCPs had structured educational rare diseases (RD) plans, while 86% used RD specific guidelines. HCPs would share educational materials within Endo-ERN (74%), and participate in an accreditation model (85%). E-learning portals of the endocrine scientific societies used 58% (ESPE) and 64% (ESE). Most participants (90%) regarded Endo-ERN coordinated educational activities (annual meetings slots, webinars, etc.) as highly important and supported a common educational platform. Social media was perceived as important for educating patients (86%) but not for physicians (36%). Seventy-five % had developed patient education materials; only 31% had specific children’s materials, and by-country availability varied from 0 to 100%. Respondents provided newly diagnosed patients with their own material in the national language (81%); referred to advocacy groups (68%), and relevant online sources (50%). Respondents believed the European Commission should fund education through Endo-ERN.

Conclusion

Identified knowledge gaps in rare endocrine disorders set the basis for fast catch-up through collaboration, alignment with patients’ needs, and further development of existing and newly developed educational resources.

Open access

Amir Hossein Zamanipoor Najafabadi, Merel van der Meulen, Ana Luisa Priego Zurita, S. Faisal Ahmed, Wouter R. van Furth, Evangelia Charmandari, Olaf Hiort, Alberto M Pereira, Mehul Dattani, Diana Vitali, Johan P de Graaf, and Nienke R Biermasz

Objective: The European Reference Network on Rare Endocrine Conditions (Endo-ERN) aims to organize high-quality healthcare throughout Europe, including care for pituitary adenoma patients. As surgery is the mainstay of treatment, we aimed to describe the current surgical practice and published surgical outcomes of pituitary adenoma within Endo-ERN.

Design and Methods: Systematic review and meta-analysis of studies reporting surgical outcomes of pituitary adenoma patients within Endo-ERN MTG6 Pituitary Reference Centers between 2010 and 2019. A survey was completed by Reference Centers on their current surgical practice.

Results: Eighteen out of 43 (42%) Reference Centers located in seven of the 20 (35%) MTG6 represented countries published 48 articles. Remission rates were 50% (95%CI: 42-59) for patients with acromegaly, 68% (95%CI: 60-75) for Cushing’s disease, and 53% (95%CI: 39-66%) for prolactinoma. Gross total resection was achieved in 49% (95%CI: 37-61%) of patients, visual improvement in 78% (95%CI: 68-87). Mortality, hemorrhage, and carotid injury occurred in less than 1% of patients. New onset hypopituitarism occurred in 16% (95%CI: 11-23), transient diabetes insipidus in 12% (95%CI: 6-21), permanent diabetes insipidus in 4% (95%CI: 3-6), SIADH in 9% (95%CI: 5-14), severe epistaxis in 2% (95%CI: 0-4), and CSF leak in 4% (95%CI: 2-6). Thirty-five (81%) centers completed the survey: 54% operate endoscopically, 57% together with an ENT-surgeon.

Conclusion: The results of this study could be used as a first benchmark for outcomes of pituitary adenoma surgery within Endo-ERN. However, the heterogeneity between studies in the reporting of outcomes hampers comparability, and warrants outcome collection through registries.

Open access

Luca Persani, Martine Cools, Stamatina Ioakim, S Faisal Ahmed, Silvia Andonova, Magdalena Avbelj-Stefanija, Federico Baronio, Jerome Bouligand, Hennie T Bruggenwirth, Justin H Davies, Elfride De Baere, Iveta Dzivite-Krisane, Paula Fernandez-Alvarez, Alexander Gheldof, Claudia Giavoli, Claus H Gravholt, Olaf Hiort, Paul-Martin Holterhus, Anders Juul, Csilla Krausz, Kristina Lagerstedt-Robinson, Ruth McGowan, Uta Neumann, Antonio Novelli, Xavier Peyrassol, Leonidas A Phylactou, Julia Rohayem, Philippe Touraine, Dineke Westra, Valeria Vezzoli, and Raffaella Rossetti

Differences of sex development and maturation (SDM) represent a heterogeneous puzzle of rare conditions with a large genetic component whose management and treatment could be improved by an accurate classification of underlying molecular conditions, and next-generation sequencing (NGS) should represent the most appropriate approach. Therefore, we conducted a survey dedicated to the use and potential outcomes of NGS for SDM disorders diagnosis among the 53 health care providers (HCP) of the European Reference Network for rare endocrine conditions. The response rate was 49% with a total of 26 HCPs from 13 countries. All HCPs, except 1, performed NGS investigations for SDM disorders on 6720 patients, 3764 (56%) with differences of sex development (DSD), including 811 unexplained primary ovarian insufficiency, and 2956 (44%) with congenital hypogonadotropic hypogonadism (CHH). The approaches varied from targeted analysis of custom gene panels (range: 11–490 genes) in 81.5% of cases or whole exome sequencing with the extraction of a virtual panel in the remaining cases. These analyses were performed for diagnostic purposes in 21 HCPs, supported by the National Health Systems in 16 cases. The likelihood of finding a variant ranged between 7 and 60%, mainly depending upon the number of analysed genes or criteria used for reporting, most HCPs also reporting variants of uncertain significance. These data illustrate the status of genetic diagnosis of DSD and CHH across Europe. In most countries, these analyses are performed for diagnostic purposes, yielding highly variable results, thus suggesting the need for harmonization and general improvements of NGS approaches.