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Alexandra Kiess Department of Pediatric Cardiology, Faculty of Medicine, Heart Center Leipzig, University of Leipzig, Strümpellstraße, Leipzig, Germany
Department of Child and Adolescent Medicine, Section of Pediatric Cardiology, University Hospital Jena, Am Klinikum, Jena, Germany

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Jessica Green Alder Hey Children's NHS Foundation Trust, Pediatric Intensive Care Unit, Eaton Road Liverpool, Great Britain

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Anja Willenberg Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics (ILM), University of Leipzig, Liebigstrasse, Leipzig, Germany

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Uta Ceglarek Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics (ILM), University of Leipzig, Liebigstrasse, Leipzig, Germany

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Ingo Dähnert Department of Pediatric Cardiology, Faculty of Medicine, Heart Center Leipzig, University of Leipzig, Strümpellstraße, Leipzig, Germany

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Wieland Kiess LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse, Leipzig, Germany
Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), University of Leipzig, Liebigstrasse, Leipzig, Germany

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Mandy Vogel LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse, Leipzig, Germany
Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), University of Leipzig, Liebigstrasse, Leipzig, Germany

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acromegaly have reported associations between growth hormone markers and cardiac markers together with cardiovascular morbidity and mortality rates. Andreassen et al. found concordant results to ours with IGF-1 levels that were inversely associated with NT

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Shota Dzemaili University of Lausanne, Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland

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Jitske Tiemensma University of California Merced, Psychological Science, Merced, CA, USA

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Richard Quinton Department of Endocrinology, Institute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom

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Nelly Pitteloud Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

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Diane Morin University of Lausanne, Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
Faculty of Nursing Science, Laval University, Québec City, Canada

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Andrew A Dwyer University of Lausanne, Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

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normative scores for the IPQ-R for the general population (i.e. healthy adults), comparisons were made to patients with acute or chronic pain ( 24 ), men with CHH ( 22 ) and patients with acromegaly ( 24 ) to provide a clinical context for these data. Age at

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L M Mongioì Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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R A Condorelli Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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S La Vignera Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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A E Calogero Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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life, HRQoL): GH deficiency (Assessment of Growth Hormone Deficiency in Adults, AGHDA) ( 18 ), acromegaly (Acromegaly Quality of Life questionnaire, AcroQoL) and Cushing’s syndrome (Cushing Quality of Life questionnaire, CushingQoL) ( 19 ). Along the

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Mikkel Andreassen Department of Endocrinology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Anders Juul Department of Growth and Reproduction, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Endocrinology, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Niels Jørgensen Department of Growth and Reproduction, Faculty of Health Science, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Patients characteristics. Numbers Primary diagnosis  Acromegaly 8  Prolactinoma 3  Mixed GH and prolactin secreting adenoma 2  Empty sella 2  Non-secreting adenoma 2

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Peter Wolf Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

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Yvonne Winhofer Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

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Martin Krššák Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

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Michael Krebs Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

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Metabolic disturbances in patients suffering from excessive production of growth hormone (GH), termed acromegaly, seem to be similar to those in the insulin resistant state, i.e. hyperglycemia, hyperinsulinemia and hypertriglyceridemia ( 63 ). Conversely

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G Giuffrida Endocrine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
PhD School of Clinical and Experimental Biomedical Sciences, University of Messina, Messina, Sicily, Italy

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F Ferraù Endocrine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
Department of Human Pathology ‘G. Barresi’, University of Messina, Messina, Sicily, Italy

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R Laudicella Nuclear Medicine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
Department of Biomorphology, University of Messina, Messina, Sicily, Italy

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O R Cotta Department of Human Pathology ‘G. Barresi’, University of Messina, Messina, Sicily, Italy

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E Messina Endocrine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy

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F Granata Department of Biomorphology, University of Messina, Messina, Sicily, Italy
Neuroradiology Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy

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F F Angileri Department of Biomorphology, University of Messina, Messina, Sicily, Italy
Neurosurgery Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy

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A Vento Nuclear Medicine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
Department of Biomorphology, University of Messina, Messina, Sicily, Italy

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A Alibrandi Department of Economics, University of Messina, Messina, Sicily, Italy

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S Baldari Nuclear Medicine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
Department of Biomorphology, University of Messina, Messina, Sicily, Italy

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S Cannavò Endocrine Unit of University Hospital ‘AOU Policlinico G. Martino’, Messina, Italy
PhD School of Clinical and Experimental Biomedical Sciences, University of Messina, Messina, Sicily, Italy
Department of Human Pathology ‘G. Barresi’, University of Messina, Messina, Sicily, Italy

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, 17 ). Three patients affected by pituitary carcinoma were treated with 90 Y-DOTATOC (2 cycles), 90 Y-DOTATATE or 177 Lu-DOTATATE (four cycles), respectively ( 13 , 14 , 16 ). The first one was affected by Nelson syndrome, the second by acromegaly

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Debra M Gordon University of the Witwatersrand (WITS) Donald Gordon Medical Centre, Parktown, Johannesburg, South Africa

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Pablo Beckers Department of Human Genetics, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Emilie Castermans Department of Human Genetics, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Sebastian J C M M Neggers Department of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands

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Liliya Rostomyan Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Vincent Bours Department of Human Genetics, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Patrick Petrossians Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Vinciane Dideberg Department of Human Genetics, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Albert Beckers Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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Adrian F Daly Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium

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. SDHB c.287G>A p.Gly96Asp Pituitary  P04 F 28 Pituitary macroadenoma (prolactinoma), resistant to dopamine agonists; neurosurgery (×2) None MEN1 c.1618C>T p.Pro540Ser  P21 M 25 Acromegaly (macroadenoma

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Karim Gariani Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and Geneva University, Geneva, Switzerland

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François R Jornayvaz Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and Geneva University, Geneva, Switzerland
Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland

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) - Pituitary gland (TSH) - Thyroid gland (free T4) - Primary hypothyroidism (thyroid disease) - Secondary hypothyroidism (pituitary (TSH) or hypothalamic disease (TRH)) Growth hormone (GH) - Pituitary gland (GH) - Ectopic secretion - Acromegaly

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Anastasia P Athanasoulia-Kaspar Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

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Matthias K Auer Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany

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Günter K Stalla Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

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Mira Jakovcevski Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany

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, pituitary tumors such as somatotropic and corticotropic adenomas resulting in hormone excess conditions such as acromegaly ( 12 , 13 ) and Cushing’s syndrome ( 13 ) have been associated with accelerated telomere shortening ( 14 , 15 ), suggesting that TL

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Veronica Kieffer
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Kate Davies University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Christine Gibson University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Morag Middleton University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Jean Munday University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Shashana Shalet University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Lisa Shepherd University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Phillip Yeoh University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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objectives. Performance appraisal. Specialist competencies The adult endocrine nurse specialist competency framework is presented in the following tables: Competency 1 : Acromegaly. Competency 2 : Benign adrenal tumours. Competency 3 : Cushing's syndrome

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