Matthias Stahl

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Summary of consensus a. All patients with GO should (Fig. 1):Be referred to specialist centers;Be encouraged to quit smoking;Receive prompt treatment in order to restore andmaintain euthyroidism.b. Patients with sight-threatening GO should be treatedwith i.v. GCs as the first-line treatment; if the responseis poor after 1–2 weeks, they should be submitted tourgent surgical decompression.c. The treatment of choice for moderate-to-severe GO isi.v. GCs (with or without OR) if the orbitopathy isactive;surgery(orbitaldecompression,squintsurgery,and/or eyelid surgery in this order) should beconsidered if the orbitopathy is inactive.d. In patients with mild GO, local measures and anexpectant strategy are sufficient in most cases, buttreatment may be justified if QoL is affectedsignificantly. In memoriam This document is dedicated to the memory of MarkPrummel (1956–2005), one of the founders ofEUGOGO, who greatly contributed to expanding ourunderstanding of clinical and therapeutic aspects of GO.

Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy.

Luigi Bartalena, Lelio Baldeschi, Alison J. Dickinson, Anja Eckstein, Pat Kendall-Taylor, Claudio Marcocci, Maarten P. Mourits, Petros Perros, Kostas Boboridis, Antonella Boschi, Nicola Curro, Chantal Daumerie, George J. Kahaly, Gerasimos Krassas, Carol M. Lane, John H. Lazarus, Michele Marino, Marco Nardi, Christopher Neoh, Jacques Orgiazzi, Simon Pearce, Aldo Pinchera, Susanne Pitz, Mario Salvi, Paolo Sivelli, Matthias Stahl, Georg von Arx, and Wilmar M. Wiersinga

Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures

Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves’ orbitopathy (GO) receiving surgery for disfiguring proptosis. Method: Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed. Results: Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 (SD 2.1) mm. After three-wall decompression the proptosis reduction was significantly greater than after two-wall decompression. Additional fat removal resulted in greater proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life (QOL) in the appearance arm of the GO-QOL questionnaire was 20.5 (SD 24.8) points. Conclusions: In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The extent of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but was rare in this series after the swinging eyelid approach.

The Role of Growth Hormone and Prolactin in Beta Cell Growth and Regeneration

Although the natural history of Type I diabetes mellitus does not support a significant regenerative capacity of the pancreatic beta cell there is, however, evidence for a substantial postnatal enlargement of the beta cell mass in both rodent and man.1,2 It was noted that the normal linear correlation between the logarithm of the body weight and the logarithm of the organ weight does not hold for the endocrine pancreas.3 As shown schematically in Figure I, the increase in the beta cell mass in the young rats lags behind that of the body weight, but catches up later in life. This may mean that the metabolic pressure on the beta cells during the rapid growth phase is not fully compensated for by a corresponding increase in the number of beta cells, which may explain the particular vulnerability of this cell type in childhood. During pregnancy there is a marked increase in the beta cell mass, which may reflect the increased demand for insulin during the considerable weight gain in the last trimester. In non-diabetic, obese humans, the islet mass is significantly greater than the islet mass of lean persons and that of obese patients with Type II diabetes.4 Thus the striking coincidence of diabetes of either type with periods of accelerated growth of the body as summarized in Table 1, may lead to speculations of a connection between the beta cell number and the susceptibility to develop diabetes. Because the growth hormone family, including prolactin and placental lactogen, are involved in many growth processes this review focuses on the possible role of these hormones in the growth and regeneration of the endocrine pancreas.5,6

Declaración de consenso del Grupo europeo sobre la orbitopatía de Graves (EUGOGO) sobre el tratamiento de la orbitopatía de Graves (OG)

LUIGI BARTALENAa, LELIO BALDESCHIb, ALISON DICKINSONc, ANJA ECKSTEINd, PAT KENDALL-TAYLORe, CLAUDIO MARCOCCIf, MAARTEN MOURITSg, PETROS PERROSh, KOSTAS BOBORIDISi, ANTONELLA BOSCHIj, NICOLA CURROk, CHANTAL DAUMERIEl, GEORGE J. KAHALYm, GERASIMOS E. KRASSASn, CAROL M. LANEo, JOHN H. LAZARUSp, MICHELE MARINOf, MARCO NARDIq, CHRISTOPHER NEOHc, JACQUES ORGIAZZIr, SIMON PEARCEs, ALDO PINCHERAf, SUSANNE PITZt, MARIO SALVIu, PAOLO SIVELLIv, MATTHIAS STAHLw, GEORG VON ARXx Y WILMAR M. WIERSINGAy