Endocrine Abstracts

Genetic testing for RET gene was available in the United Kingdom within few years of its discovery, undoubtedly another bonus of universal, nationwide health care system. It was the beginning of Precision Medicine era, which became a watchword for preventative and personalized treatments based on phenotypic, biomarker and genetic characteristics. Surgical Precision on the other hand is an idiom for doing something very well and with meticulous attention to detail. In my presentation I will explore how “precise” surgeons should or can be when treating patients with thyroid, parathyroid and adrenal tumours caused by RET mutations. Although I will discuss the importance of somatic mutations in sporadic tumours and their impact on surgical strategies, main focus of my talk will be on centrality of germline mutations in planning treatments for patients with familial tumour syndromes. I will discuss genotype-phenotype correlations in common and rare mutations and outline how this allows us to tailor timing and extent of surgery in individual patients, with examples from my practice how this works well in most but not all cases. National UK Audit of Prophylactic Thyroidectomies in Children with MEN2 is an important source of information about ‘real world evidence” highlighting quality of treatment these children received. I will present data from years 1995-2013 (with some updates), especially in relation to timing of genetic test and surgery and their impact on histology, postoperative complications and long term follow up with calcitonin. Last part of my presentation will attempt to give insight into how surgical services deliver treatments for these patients now and how they can be improved.