Position Statements

These statements have been prepared by members of the Endocrine Society of Australia, in collaboration with members of related societies (where relevant).  The statements are not designed to necessarily communicate with a lay audience, nor are they designed to be for patient support purposes.

These statements have the endorsement of the Council of the Endocrine Society of Australia.

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Bone health in women with Breast Cancer

Calcium and bone health

Calcium and Osteoporosis

Growth Hormone Replacement

Heavy Menstrual Bleeding

Male Hypogonadism

Secondary Fracture Prevention

Thyroxine preparations / Dessicated Thyroid

Vitamin D 

 

Bone health in women with oestrogen receptor - positive breast cancer receiving endocrine therapy

Download position statement here

 

Calcium and bone health

Download position paper

 

Calcium and Osteoporosis

The Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and Endocrine Society of Australia collectively reject the suggestion of Mr Pete Evans (reported in the Sydney Morning Herald [1] ABC [2] and on the programme Sunday Night [3] (26th March 2017) that “calcium from dairy can remove the calcium from your bones" or that calcium obtained from dairy foods can cause or contribute to osteoporosis.

Ensuring sufficient calcium intake is an important component for bone health across the entire lifespan. Dairy foods are an important and inexpensive source of calcium for many individuals, and most Australians obtain the majority of their calcium intake from dairy sources. Dairy foods also represent an important source of protein and calories for many frail older people. 

Men and women with osteopaenia or osteoporosis should be reassured and confident that a good dairy intake does not have adverse effects upon skeletal health.

Read the official response here 

Sources

[1] http://www.smh.com.au/entertainment/doctor-criticises-chef-pete-evans-for-giving-potentially-deadly-diet-advice-20160829-gr3ydb.html
[2] http://www.abc.net.au/news/2016-08-29/pete-evans-slammed-for-advice-to-osteoporosis-sufferer/7793572
[3] https://au.news.yahoo.com/sunday-night/features/a/34792906/my-kitchen-rules-judge-pete-evans-launches-attack-on-media-ama-says-he-shouldnt-dabble-in-medicine/#page1

  

Growth Hormone Replacement of Growth Hormone Deficiency in Adults

The Endocrine Society of Australia (ESA) holds the view that adults with growth hormone (GH) deficiency are not normal and have impaired health. Such patients have a characteristic clinical syndrome which includes abnormal body composition, reduced physical fitness, increased cardiovascular risk factors, osteopaenia and impaired psychological function. Based on evidence that GH replacement is beneficial, the ESA endorses the principle that adults with GH deficiency should be considered for GH replacement therapy. Such patients must be accurately diagnosed. Patients with a history of organic hypothalamic-pituitary disease exhibiting characteristics of the GH deficient syndrome and who fulfil rigorous diagnostic criteria should be considered eligible for treatment.

The ESA recommends the guidelines of the Endocrine Society for the diagnosis, treatment and monitoring of GH deficient patients on GH therapy^. 

The ESA does not support the use of GH in adults without GH deficiency.

Download Clinical Practice Guideline

^ Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 96: 1587-1609, 2011

 

Heavy Menstrual Bleeding Clinical Care Standard

Heavy menstrual bleeding is a common problem affecting 25% of women of reproductive age. It has been defined as ‘excessive menstrual blood loss which interferes with a woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms’.

Around 50% of women referred to secondary care for heavy menstrual bleeding experience severe or very severe pain, even when they do not have any uterine pathology, and many women who seek medical help do so because of disabling pain.

The range of management options for heavy menstrual bleeding has expanded and improved since the 1970s and 1980s, when rates of hysterectomy for menstrual disorders were first observed to be relatively high and to vary considerably between regions. Although hysterectomy remains an option, it is not generally recommended for first-line management unless less invasive options are unsatisfactory or are inappropriate.

The development of a Clinical Care Standard on heavy menstrual bleeding was a recommendation of the first Australian Atlas of Healthcare Variation.

The goal of the Heavy Menstrual Bleeding Clinical Care Standard is to ensure that women with heavy menstrual bleeding are offered the least invasive and most effective treatment appropriate to their clinical needs, and have the opportunity to make an informed choice from the range of treatments suitable to their individual situation.

The Heavy Menstrual Bleeding Clinical Care Standard was launched on 20 October 2017 at the Rural Medicine Australia Conference 2017 (RMA17) in Melbourne. Watch a video of the launch and panel discussion online.

You can also watch an interview with Professor Anne Duggan and Mrs Hayley Harrison filmed at RMA17 and reproduced courtesy of the Australian College of Rural and Remote Medicine.

Find the clinical standard here: https://www.safetyandquality.gov.au/our-work/clinical-care-standards/heavy-menstrual-bleeding

Download full standard

 

Male Hypogonadism

The Endocrine Society of Australia commissioned this position statement in 2015 to update its previous (2000) guidelines for testosterone prescribing and to inform the recommended management of men with androgen deficiency.

Since 2000, prescriptions of testosterone have risen dramatically in Australia and elsewhere, without any new proven indications, consistent with its use extending beyond the treatment of men with pathological hypogonadism due to pituitary or testicular disease.

Controversy has also arisen over the role of testosterone treatment in older men with medical comorbidities who have low levels of circulating testosterone, in the absence of hypothalamic, pituitary or testicular disease. There are gaps in the evidence base in relation to the potential benefits of testosterone treatment in men with obesity or type 2 diabetes and those receiving long term glucocorticoid or opioid therapy, who may exhibit low levels of circulating testosterone.

There is also ongoing debate about the risk of cardiovascular adverse events related to testosterone treatment. In 2015, in view of the rising rates of testosterone prescription, the Australian Government tightened the criteria for which testosterone therapy would be subsidised in the absence of pathological hypogonadism.

The statement is divided into two parts: 

Download Part 1

Download Part 2

 

Secondary Fracture Prevention: A Call to Action

In 2015, the Australian and New Zealand Bone and Mineral Society (ANZBMS) launched its pivotal Position Paper on Secondary Fracture Prevention, calling for radical change in how people who have suffered a fragility fracture are being managed.

Download position paper

Download ABC Story- Osteoporosis: Patients suffering unnecessary fractures due to missed diagnoses, doctors say

 

New PBS testosterone criteria

Healthy Male and the Endocrine Society of Australia have released an advisory note on the implementation of the new PBS criteria for the prescription of testosterone.

The Pharmaceutical Benefits Advisory Committee (PBAC) announced new criteria for prescription of testosterone on the Pharmaceutical Benefits Scheme (PBS). The new criteria contain two major changes to the way testosterone is prescribed on the PBS.

Download the advisory note

 

Thyroxine preparations available in Australia

For many years, two thyroxine preparations have been marketed in Australia, Oroxine and Eutroxsig (both marketed by Aspen Pharmaceuticals), available in 50, 75, 100 and 200 μg tablets. These preparations are identical, and so it has been immaterial which is dispensed to patients, and brand switching has not been problematic. A new preparation , Eltroxin (also marketed by Aspen) is now available which features a wider range of tablet strengths (25, 50, 75, 100, 125, and 200 μg) and (unlike Oroxine/Eutroxsig) does not require refrigeration. This may allow more accurate daily dosing for patients and may be more convenient.

Download full statement

Desiccated Thyroid/Thyroid Extract Position Paper

 

Vitamin D and Health in adults in Australia and New Zealand

Download position statement