Reviews & Analysis

In April 2011, the International Olympic Committee determined that women with hyperandrogenism and androgen levels above the lower limit of the male range cannot compete against other women. This attempt to implement a 'level playing field' has received much criticism. But is it justified?

Insulin resistance is a characteristic feature of type 2 diabetes mellitus. The activation of SIRT1, a deacetylase, is reported to be very beneficial for the treatment of type 2 diabetes mellitus in animal models. Recent reports reveal the mechanisms by which insulin signaling might be targeted by SIRT1.

Extensive reference data sets of pediatric bone density measurements are now available, together with equations to translate BMD into relevant Z-scores and correct for abnormal stature. So now is the right time to ask: are you thinking about bone density in children correctly?

A recent report has identified uroguanylin as an endocrine signal that exerts a physiological role in energy homeostasis, adding another factor to the gut–brain axis. From a clinical point of view, several observations highlight the uroguanylin–guanylyl cyclase C pathway as a potential therapeutic target for the development of antiobesity drugs.

Does untreated celiac disease associated with type 1 diabetes mellitus worsen microvascular outcomes? Previous studies have concluded that a gluten-free diet offers no major benefit for glycemic control, whereas Leeds and colleagues provide preliminary data to the contrary. The question awaits a long-term prospective study or a clinical trial.

Dose-response studies with patient-specific outcomes rather than surrogate measures of efficacy are needed to determine the benefits of vitamin D supplementation in the elderly. A novel study from Australia now casts doubt on the usefulness of intermittent, high-dose vitamin D supplementation as a strategy to reduce falls and fractures.

Primary aldosteronism is a common, but often overlooked, cause of arterial hypertension. Recent guidelines by the Japanese Endocrine Society should improve detection of this surgically curable disorder, but their endorsement of a 'confirmatory' test in patients with a positive aldosterone-to-renin ratio must be viewed with caution.

Health-care professionals must be educated about the existence of obese individuals who are metabolically healthy and normal-weight individuals who are metabolically unhealthy. A better understanding of obesity subgroups could provide new insights into the development of cardiovascular diseases and type 2 diabetes mellitus and help chose adequate treatments.

Glycemic control for many patients with type 2 diabetes mellitus (T2DM) is elusive, and the adverse effects of treatment, including hypoglycemia and weight gain, are partially culpable. Until recently, glycosuria has been regarded only as a consequence of T2DM, but dapagliflozin employs glycosuria as a mechanism of treatment. Will this paradigm shift gain acceptance?

A novel study by Del Mastro and colleagues suggests that the occurrence of early menopause as a consequence of chemotherapy can be reduced by triptorelin-induced temporary ovarian suppression during chemotherapy in premenopausal patients with early-stage breast cancer. But does this treatment preserve fertility, and will the benefits of continued menstrual function outweigh the risks?

Animal studies have identified endocrine disrupting chemicals as potential, albeit unproven, contributors to human disorders, especially to those with fetal origins. These disorders can be detected early if pediatricians are vigilant. Recent evidence for population-level changes in young men and girls, which involve developmental endocrine alterations, underscores the urgency for action.

Selective estrogen receptor modulators (SERMs) hold the promise of an ideal estrogenic compound. Moderate efficacy for the prevention of osteoporotic vertebral fractures has now been found after 5 years of treatment with the SERM bazedoxifene; however, expectations for one SERM to provide multiple benefits for postmenopausal women might be a pipe dream.

Diabetes mellitus has been linked to brain abnormalities and cognitive decline. A report from the Framingham Offspring Study now demonstrates that, in middle-aged and older adults, the core metabolic indicators of diabetes mellitus correlate with continuously distributed properties of brain and cognition, within a clinically normal range.

30 years have passed since the first trials of immunotherapy aimed to halt the progression of autoimmune type 1 diabetes mellitus. Today, these efforts are beginning to pay off by generating real hope. Results from recent extensive phase II and III trials lay the foundation for the design of future studies.

Thyroid nodules are frequent clinical findings, but only a small proportion is malignant. Differential diagnosis and risk stratification for thyroid malignancy is, therefore, required to avoid unnecessary surgery. Could immunostaining of two protein markers ramp up a clinician's ability to distinguish lesions that require surgical intervention from those that do not?

The increasing diversity of patient groups and rising prevalence of vitamin D deficiency highlight a pressing need for consensus-based guidance in terms of the evaluation, treatment and prevention of this condition. Following the Institute of Medicine's population-based recommendations, the Endocrine Society attempts to provide clear guidelines for clinicians but runs the risk of adding to the confusion.

A recent study of selenium supplementation in patients with mild Graves ophthalmopathy (GO) has demonstrated improvements in associated soft-tissue manifestations of the disease. The findings of this multicenter trial reveal a potential treatment option for the mild form of this vexing disease, which affects the majority of patients with GO.

Bone turnover markers are the Cinderella of osteoporosis medicine: despite their great potential, they live a life of neglect and disdain under their glamorous but wicked sister, BMD. With a new position statement, Vasikaran and colleagues are inviting Cinderella to the Prince's ball, for her true worth to be acknowledged. Will it work? Doubts are justified.

Treatment options for osteoporosis are limited for older individuals with chronic kidney disease. A secondary analysis of the FREEDOM trial sheds light on the efficacy and safety of denosumab in patients with impaired kidney function, but underlines that challenges remain in the treatment of osteoporosis in patients with severe chronic kidney disease.

Isolated studies have suggested that thyroid antibodies may signal an increased risk of miscarriage and/or preterm birth in pregnant women. A recent meta-analysis by Thangaratinam and colleagues concludes that a clear association appears evident. Less certain, however, is whether this pregnancy risk can be reduced with any treatment intervention.