Reviews & Analysis

Raised levels of aldosterone, but also concentrations within the normal range are associated with elevated blood pressure. The authors of this Review assess evidence for the role of aldosterone in the development and maintenance of hypertension, including experimental and clinical studies, and discuss the genetic and environmental mechanisms that underlie its effects.

The results of two independent, observational studies suggest that antidiabetic medications might have differential effects on cancer risk in patients with diabetes mellitus. Should these findings influence our approach to diabetes treatment?

Women with gestational diabetes mellitus have a substantial risk for progression to a permanent diabetic state, according to researchers in the UK. Could early identification of women at high risk for disease progression lead to improved intervention and preventative measures?

Although low-grade inflammation of adipose tissue is thought to be central to the development of insulin resistance in individuals with obesity, the underlying cause of this inflammatory state remains elusive. A new study by Kos and colleagues suggests that the glycoprotein SPARC limits adipose-tissue expansion and promotes inflammation and insulin resistance.

The incidence of type 2 amiodarone-induced thyrotoxicosis (AIT) is increasing. A new study provides evidence that glucocorticoid therapy is safe, effective and associated with prompt restoration of euthyroidism in previously untreated type 2 AIT. The outcome of initial combined glucocorticoid and thionamide therapy can also help differentiate between type 1 and type 2 AIT.

Graves ophthalmopathy is a disfiguring and often incapacitating disease that is difficult to treat. A meta-analysis has compared the efficacy and tolerability of available treatment modalities and shows, among other findings, that intravenous pulse corticosteroid therapy is the most efficacious treatment when immunosuppression is indicated.

The use of bariatric surgery for the treatment of morbid obesity has increased dramatically over the past decade, which has raised concerns about safety, efficacy and cost-effectiveness. A new study by the Longitudinal Assessment of Bariatric Surgery consortium has assessed the safety of these increasingly frequent procedures.

Type 2 diabetes mellitus is a complex disease with a heterogeneous genetic and environmental background. Three relatively infrequent polymorphisms in genes of the insulin signaling pathway modulate the risk of type 2 diabetes mellitus and cardiovascular diseases related to insulin resistance in specific subgroups of individuals. This article discusses the role of these variants and demonstrates how difficult it is to ascertain the contribution of relatively infrequent genetic variants on disease susceptibility.

Amiodarone is widely used for treating cardiac arrhythmias, but is associated with various adverse effects. This Review discusses how the treatment can affect thyroid function, leading to amiodarone-induced hypothyroidism or hyperthyroidism. It compares outcomes with dronedarone, a structurally similar anti-arrhythmic drug that does not contain iodine and may have fewer and less serious adverse effects.

Depression, anxiety and diabetes-specific distress are common and serious comorbid health problems in type 2 diabetes mellitus that often remain unrecognized and thus untreated. Widely used guidelines have therefore recommended assessments of emotional well-being in type 2 diabetes mellitus. The present Review discusses whether there is evidence to support this recommendation.

Multiple sclerosis and type 1 diabetes mellitus are seemingly very different autoimmune diseases. However, this Review discusses recent studies in genetics, epidemiology and immunology that have uncovered many features common to both disorders. Overlaps between T1DM and MS might lead to similar strategies in preventing and treating these debilitating conditions.

Long-term adverse consequences of excess circulating glucocorticoids are gaining increasing recognition. The results of a study in children with endogenous Cushing syndrome now show that hypertension can persist even in remission, and raise important issues for the long-term management of these children's health, and potentially for the many children treated with glucocorticoids.

Screening of patients with paraganglioma revealed a high prevalence of germ line mutations in genes encoding subunits of the succinate dehydrogenase complex, according to a new study. Should gene testing become a routine part of the clinical management of patients with paraganglioma?

Agranulocytosis is the most severe adverse effect of antithyroid drug therapy. The findings of a novel study from Japan suggest that this complication occurs more frequently if higher rather than lower starting doses of the thionamide drug methimazole are prescribed. Has the time come to reassess current therapy regimens?

Pregnancy can exacerbate endocrinopathies and obscure their diagnosis in patients with parathyroid or thyroid disease. A large, population-based study published in Archives of Surgery demonstrates that pregnant women carry an increased risk of surgical complications, longer hospitalization and higher costs from parathyroid and thyroid surgery than nonpregnant patients.

The development of anti-obesity drugs has not been straightforward. With very few drugs on the market, and bad publicity related to adverse events, obesity remains a major challenge for the pharmaceutical industry. In light of past experience with endocannabinoid-system antagonists, such as rimonabant, the authors of this Perspectives article propose that a major paradigm shift in clinical practice might be necessary to justify the use of pharmacotherapy for obesity.

Initial diagnosis of insulinoma requires demonstration of inappropriately elevated insulin levels and concurrent hypoglycemia in the absence of administration of exogenous insulin or sulphonylureas. This article presents the case of a patient with insulinoma, who presented with hypoglycemia without coinciding evident hyperinsulinemia according to current guidelines. The article details current diagnostic criteria and highlights the role of clinical judgment in the investigation and management of cases, which do not conform to an expected pattern.

Estrogen therapy can reduce cognitive decline in aging women. However, the beneficial effects of estrogen on cognition are apparent only when treatment is initiated around the time of menopause; the same effect is not detected when estrogen therapy is started years later. The 'critical period' hypothesis attempts to explain this discrepancy. Here, Barbara Sherwin reviews studies in which the timing of estrogen therapy was provided and asks whether their findings support the critical period hypothesis.

Regulation of systemic phosphate homeostasis is strictly controlled by a limited number of factors, including FGF23 (a bone-derived protein) and Klotho (a membrane-bound protein). Dysregulation of FGF23 and Klotho is associated with altered phosphate turnover in several acquired and genetic human diseases. The endocrine effects of the FGF23–Klotho axis in normal physiology and disease are described by the author of this Review.

The metabolic syndrome is a complex disorder that consists of an accumulation of visceral fat tissue, dyslipidemia, insulin resistance and hypertension, and can lead to type 2 diabetes mellitus and cardiovascular disease. This article reviews the mechanisms that underlie the metabolic syndrome, focusing on the role of testosterone. The potential of testosterone substitution therapy to treat patients with the metabolic syndrome is also discussed.