Reviews & Analysis

This Review summarizes clinical practice for differentiated thyroid cancer, highlighting advances in therapy, including surgery and the use of radioactive iodine, as well as improved diagnostic tools and prognostic classifications. Different management strategies for patients with low-risk, intermediate-risk and high-risk differentiated thyroid cancer are discussed.

Neuroendocrine neoplasms are derived from the diffuse endocrine system and represent a spectrum of tumours with a diverse range of molecular abnormalities, functionality and anatomical locations. Here, some key advances in molecular diagnosis, functional imaging and therapeutic strategies that have been published in 2020 are discussed.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by reproductive and metabolic disturbances. Androgen excess is a hallmark of PCOS, driving many of the phenotypic features. In 2020, several findings highlight altered metabolic pathways as an underlying biological mechanism in PCOS. These findings add to our understanding of the complex interaction between metabolic homeostasis and reproduction.

Heart failure and chronic kidney disease are frequent causes of morbidity and mortality in people with type 2 diabetes mellitus. Cardiovascular outcome trials have confirmed benefits of sodium–glucose co-transporter 2 inhibitors on cardiovascular events, cardiovascular deaths, hospitalization for heart failure and renal outcomes. These benefits now extend to people with and without type 2 diabetes mellitus.

This Review examines the evidence that β-cells are active participants in the dialogue with the immune system during the development of type 1 diabetes mellitus. The authors suggest that therapies targeting β-cell health, vitality and function might prove essential, in combination with immunotherapy, to change the course of events leading to β-cell destruction.

Exposure to environmental pollutants such as endocrine-disrupting chemicals (EDCs) during critical periods of development can have long-term reproductive consequences. This Review discusses the cellular and molecular consequences of perinatal exposure EDCs with a focus on the neuroendocrine control of reproduction.

It is well established that marketing of unhealthy food is highly prevalent and has a detrimental effect on children’s eating behaviours and diet. A new study highlights how a new type of social media influencer — children themselves — is contributing to this phenomenon.

The bioactive peptides galanin, spexin and kisspeptin have a common ancestral origin. This Review summarizes the available evidence on the role of these peptides in the regulation of metabolism, pancreatic β-cell function, energy homeostasis, mood and behaviour.

Owing to the strong association of non-alcoholic fatty liver disease with obesity and cardiometabolic disease, in 2020 experts controversially proposed to rename this condition as ‘metabolic associated fatty liver disease’. Additional studies have elucidated new genetic and dietary modifiers of this disease. This knowledge is essential to improve diagnosis, risk-stratification and treatment.

The development and application of effective immunotherapies for type 1 diabetes mellitus has lagged behind our ability to identify and stage individuals in pre-clinical stages of disease. This Year in Review addresses advances in immunotherapy aimed towards prevention and our readiness to roll out screening in the broader population.

This Review summarizes current knowledge on non-classic and less common causes of hypopituitarism, such as traumatic brain injury, genetic causes, use of immune checkpoint inhibitors, autoimmune diseases and inflammatory diseases. Furthermore, emerging evidence that posterior pituitary damage can affect oxytocin secretion is highlighted.

Metabolic diseases emerged as important risk factors for severe COVID-19, but the mechanisms responsible remained unclear for some time. The severity of metabolic diseases was also associated with worse outcomes in patients with COVID-19, forcing clinicians to adjust their thinking on which patients with metabolic disease, but without COVID-19, to prioritize for treatment during and immediately after the pandemic.

U-shaped or J-shaped relationships have been demonstrated between BMI and all-cause or cardiovascular mortality. Now, a study has demonstrated the correlation of increased waist circumference, high adipose tissue mass and low adipose tissue-free mass with all-cause and cardiovascular mortality in an Asian population.

The pathophysiology of coronavirus disease 19 (COVID-19) and diabetes mellitus are interlinked, and diabetes mellitus is associated with severe COVID-19 outcomes. This Review highlights new advances in diabetes mellitus and COVID-19, considering disease mechanisms and clinical management of patients with diabetes mellitus in the ongoing pandemic.

This Review provides insight into sexual dimorphism in adipose tissue distribution and substrate metabolism in adipose tissue, skeletal muscle and liver, as well as the underlying mechanisms. The effects of these sex differences on cardiometabolic health are outlined and the potential for developing sex-specific prevention and treatment strategies is discussed.

Anabolic agents represent a novel approach to improving bone quality in people with osteoporosis. This Review discusses anabolic agents in relation to other therapeutic options for osteoporosis to help guide their clinical application in the future.

In two phase III trials, surufatinib, a novel oral tyrosine kinase inhibitor targeting immune cells and angiogenesis, was effective for treating pancreatic and extra-pancreatic neuroendocrine tumours. These findings further expand the therapeutic options for patients with gastro–entero–pancreatic, thymic and lung neuroendocrine tumours.

Disruption of the circadian system can alter microbiome communities and can perturb host metabolism leading to the metabolic syndrome. This Perspective discusses the role of intestinal microbiota in mediating the effects circadian dysrhythmia on human health.

A large fraction of patients with diabetes mellitus require insulin treatment to control glucose metabolism; however, this treatment brings risks of hypoglycaemia and provides suboptimal metabolic control. Transplantation of stem cell-derived pancreatic islet cells could be an ideal solution, which is approaching clinical translation.

This Review highlights the landmark T1DM and T2DM trials that inform the current guidelines for HbA_1c targets, which remain contentious. In addition, the Review discusses individualized HbA_1c targets, examines the limitations of HbA_1c and considers alternatives for monitoring glycaemic control.