Volume 8 Issue 2, February 2012

The complex relationship between pregnancy and thyroid function, and its clinical effect on mother and baby, continued to stimulate research in 2011. Key advances were made on three important issues: how long maternal thyroid function affects fetal thyroid hormone levels; whether thyroid autoimmunity affects pregnancy outcome; and the prevalence of permanent hypothyroidism after postpartum thyroiditis.

With primary aldosteronism now widely acknowledged as common and associated with both hypertension-related and non-hypertension-related pathology, research interest into its causes and consequences continues to grow. In 2011, major breakthroughs occurred in understanding the role and nature of underlying genetic disturbances and elucidating the pathophysiology of its cardiovascular sequelae.

Polycystic ovary syndrome (PCOS) is a complex genetic disease that affects approximately 7% of women of reproductive age worldwide. From novel pathways implicated in the etiology of PCOS through genome-wide association to characterization of the reproductive and metabolic changes that occur in ageing women with PCOS, the year 2011 has seen a number of studies published that highlight the intricacies of this condition.

Clinical and experimental studies suggest that early life experiences, perhaps spanning multiple generations, affect lifelong risk of metabolic dysfunction through epigenetic mechanisms. Data published in 2011 suggest that epigenetic analysis could potentially have utility as a marker of early metabolic pathology and might enable early life prophylaxis.

Over the past decade, investigators have actively searched for safer therapeutic approaches to replace or complement the use of bisphosphonates and/or parathyroid hormone, exploring both antiresorptive and osteoanabolic pathways. Besides marked progress in basic research, the year 2011 has seen several compounds for the treatment of osteoporosis enter or progress within clinical trials.

Research in 2011 regarding β-cell destruction, early immunointervention trials and development of late complications in type 1 diabetes mellitus have highlighted the heterogeneity of this disease. Patient phenotyping should be performed for the implementation of tailored therapies, especially taking into account the age at which the disease is diagnosed.

Antiresorptive therapies, such as bisphosphonates, estrogens, selective estrogen receptor modulators, calcitonin and denosumab, are used to increase bone strength in individuals with osteoporosis. However, no single antiresorptive therapy is appropriate for all patients or clearly superior to other therapies. This Review describes the advances in our understanding of antiresorptive therapies and summarizes the benefits and risks associated with various drugs with an antiresorptive effect.

This Review discusses the association between mitochondrial function and insulin sensitivity in various tissues, such as skeletal muscle, liver and heart, with a main focus on studies in humans, and addresses the effects of therapeutic strategies that affect mitochondrial function and insulin sensitivity.

Neonate screening for congenital hypothyroidism is the most successful population-based screening test in pediatrics. The purpose of this Review is to summarize the current knowledge on the etiology underlying thyroid dysgenesis and dyshormogenesis and to provide an update on the evidence concerning the diagnosis and treatment of patients with congenital hypothyroidism.

The contribution of antipsychotic medications to an increased risk of type 2 diabetes mellitus and cardiovascular disease is controversial. Despite existing guidelines and recommendations, many antipsychotic-drug-treated patients are not routinely assessed for metabolic and cardiac risk factors. This Review outlines the metabolic and cardiovascular risks of various antipsychotic medications in adults and children, defines the disparities in health care and makes recommendations for screening and monitoring of patients taking these agents.