Reviews & Analysis

An Endocrine Society-appointed task force has developed an evidence-based clinical practice guideline for the diagnosis and treatment of polycystic ovary syndrome. The guidelines provide suggestions for the management of patients with polycystic ovary syndrome and highlight many areas of uncertainty requiring further scientific efforts.

Polycystic ovary syndrome (PCOS) is frequently associated with metabolic dysfunction. A new study suggests that in women with PCOS the severity of menstrual dysfunction serves as a predictor of the presence, and possibly the degree, of insulin resistance. This finding might serve to refine the indications for metabolic screening in PCOS.

Optogenetic activation of a distinct, inhibitory pathway that connects the bed nucleus of the stria terminalis with the lateral hypothalamus leads to voracious eating in mice. This study adds yet another piece to the brain-feeding-circuit puzzle and makes use of a functional circuit-mapping technique that enables interrogation of neuronal connectivity in an unprecedented way.

Many important associations have been found between the newly discovered myokine irisin and measures of metabolic disease. However, not much is known regarding the role of irisin in human disease. Two recent reports now identify novel metabolic associations for this molecule in humans.

Alefacept, a fusion protein approved for psoriasis, has been trialled in patients with new-onset type 1 diabetes mellitus. However, the withdrawal of the drug from the US market and the unmet primary end point do not raise hope for this drug, even though some secondary end points were met and the study highlighted interesting immunological efficacy.

The increased prevalence of obesity has led to rising numbers of bariatric surgical procedures being performed annually. Postoperative metabolic improvements in glucose levels, blood pressure and lipids have led to the recognition that surgery can be a highly effective therapy for type 2 diabetes mellitus. A recent report evaluates durability of diabetes remission and metabolic improvements.

Findings from the Women's Health Initiative hormone study send the message that clinicians can feel confident prescribing menopausal hormone replacement therapy (MHT) to young menopausal women with moderate-to-severe symptoms who do not have absolute contraindications for hormone therapy. However, MHT is indicated for the alleviation of symptoms, not for chronic disease prevention.

In a carefully conducted, outstanding example of clinical research, Finkelstein et al. clearly demonstrate the physiological underpinnings for the action of testosterone and the relative roles of its androgenic and estrogenic effects on body composition and sexual function. This study has important clinical implications for testosterone replacement therapy of male hypogonadism.

Strontium ranelate, a therapeutic for osteoporosis, was thought to have a dual mode of action, simultaneously stimulating bone formation and reducing resorption. A recent study casts doubt on this explanation, suggesting instead that it has a mild suppressive effect on bone formation with little effect on bone resorption.

A recent study shows that inflammation could be the underlying factor that determines the differences in metabolic profiles between subgroups of obesity. An improved understanding and characterization of these subgroups should help to develop innovative approaches to treat obesity.

The association of type 2 diabetes mellitus with an increased risk of cardiovascular disease has been extensively documented, but the origins of this association remain largely in the realm of hypotheses. With surprisingly few insights into mechanisms of increased cardiovascular disease risk, efforts to shed new light on this important question are welcome.

An imbalance between angiogenic and antiangiogenic factors in pregnancy has been suggested as a risk factor for the subsequent development of pre-eclampsia. A new study in pregnant women with type 1 diabetes mellitus indicates that these factors may be used as predictive biomarkers for pre-eclampsia.

Despite >30 years of experience with, and marked improvements in, insulin pumps for treatment of type 1 diabetes mellitus, use of these devices in paediatrics has remained controversial. However, a recent report provides convincing new evidence of the long-term benefits of pump therapy in children and adolescents.

The unprecedented increase in the prevalence of obesity has been followed by a rapid rise in bariatric surgery. Bone has been linked with fat metabolism. Thus, if weight loss increases the risk of osteoporosis, understanding the effect bariatric surgery has on bone health is vital. Two recent articles contribute to this area of research.

In routine primary care, clinicians are slow to intensify glycaemic management in patients with type 2 diabetes mellitus (T2DM), despite access to an increasing number of therapeutic resources. This so-called clinical inertia is troubling and could explain why we are failing to meet targets for diabetes control in many patients.

New data show that fertility is possible in women who survive childhood cancer. The challenge is to identify which patients will be left infertile by cancer treatment and who might be able to conceive.

Bariatric surgery is an effective weight-loss strategy and often results in remission of type 2 diabetes mellitus (T2DM); still, how this surgery affects T2DM is unknown. A new study suggests that fibroblast growth factor 19 and bile acids are involved in remission of T2DM after bariatric surgery.

Papacleovoulou and colleagues demonstrate that maternal cholestasis during pregnancy is associated with offspring adiposity and metabolic abnormalities, both in humans and in mice. This study reinforces the overwhelming evidence of the critical role of the in utero environment as a major determinant of adult health and disease.

A recent observational study has reported that androgen deprivation therapy for prostate cancer is associated with an increased risk of acute kidney injury. As a result of limited biological plausibility and critical measured and unmeasured confounders, the reported link is more likely to be casual than causal.

A recent study has identified novel African-derived haplotypes, previously unreported in white people, which predispose to or are protective against type 1 diabetes mellitus (T1DM) in African Americans. These findings could have important implications for T1DM disease risk and prognosis assessment in African Americans.