Reviews & Analysis

Despite remarkable progress in the diagnosis and treatment of primary adrenal insufficiency, patients still suffer from delayed diagnosis, impaired well-being and the risk of life-threatening adrenal crisis. This Case Study highlights the need to evaluate individuals with chronic hyponatremia or unexplained weight loss and lack of energy for adrenal insufficiency.

Circadian rhythms make a critical contribution to endocrine functions that involve adipose tissue at the systemic, organ and stem cell levels. This Review examines the data that link circadian biology to adipose tissue and its related metabolic organs, such as the liver and pancreas. These findings might affect clinical practice in the coming years.

The relationships between fetal cell microchimerism and human physiology and pathology represent an interesting and novel research field. This Review provides an overview of the role of fetal microchimeric cells in autoimmune and nonautoimmune diseases. Moreover, the mechanisms by which fetal cell microchimerism is believed to modulate the protection against cancer or tumor progression will be discussed, together with future research directions.

The growing incidence in thyroid cancer results mainly from the detection of small or very small papillary thyroid carcinomas. The management of patients with such small tumors represents a major clinical challenge. Could evaluation of the BRAF status of such tumors aid risk stratification and patient management?

This Review summarizes the role of reactive oxygen species and oxidative stress in diabetes mellitus and in the pathogenesis of endothelial cell dysfunction and diabetic nephropathy. Furthermore, the authors explore possible therapeutic interventions to reduce oxidative stress and endothelial cell dysfunction and retard the progression of diabetic nephropathy.

Research into ciliopathies could cast new light on endocrine signaling pathways, which might lead to the development of novel treatments for patients with obesity and type 2 diabetes mellitus. This Review discusses how research into the extremely rare Alström syndrome could provide insights into the cellular pathways that are important in insulin secretion and other endocrine functions.

Stress is a state of physiological or psychological strain caused by adverse stimuli. Prostaglandin E₂ (PGE₂), acting through its four receptor subtypes (EP1, EP2, EP3, and EP4), is involved in stress responses. This Review discusses how PGE₂orchestrates a range of stress responses via the EPs.

The treatment of testicular germ cell tumors has been called one of the success stories of modern medicine, with sustained response to treatment in >90% of cases, regardless of clinical stage. This Review discusses pathology, diagnostic procedures and treatment of testicular germ cell tumors, and highlights the importance of individual therapeutic management within a multidisciplinary approach according to the risk of short-term and long-term toxic effects.

Measurement of salivary cortisol is used in the diagnosis of hypercortisolism and hypocortisolism. A new study by Perogamvros et al. suggests that measuring salivary cortisone, the inactive metabolite of cortisol, may be clinically useful under certain circumstances. But does analysis of salivary cortisone levels really provide an advantage over the assessment of salivary cortisol?

A recent study has shown that the diagnosis of new-onset type 2 diabetes mellitus is associated with a substantial risk of developing chronic liver disease. Should screening for liver disorders be part of the routine evaluation of patients with type 2 diabetes mellitus?

Rosiglitazone is the second of the marketed thiazolidinediones to fall from grace, and its demise bears an uncanny resemblance to the earlier downfall of troglitazone. Both narratives demonstrate the inadequacy of a regulatory system that is mandated to place a higher value on commercial secrecy than on patient safety.

The Endocrine Society's recent Scientific Statement on postmenopausal hormone therapy highlights the dangers of calculating risks and benefits associated with hormone therapy for women in early menopause on the basis of evidence from previous studies. But does it provide a quantum shift in the clinician's perception of risk versus benefit from hormone therapy?

An FDA advisory panel voted against approval of the appetite-suppressing, anti-obesity drug lorcaserin in September this year. Do the findings of a recent, randomized trial of lorcaserin provide clues to the decision?

A recent report based on nationally representative data suggests that US adults are more successful at long-term weight-loss maintenance than was previously thought. Should the benefit of weight-loss programs be re-evaluated?

Pituitary stalk thickening may occur as a result of diverse causes, including neoplastic, inflammatory and infectious diseases, and may lead to central diabetes insipidus, anterior hypopituitarism and local mass effect. This report discusses the case of a patient with pituitary stalk thickening associated with Langerhans cell histiocytosis, and highlights pertinent diagnostic and management issues.

This Review describes the process of positive and negative selection of developing T cells in the thymus and the role of the autoimmune regulator (AIRE) in the presentation of tissue-restricted antigens. Furthermore, it addresses how mutations of this gene lead to the failure to eliminate autoreactive T cells, which can lead to clinical autoimmune syndromes.

Bisphosphonate-associated osteonecrosis (BON) is a rare complication that almost exclusively affects the jaws. BON has only been recognized within the past 10 years; therefore, management strategies for patients with BON are poorly defined. In this Review the authors discuss the pathobiology, diagnosis, presentation, incidence and prevalence of BON, as well as highlighting risk factors and tumor types associated with this complication.

Genetic and molecular research has improved our understanding of the mechanisms underlying lipodystrophy, a disorder characterized by complete or partial loss of adipose tissue. This Review describes the various types of lipodystrophy syndromes known to date, as well as mechanisms responsible for concomitant metabolic abnormalities, and provides a perspective on current treatment options and novel therapeutic approaches, with a focus on the adipokines leptin and adiponectin.

Congenital adrenal hyperplasia is one of the most prevalent genetic endocrine diseases. A new guideline from the Endocrine Society offers expert opinion and evidence-based recommendations on the diagnosis and management of this challenging condition.

Although decreased bone mass and osteopenia are common complications of autoimmune diseases, the mechanisms that explain the bone loss are diverse. This Review discusses the multiple faces of autoimmune-induced bone loss—from the direct destruction of bone by inflammation, as observed in rheumatoid arthritis, to the less-characterized potential perturbation of metabolic pathways that systematically control bone mass in type 1 diabetes mellitus or autoimmune thyroid diseases.