News & Views in 2009

Researchers have randomly assigned 811 overweight adults to low-calorie diets with differing percentages of energy derived from protein, carbohydrate, and fat; participants were followed up for 2 years. All groups experienced modest weight loss and improvements in cardiac and diabetes risk factors. Does this finding mean that clinicians can finally advise their patients on the best way to lose weight?

Parathyroidectomy is curative in primary hyperparathyroidism, but elderly patients are often denied this treatment owing to concerns over operative risks and doubts over efficacy of the intervention in improving symptoms. This view is changing, however, as evidence accumulates of the efficacy and safety of the procedure in the aged.

Previous randomized, controlled studies of growth hormone supplementation in the elderly have reported body-composition improvements but no beneficial effect on strength or physical function. The findings of a new study, however, hint at a potential benefit from the treatment for elderly individuals with functional decline.

Response to medical therapy for acromegaly is highly variable, with few predictive factors available to help clinicians make informed treatment choices. Researchers in the UK now suggest that prior radiotherapy might influence an individual's response to secondary therapy with dopamine agonists or somatostatin analogs.

Aspirin is probably the most commonly used drug worldwide and has major analgesic, antipyretic and antiplatelet activities. Data from the Physicians' Health Study now suggest that regular use of low-dose aspirin might help reduce the risk of type 2 diabetes mellitus by around 14% in otherwise healthy men.

Traditional methods of male contraception, such as condoms and vasectomy, are unacceptable to many couples as they can be unreliable or the effects not easily reversed. Depot administration of male hormonal contraception could provide a safe, effective, reliable and reversible alternative, report researchers in China.

Evidence of gradual increases in serum concentration of C-peptide as pregnancy progresses in women with type 1 diabetes mellitus provides novel insight into mechanisms of β-cell failure and regeneration, and the potential role of C-peptide in diabetes mellitus and health.

The traditional view of nonclassic congenital adrenal hyperplasia is that affected individuals are not glucocorticoid-deficient. The results of a French study now cast doubts on this assumption, however, and raise important issues for classification and management of patients with this common genetic disorder.

Intensive insulin therapy to maintain tight glucose control is associated with reduced morbidity and mortality in adult patients hospitalized with critical illnesses. Can the same rationale also be applied to critically ill children admitted to the pediatric intensive-care unit?

The advent of high-throughput molecular analysis has appreciably improved the diagnostic and prognostic workup of several types of cancer. A French study now offers hope that benign and malignant adrenocortical tumors can be distinguished on the basis of distinct differences in their gene-expression profiles.

Trends in the presentation and management of insulinoma observed at the Mayo Clinic over the past 20 years have been reviewed in a new study. The findings shed light on poorly known and new findings of insulinoma and enable critical appraisal of current guidelines for the diagnosis and management of this condition.

The incidence of type 2 diabetes mellitus is rising, which increases the demand for cardiovascular prevention treatments. This situation raises an important question: should all individuals with this disorder be considered to have a high risk of cardiovascular events and be treated with preventative therapy, such as statins, or should risk-prediction regimens be used to guide therapy?

Persistent hyperglycemia increases the risk of cardiovascular events in patients with type 2 diabetes mellitus who have a history of acute myocardial infarction. Whether clinicians should target prandial glucose levels rather than basal glucose levels to reduce this excess risk is keenly debated.

Hypoglycemia is the major barrier to good glycemic control in patients with diabetes mellitus. Furthermore, randomized controlled trials have emphasized the grave risks associated with severe hypoglycemia in patients with long-standing type 2 diabetes mellitus, and hypoglycemia has also been recognized as a complication of bariatric surgery. New Endocrine Society guidelines on adult hypoglycemic disorders are, therefore, extremely pertinent.

Increases in rates of bariatric surgery are staggering, and many obese individuals who undergo such procedures are women of reproductive age. So, how does the surgery affect women's fertility and pregnancy outcomes thereafter? A new systemic review aimed to find out.

A clinical review of studies on bisphosphonate therapy for pediatric osteoporosis has revealed that they increase BMD, but whether they also improve fracture rates or functions of daily life is unclear. Can the findings of this clinical review help inform clinicians whether, when and how to use these agents in children?

Clinical investigation of enlarged, local lymph nodes after surgery for papillary thyroid carcinoma is problematic. Use of the fine-needle aspiration thyroglobulin assay could help to identify patients whose disease has progressed to lymph-node metastasis.

Pediatric obesity is a global phenomenon in danger of spiraling out of control. New guidelines from the Endocrine Society offer expert opinion on the prevention and management of this challenging health-care problem.

Controversy surrounds the skeletal consequences of altered thyroid function. According to the latest report from the Tromsø population survey, however, variations of serum TSH concentration that remain within the normal range do not greatly influence BMD.

In the past few years, new genetic risk factors for type 2 diabetes mellitus have been identified in large-scale studies of genetic associations. But can their inclusion in clinically based risk models improve disease prediction?