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Diabetes and obesity are associated with pathway-selective insulin resistance in the phosphatidylinositol 3-kinase and CBL E3 ubiquitin protein ligase–(CBL)/CBL E3 ubiquitin protein ligase associated protein (CAP) signaling pathways, while insulin signaling via extracellular signal-regulated kinase (ERK) is comparatively unaffected, tipping the balance of insulin's actions so that they favor abnormal vasoreactivity, angiogenesis, and other pathways implicated in the development and progression of microvascular disease.
Hypertension and heart failure can be treated with mineralocorticoid-receptor antagonists, although therapy is associated with an increased incidence of hyperkalemia. Data from three influential clinical trials—RALES, EPHESUS and 4E—are described and the findings discussed within the context of mineralocorticoid-receptor biology.
Gamma Knife® radiosurgery is widely used to treat patients with pituitary adenoma. Although this procedure has a high success rate, it is also associated with potential complications, including visual dysfunction. This Viewpoint considers whether the benefits of Gamma Knife®surgery outweigh the risks.
