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Screening for mutations in theRETproto-oncogene has revolutionized management of multiple endocrine neoplasia type 2 (MEN2), although controversy still exists regarding the timing and extent of surgical intervention. This Viewpoint discusses the relationship between genotype and phenotype in MEN2 and describes strategies to determine the appropriate age for patients to undergo thyroidectomy.
At present, patients with hypoadrenalism are treated with hydrocortisone replacement regimens which aim to mimic the natural circadian rhythms of glucocorticoid secretion. As current knowledge regarding glucocorticoid biology increases, however, it is becoming clear that replacement therapies are nonphysiologic and could affect patients' quality of life.
Isoenzymes of 11[beta]-hydroxysteroid dehydrogenase affect the tissue-specific interconversion of cortisone and cortisol. In rodents, selective inhibitors of these enzymes improve insulin sensitivity, and we await clinical trials to test whether such drugs can be “magic bullets” to treat type 2 diabetes and the metabolic syndrome.
