Review Articles in 2011

Type 2 diabetes mellitus is one of the fastest growing public health problems. Both genetic background and environmental factors are responsible of its etiology. This Review discusses evidence of the relationship between adult and fetal exposure to common environmental endocrine disruptors and an increased risk of development of type 2 diabetes mellitus and other diseases related to insulin resistance.

Acromegaly is a rare condition, which is associated with increased morbidity and mortality, both of which can be reduced with appropriate therapy. This Review discusses the evidence for the current medical management of patients with acromegaly and outlines possible future pharmacological therapies for this patient group.

Several studies have demonstrated that reactivation of telomerase in the presence of short telomeres is one of the most common features of human cancers. This Review focuses on the alterations of the telomerase complex that are associated with cancers of the endocrine system, particularly the possible diagnostic, prognostic and therapeutic applications of telomerase.

This Review summarizes the data on medical treatment of patients with prolactinomas. In particular, the authors focus on previous findings of an association between cardiac valve disease and treatment with dopamine agonists in patients with hyperprolactinemia and on the possibility that permanent control of prolactin levels can be achieved after withdrawal from these drugs.

Systematic screening studies, performed mainly in patients with diabetes mellitus, have revealed an unexpectedly high prevalence of occult Cushing syndrome. However, a screening strategy is only justified if it is supported by enough evidence of its efficacy and if benefits will outweigh drawbacks. The authors review currently available systematic screening studies for occult Cushing syndrome and assess the indications for and against screening for this condition.

Pituitary tumors arising from differentiated hormone-expressing cells are commonly encountered, are mostly sporadic and are invariably benign. Improved understanding of the mechanisms that underlie pituitary tumorigenesis will enable development of tumor aggression markers as well as novel targeted therapies. This Review describes these mechanisms, which result in cell cycle dysregulation, signaling defects or loss of tumor suppressor factors.

Treating pregnant women with antithyroid drugs puts the fetus at risk of overtreatment and subsequent development of fetal hypothyroidism and goiter formation, which might have serious implications for the fetus. This article reviews the reported cases of fetal goiter formation and aims to clarify if and how such cases could have been prevented, and how to react when prevention has failed.

Clinical advances have made pregnancy increasingly possible for many women with pituitary adenomas. However, this achievement has been accompanied by a considerable risk to both mother and fetus. This article reviews the achievements in fertility restoration and gestational and postgestational management of patients with pituitary tumors and will point out strategies to improve both efficacy and safety of the described procedures.

Adrenocortical carcinoma is a rare heterogeneous neoplasm with an incompletely understood pathogenesis and a poor prognosis. No general consensus on the diagnostic and therapeutic measures for adrenocortical carcinoma exists, but collaborative efforts have substantially advanced the field. This Review provides an updated approach to the patient with suspected adrenocortical carcinoma and discusses etiology, diagnosis and treatment options.

In the past decade, several society-sponsored guidelines on thyroid nodules have been published. This Review highlights essential recommendations from these guidelines. Furthermore, the article outlines the few areas of disagreement between the guidelines and discusses areas in which future research is needed.

Automated closed-loop insulin delivery, also referred to as the 'artificial pancreas', has been an important but elusive goal of diabetes treatment for many decades. This Review discusses the design of an artificial pancreas, its components and clinical results, as well as the advantages and disadvantages of different types of automated closed-loop systems and potential future advances.

New antidiabetic agents enable many patients with type 2 diabetes mellitus (T2DM) to achieve target HbA_1clevels. However, a range of factors can interfere with the ability of some patients to reach metabolic targets. This Review discusses the current therapies for patients with T2DM and assesses the relative benefits and risks of surgical treatment of overweight and obese patients with T2DM.

Transsphenoidal surgery leads to remission in 70–90% of patients with Cushing disease. However, the risk of recurrence could reach 20–25% at 10 years after surgery. This Review summarizes data on the efficacy and safety of established therapies for patients with Cushing disease and highlights agents that are being investigated as possible future therapies for patients with this condition.

G protein-coupled receptors (GPCRs) are key factors in endocrinology; studies of loss-of-function or gain-of-function mutations have contributed to our understanding of the pathophysiology of several diseases. This Review provides an update on the field of GPCR mutations and endocrine diseases and illustrates how GPCR mutations might contribute to our understanding of the diverse facets of GPCRs involved in the field of endocrinology.

This Review highlights the interindividual and intraindividual variability of TSH levels and discusses the current controversy that surrounds the appropriateness of reference ranges defined on the basis of age, race, sex and amount of iodine intake. Moreover, the current evidence on lowering or increasing the upper limit of the TSH reference interval is reviewed and the need to individualize levothyroxine treatment in patients with elevated TSH levels is discussed.

This Review summarizes the data on the pharmacology and clinical effects of five different vaptans in healthy individuals and patients with hyponatremia. It will also direct attention to certain unexplained characteristics of these drugs that may affect the use of vaptans in individual patients and offer recommendations on the use of vaptans versus the more traditional methods of treating the various types of hyponatremia.

Studies in the past few years have highlighted many extra-skeletal functions of vitamin D. Prominent amongst these is the ability of vitamin D to stimulate antibacterial activity in a diverse array of cells types. In this Review, the author discusses our new perspective on vitamin D as an immunomodulator, and the possible effect of this role in human disease.

Environmental endocrine disrupting chemicals (EDCs) perturb reproductive development and function. Recent evidence suggests that developmental EDC exposures may disrupt the sexual differentiation of reproductive neuroendocrine systems through epigenetic programming of hypothalamic gene expression. This Review discusses endocrine disruption by four prototypical EDCs: vinclozolin, diethylstilbesterol, bisphenol A and polychlorinated biphenyls, and presents evidence for epigenetic modifications and transgenerational transmission of endocrine disrupted traits to future generations.

This Review discusses the genetic, prenatal and environmental antecedents of polycystic ovary syndrome. The reproductive, metabolic, cardiovascular, psychiatric and neoplastic complications of this common condition are presented, followed by a comprehensive discussion of diagnostic and therapeutic measures.

People are now living longer with type 2 diabetes mellitus; novel complications, such as dementia, could start to emerge. This Review discusses the mechanisms thought to underlie the association between type 2 diabetes mellitus and dementia.