News & Views in 2010

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?

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?

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.

Two recent reports suggest that differences in levels of thyroid-related hormones within the euthyroid reference range can affect BMD and the risk of fracture. The mechanism by which differences in the concentration of these hormones affect bone is probably complex, and the implications for patients with bone disease remain uncertain.

Accurate testing of the integrity of the hypothalamic–pituitary–adrenal axis in children at risk of central adrenal insufficiency is difficult and a subject of debate. Findings of a new study by Di Iorgi et al. reveal the usefulness of a potential alternative to the insulin tolerance test—the glucagon stimulation test.

Various symptoms are typical of severe testosterone deficiency in young men; in aging men, however, these symptoms are nonspecific and overlap with symptoms of other prevalent disorders. A new study offers evidence-based criteria for the identification of late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level.

Evidence about the relative risks and benefits of thiazolidinediones, such as rosiglitazone and pioglitazone, for the treatment of type 2 diabetes mellitus has been inconsistent. Meta-analyses and epidemiologic reviews suggest that rosiglitazone may increase cardiovascular risk, but two randomized trials do not. A novel epidemiologic analysis has been a focal point of recent FDA deliberations on this issue.

A novel report in the Journal of Bone and Mineral Research describes the aggressiveness of primary hyperparathyroidism associated with multiple endocrine neoplasia type 1 (MEN1) syndrome on kidney and bone complications. Will these findings influence the future management of parathyroid disease in patients with MEN1 syndrome?

Surgical resection of pituitary tumors is the treatment of choice for patients with hormone-secreting tumors or those that impair vision and other neurological functions. A recent study by Grossman et al., however, found transsphenoidal surgery to be associated with increased mortality and morbidities in elderly patients, which suggests the need for careful individualized decision-making in this vulnerable population.

The THERAPY trial investigators conclude that, when pregnancy is confirmed in adequately treated women with hypothyroidism, doubling the dose of prepregnancy levothyroxine on 2 days each week safely prevents maternal hypothyroidism in the first trimester of pregnancy in most cases. Is this really the best strategy to adopt?

Controversy surrounds the importance and potential benefits (or lack thereof) of identifying and treating women whose pregnancies are complicated by gestational diabetes mellitus. A meta-analysis of five randomized, controlled trials has now demonstrated that adverse outcomes are reduced by specific treatment for gestational diabetes mellitus when compared with routine obstetrical management.

Most breast-fed and many formula-fed infants in the USA have an inadequate daily intake of vitamin D—below the amounts recommended by the American Academy of Pediatrics (AAP)—according to the results of a study by Perrine et al. The majority of infants might, therefore, need daily vitamin supplementation to meet the 2008 AAP recommendation.

Combination therapy with vitamins B₆, B₉ and B₁₂ is a therapeutic intervention to decrease levels of plasma homocysteine and the risk of cardiovascular disease. However, a recent trial found that cosupplementation with these vitamins exacerbated the decline in renal function and increased the risk of vascular disease in patients with diabetic nephropathy. Confidence in this high-dose vitamin supplement is shaken.

Case reports published over 100 years ago suggested that high-dose sodium salicylate could reduce the symptoms of type 2 diabetes mellitus, but adverse affects precluded clinical use. Now, results from the TINSAL-T2D study that used salsalate, a salicylate prodrug, provide renewed hope for NSAID treatment of type 2 diabetes mellitus.

Lowering blood pressure to normal levels, below those currently recommended, does not reduce the risk of cardiovascular disease events in patients with type 2 diabetes mellitus. Nor does treating dyslipidemia with fibrate and statin combination therapy reduce the risk of cardiovascular disease events more than treatment with statin alone.