News & Views in 2016

Endocrine-disrupting chemicals (EDCs) can contribute to the development of certain disorders and are known to have a high health-care burden in some countries. A new analysis has revealed the substantial impact of EDCs on health and associated costs in the USA.

The link between mood disorders and hormonal fluctuations has long been known, but the direction of this correlation has been questioned. New research suggests that initiation of hormonal contraception leads to increased risk of first-time diagnosis of or treatment for depression over a short time frame, particularly for adolescents.

Early attempts at the reinduction of ¹³¹I uptake by redifferentiation of ¹³¹I-negative differentiated thyroid cancer (DTC) had limited success. Novel therapies targeting the pathways that restore expression of the sodium iodine symporter now offer new hope of success for redifferentiation therapy in DTCs with the BRAF^V600E mutation.

Treatment of type 2 diabetes mellitus with GLP1 receptor agonists can result in long-term glycaemic control or can fail over time, in which case insulin can be used as an alternative or as an additive treatment. New research shows that the latter is more likely to achieve glycaemic targets than the former.

In a recent study by Cosman and colleagues, romosozumab — a humanized monoclonal antibody targeting sclerostin — is shown to reduce the risk of vertebral and clinical fractures at 12 months compared with placebo. However, the low fracture risk of study participants necessitates the completion of an on-going clinical trial before romosozumab can be fully adopted into clinical practice.

In the Steno-2 trial, 160 individuals with type 2 diabetes mellitus, mostly in their 50s, were randomly assigned to multifactorial interventions or conventional care. Whereas microvascular and macrovascular complications were reduced during the 7.8 years of the trial period with intensive therapy, the observational follow-up data at 13.3 years and, now, 21 years demonstrate a benefit on mortality.

A new population-based cohort study in patients with type 2 diabetes mellitus has found that systolic blood pressure below the level currently recommended by hypertension guidelines is associated with a lower risk of cardiovascular events than the present threshold. However, whether blood pressure goals should be lowered remains contentious.

In 1998, two children with congenital adrenal insufficiency and early-onset morbid obesity were found to have causative null mutations in POMC. In a new study, therapy with the melanocortin-4 receptor agonist setmelanotide has for the first time brought hope of a normal life to patients with POMC-deficiency.

Polycystic ovary syndrome (PCOS) is associated with adverse metabolic and reproductive outcomes and guidelines recommend early diagnosis, screening and management. However, new stricter definitions of the diagnostic features of polycystic ovaries on ultrasonography might in fact exclude some women from a diagnosis of PCOS who could benefit from preventive management.

The latest report from the Childhood Cancer Survivor Study highlights the effect of cancer therapy on endocrine abnormalities over >30 years of follow up. Overall, 44% of patients had one endocrine abnormality, 16.7% had two and 6.6% had three or more. The findings highlight the need for long-term endocrine monitoring of these patients.

Adrenal incidentalomas are masses found in the adrenal glands during examination for other indications. New guidelines from the European Society of Endocrinology in collaboration with the European Network for the Study of Adrenal Tumors present evidence-based recommendations for the clinical management of these tumours following their detection in patients.

Diabetic ketoacidosis (DKA) is the leading cause of death, morbidity and excessive health-care utilization and costs in patients with type 1 diabetes mellitus; DKA is common at initial diagnosis, but uncommon thereafter. A new study has determined the risk factors for multiple DKA episodes and their relationship to the risk of death.

Recent data from surveys in the USA have shown that 37.7% of adult individuals and 17.0% of children currently have obesity, with no sign of a reduction despite federal and local obesity prevention strategies. In particular, severe obesity seems to be increasing. Obesity, therefore, remains a major public health problem that requires drastic action.

A recent study by Clayton et al. shows that overall mortality is increased for patients with Cushing disease, even in remission, but that mortality is normal if long-term remission is induced by only one pituitary surgery. These findings emphasize the importance of expert pituitary surgery.

Oral contraceptives are the mainstay of long-term PCOS treatment, but have potential adverse cardiometabolic effects. In a randomized controlled trial comparing oral contraceptive use and structured exercise in women with PCOS and overweight on a calorie-restricted diet, androgen excess was ameliorated with oral contraceptive use and structured exercise improved markers of cardiometabolic risk.

Recently, 45 international medical and scientific organizations agreed that bariatric or metabolic surgery should be included among the therapeutic interventions for people with type 2 diabetes mellitus and obesity. The endorsement of these guidelines follows findings that several surgical procedures developed for weight loss improve glycaemia more effectively than any pharmacological or lifestyle approach.

Animal models of human congenital infection are needed to understand when, how and why Zika virus (ZIKV) is transmitted to the fetus. The recent development of mouse models of ZIKV placental transmission, which results in high rates of pregnancy loss, alongside fetal brain and ocular malformations, have started to unravel the mysteries of placental infection and transmission.

Susceptibility to impaired metabolic health in relation to obesity is not necessarily mediated by overall fatness, but is largely dependent on the distribution of body fat and the ability to sufficiently expand adipose tissue depots. A recent study published in Diabetes provides genetic evidence to support the concept of a 'metabolically healthy obese' phenotype.

The sequenced genomes of individuals aged ≥80 years, who were highly educated, self-referred volunteers and with no self-reported chronic diseases were compared to young controls. In these data, healthy ageing is a distinct phenotype from exceptional longevity and genetic factors that protect against disease might be enriched in this population.

In a new estimate, the global incidence of diabetes mellitus has quadrupled since 1980 and now affects nearly as many individuals as the 'Spanish flu' pandemic of the early 20^th century. With such an increasing burden on healthcare systems, what can be done to limit the devastating impact of this disease?