Perspectives

Medically not yet explained symptoms (MNYES) are an important consideration in patients treated for hypothyroidism who experience persistent symptoms. This Perspective brings attention to the issue of MNYES in hypothyroidism and considers effective management.

Climate change is causing human populations to be exposed to increasingly higher ambient temperatures and more frequent and extreme heatwaves than previously observed. This Perspective considers the available evidence on the endocrine effects of heat exposure, and maps out a path for future research into this field.

Nutritional imbalances (such as overnutrition in obesity) alter many properties of the neurovascular system, including neurovascular coupling and blood–brain barrier permeability. This Perspective examines how lifestyle interventions targeting weight loss, including intermittent fasting, caloric restriction and physical activity, affect the neurovascular system and neuronal networks.

Accurate measurement of adiposity and adipose tissue distribution is essential for the treatment of obesity and cardiometabolic disease, but can often prove challenging. This Perspective discusses the advantages and disadvantages of different methods of assessing adiposity in clinical settings.

Continuous glucose monitoring (CGM) is an effective tool in the management of diabetes mellitus. This Perspective discusses the potential benefits of widespread adoption of CGM in people with type 2 diabetes mellitus at different stages of disease progression and treatment intensification.

This Perspective presents the outcomes of an interdisciplinary international workshop that addressed the implications of the WHO classification change of pituitary adenoma to neuroendocrine tumours. The authors propose that a comprehensive classification system be developed integrating clinical, genetic, biochemical, radiological, pathological and molecular information for all anterior pituitary neoplasms.

An urgent need exists for technologies and devices capable of frequent and real-time insulin measurements in patients with diabetes mellitus to guide optimal insulin dosing. This Perspective discusses the advances and challenges in moving insulin assays from laboratory-based assays to frequent and continuous measurements in decentralized settings.

More genetic variants associated with type 2 diabetes mellitus are being identified. This Perspective article outlines various tools and platforms that can be applied to prioritize candidate genes associated with an increased risk of disease for functional validation.

In type 1 diabetes, the immune system destroys pancreatic β-cells but not neighbouring α-cells. Here, the authors describe the key differences between β-cells and α-cells that could account for their differential autoimmune vulnerability, and how these differences could result in the preferential endurance and survival of α-cells over β-cells.

This Perspective discusses potential approaches to managing patients in the early stages of developing type 1 diabetes mellitus, which could enable the initiation of insulin therapy to be delayed in some patients.

Studies have shown that the three pathways of regulated necrosis, namely necroptosis, pyroptosis and ferroptosis, can be therapeutically targeted. This Perspective summarizes existing data on the newly characterized cell death pathways in endocrine disorders.

Understanding mineralized tissues, such as bone and cartilage, in health and disease requires a thorough knowledge of their structures. This Perspective proposes a new imaging and characterization strategy for mineralized tissue research that utilizes focused ion beam-scanning electron microscopy.

As we approach the 30th anniversary of the 1991 Wingspread Conference on endocrine disruption, this Perspective addresses some historical points regarding the advent of the endocrine disruption field and the conceptual changes that endocrine disruption brought about.

Disruption of the circadian system can alter microbiome communities and can perturb host metabolism leading to the metabolic syndrome. This Perspective discusses the role of intestinal microbiota in mediating the effects circadian dysrhythmia on human health.

Lipoedema is a disorder characterized by the symmetrical accumulation of mechanically compliant adipose tissue in the proximal extremities. This Perspective article proposes a new mechanism for lipoedema, in which dysfunctional caveolin 1 in adipose tissue becomes uncoupled from key feedback loops with matrix metalloproteinase 14, oestrogen receptor and prospero homeobox 1.

Osteoporosis interventions are currently recommended in a small proportion of postmenopausal women, of whom ~50% will experience bone fracture. This Perspectives proposes that broader use of generic bisphosphonates would result in reductions in total fracture numbers and suggests that the current bone density definition of osteoporosis requires reappraisal.

Prediabetes phenotype can influence the effectiveness of lifestyle intervention-based diabetes prevention programmes. This Perspectives suggests that diabetes prevention programmes are not effective in individuals with isolated impaired fasting glucose and calls for further research to improve prevention of type 2 diabetes mellitus in this population.

In this Perspectives, Lean and colleagues discuss harnessing social movements to address the obesity epidemic.

Although dietary protein is crucial for human health, excessively high protein intake could have negative health consequences. This Perspective serves as a word of caution against the trend of protein-enriched diets and provides an evidence-based counterpoint that underscores the potential adverse public health consequences of high protein intake.

The COST programme funded two European Actions for the systematic elucidation of differences of sex development and congenital hypogonadotropic hypogonadism. In this Perspective article, the authors describe the achievements of these two related COST Actions and highlight the gaps in research.