Reviews & Analysis

Pediatric obesity is a global phenomenon in danger of spiraling out of control. New guidelines from the Endocrine Society offer expert opinion on the prevention and management of this challenging health-care problem.

Controversy surrounds the skeletal consequences of altered thyroid function. According to the latest report from the Tromsø population survey, however, variations of serum TSH concentration that remain within the normal range do not greatly influence BMD.

Gastroparesis is a complication of diabetes mellitus that is associated with prolonged periods of suboptimal glycemic control. This article describes a patient who had diabetic gastroparesis that was unresponsive to conventional treatments. Her severe vomiting was successfully controlled by use of the antiemetic drug aprepitant for 4 months before a gastric electrical stimulation device was fitted.

Glucose control does not have a clear cardiovascular benefit in people with established, long-duration diabetes mellitus; however, it reduces the risk of diabetes-related eye disease and kidney disease, myocardial infarction and mortality in those with recent-onset diabetes mellitus. Here, the author discusses the relationship between blood glucose level and cardiovascular disease and compares the cardiovascular effects of various glucose-lowering drugs and strategies.

Sleep curtailment, which has become a common behavior in modern society, and sleep disorders, such as obstructive sleep apnea, might have detrimental effects on endocrine functions and glucose metabolism. This review discusses the role of sleep loss and poor-quality sleep in the development of obesity and diabetes mellitus, and highlights the importance of screening for sleep problems in patients with endocrine and metabolic disorders.

Carcinoid tumors are characterized by their ability to secrete hormones, such as serotonin, tachykinins and other mediators that might contribute to carcinoid syndrome. The authors of this Review describe the incidence and prevalence of carcinoid tumor related fibrosis, which is a major complication of this syndrome, and explore the role of potential causative agents.

Incretin-based drugs have several advantages over commonly used antidiabetic agents, including a glucose-dependent mechanism of action and no risk of weight gain. However, their long-term efficacy, safety and durability are yet to be established. This Review summarizes the available data on the mechanisms of action of currently used and emerging incretin-based agents.

Obesity is associated with a systemic, chronic, inflammatory response that involves the production of various cytokines, such as tumor necrosis factor and interleukins. Several interleukins, in particular IL-6 and IL-1, have been suggested to contribute to the development of insulin resistance and type 2 diabetes mellitus, by acting both on insulin signaling pathways and on pancreatic beta and alpha cells. This article provides insights into the latest findings regarding the role of these interleukins in the pathology and physiology of obesity-related insulin resistance and type 2 diabetes mellitus.

Trans fatty acids, which are largely consumed from partially hydrogenated vegetable oils, adversely affect circulating lipid and lipoprotein levels and endothelial function, trigger systemic inflammation, and might increase visceral adiposity, body weight, and insulin resistance. The authors provide an overview of these adverse effects and their relationships with clinical endpoints, with a focus on potential effects on insulin resistance and diabetes.

In the past few years, new genetic risk factors for type 2 diabetes mellitus have been identified in large-scale studies of genetic associations. But can their inclusion in clinically based risk models improve disease prediction?

A region of chromosome 9p21 is linked to an increased risk of coronary artery disease in the general population. Variants of the same allele might also affect risk of cardiovascular disease in patients with type 2 diabetes mellitus, according to a new study.

The use of aspirin for the primary prevention of cardiovascular events in patients with type 2 diabetes mellitus is controversial. According to the findings of a Japanese trial, aspirin does not reduce the risk of cardiovascular events in this group of patients, unless they are aged 65 years and above.

Autoimmune thyroiditis has increased prevalence in patients with celiac disease and vice versa. New research suggests that serum transglutaminase 2 autoantibodies, which are present in patients with celiac disease, might have a role in the development of thyroid dysfunction.

Childhood obesity is a serious public health concern. This Case Study discusses the evaluation and treatment of a child with obesity. The article details how careful assessment can exclude genetic causes of obesity in most children and outlines how children without genetic causes of the condition can benefit from individualized lifestyle modification programs.

Chronic hyperglycemia in diabetes mellitus can lead to erythropoietic stress and subsequent anemia, which might contribute to diabetes-related complications. The authors of this Review discuss the various causes of diabetes-related anemia and current guidelines on its correction, and emphasize the role of screening and monitoring for this preventable condition in patients with diabetes mellitus.

Innate immunity and inflammatory mediators have been suggested to have a much broader role in type 1 diabetes mellitus than initially assumed. Inflammation might contribute to early induction and amplification of the immune assault against pancreatic β-cells and, at later stages, to the stabilization and maintenance of insulitis. This review summarizes the latest findings that demonstrate the role of inflammation in the different phases of the course of type 1 diabetes mellitus.

Studies of common genetic variants have yielded new insights into the actions of thyroid hormones and highlighted the importance of local regulation of thyroid hormones in tissues. The authors describe genetic polymorphisms that are related to the thyroid hormone pathway and discuss the influence of these polymorphisms on various biological systems.

The discovery of human embryonic stem cells raised hopes that cell-based therapies would soon become widely available. However, ethical concerns have limited their clinical use. An alternative approach is to reprogram adult somatic cells to a pluripotent state. The pros and cons of generating pluripotent stem cells for clinical applications are discussed.

Idiopathic short stature (ISS) describes a group of conditions associated with subnormal growth in the absence of an obvious cause. ISS represents an important problem in pediatric endocrinology; however, its heterogeneous nature can make clinical management difficult. Here, the possible merits of growth-hormone therapy for children with ISS are discussed.

Oral and transdermal estrogen therapies are both routinely used to treat menopausal symptoms, but there are multiple differences between their physiological effects. The author of this Viewpoint compares the pharmacodynamics of oral and nonoral estradiol therapies, and discusses the most important risk factors to consider when using either administration route.