Reviews & Analysis

Health-related quality of life (HRQOL) is an index of the perceived effects of disease and therapy on the individual patient. HRQOL is a multi-dimensional concept and debate continues about the utility of generic versus disease-specific questionnaires for assessing HRQOL. The authors of this Viewpoint examine the position of the health economist in HRQOL analysis.

Although diabetic ketoacidosis is considered a key clinical feature of type 1 diabetes mellitus, this phenomenon has become increasingly common in patients with type 2 diabetes mellitus. The authors of this Viewpoint examine the diagnostic criteria, precipitating causes, and pathogenesis of diabetic ketoacidosis associated with type 2 diabetes mellitus.

Limitation of caloric intake is often used to promote weight loss in overweight or obese individuals; however, this strategy can fail because of the associated increase in appetite and decrease in total daily energy expenditure. In this Viewpoint, an alternative approach to caloric restriction is discussed—the modified macronutrient diet.

Management of children with complex genital anomalies is one of the most difficult challenges a physician can face. The author of this Viewpoint argues that a multidisciplinary team of specialists—led by a pediatric endocrinologist—should be involved in the decision-making process to ensure the best possible outcome for the affected child.

The term 'andropause' is used to describe a syndrome in aging men that is characterized by symptoms of hypogonadism in the presence of low serum testosterone levels. As these changes do not occur independently of several other age-related changes, the authors discuss whether a genuine state of andropause really exists.

Hypopituitary adults with untreated growth hormone deficiency (GHD) have reduced life expectancy from cardiovascular disease. The positive effects of GH on cardiac structure and function have, therefore, been advocated in favor of GH replacement therapy for such patients. The relevance of these effects to GHD management is discussed in this Viewpoint.

Concurrent eating disorders represent one of the most challenging issues in the management of type 1 diabetes mellitus: a vicious loop of disturbed eating behaviors, reduced metabolic control, and psychological distress is associated with poor clinical outcome. The risk factors and available treatment options for concurrent eating disorders are discussed in this Viewpoint.

Functional hypothalamic amenorrhea is associated with low levels of leptin, consistent with a state of energy deprivation. The author of this Viewpoint discusses whether administration of recombinant human leptin could replace the nutrition and behavioral interventions that are currently the treatment of choice for this disorder.

Transsphenoidal surgery is the first-line treatment for non-functioning pituitary adenomas (NFPA); however, optimal management of residual tumor after surgery remains actively debated. Although dopamine agonists do not promote appreciable tumor shrinkage in NFPA, the author of this Viewpoint suggests that these agents could be used to prevent tumor re-enlargement.

Anovulatory infertility is a major problem associated with polycystic ovary syndrome; however, several treatment options are now available to induce ovulation in affected individuals. The pros and cons of these medications, which include clomifene citrate, follicle-stimulating hormone, insulin-sensitizing agents, and aromatase inhibitors, are discussed in this Viewpoint.

The insulin-sensitizing agent metformin has been heralded as a novel therapy for women with polycystic ovary syndrome-associated anovulatory infertility. The author of this Viewpoint reviews the evidence from clinical trials and asks whether metformin will become the first-line therapy for ovulation induction in polycystic ovary syndrome.

Simultaneous kidney–pancreas transplantation (SKPT) is the preferred treatment for patients with diabetes and end-stage diabetic nephropathy. Both immunologic and non-immunologic factors can affect patient outcome after SKPT. In this Viewpoint, the role of the metabolic syndrome as a risk factor for chronic renal transplant dysfunction is discussed.

Data from clinical trials have suggested that short-term treatment with estrogen (<10 years) results in a reduced incidence of breast cancer, whereas long-term treatment (>20 years) is associated with an increased risk of breast cancer. The authors of this Viewpoint describe possible mechanisms to account for these seemingly paradoxical effects.

Enrollment of children in clinical trials raises many ethical and regulatory issues, particularly when there is no prospect of direct benefit to the participant. The author of this Viewpoint discusses the US federal regulatory guidelines and asks whether they offer appropriate access and protection for all participants in pediatric diabetes research.

Traumatic brain injury (TBI) can result in hypopituitarism, which in turn affects survival and reduces quality of life. Although this problem is recognized, TBI-related pituitary dysfunction remains underdiagnosed. There is currently no consensus about which patients should be screened; however, the authors of this Viewpoint suggest that case-finding might be the most effective approach.

Growth hormone abuse is prevalent in sport because of the perceived benefits on lean muscle mass, strength, and performance. As discussed in this Viewpoint, however, inappropriate use of growth hormone might be associated with adverse effects, such as hypertension and cardiomyopathy, particularly when athletes concurrently abuse anabolic androgen steroids.

Although niacin reduces cardiovascular events in patients with type 2 diabetes mellitus or the metabolic syndrome, it is considered a reserve therapeutic agent because of adverse effects on glycemic control. The author of this Viewpoint argues, however, that the lipoprotein-altering effects of niacin might outweigh the potential hazards of niacin-mediated hyperglycemia.

Hypoglycemia-associated autonomic failure (HAAF) describes the syndromes of defective glucose regulation and hypoglycemia unawareness. Originally characterized in type 1 diabetes, the author of this Viewpoint suggests that HAAF is also a component of iatrogenic hypoglycemia in patients with type 2 diabetes, and represents a barrier to glycemic control.

Although the success rate of islet transplantation for patients with type 1 diabetes has improved, many issues still need to be resolved. In this Viewpoint, the authors highlight areas of concern, including the inefficiency of current isolation protocols and the occurrence of adverse events, and ask how the efficacy of this procedure can be enhanced.

Elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF1) in conditions such as acromegaly have been implicated in increased cardiovascular risk. The authors of this Viewpoint argue, however, that hormone deficiency might pose a greater risk than hormone excess, and ask the question—what levels of GH and IGF1 can be considered 'safe'?