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Screening for mutations in theRETproto-oncogene has revolutionized management of multiple endocrine neoplasia type 2 (MEN2), although controversy still exists regarding the timing and extent of surgical intervention. This Viewpoint discusses the relationship between genotype and phenotype in MEN2 and describes strategies to determine the appropriate age for patients to undergo thyroidectomy.
At present, patients with hypoadrenalism are treated with hydrocortisone replacement regimens which aim to mimic the natural circadian rhythms of glucocorticoid secretion. As current knowledge regarding glucocorticoid biology increases, however, it is becoming clear that replacement therapies are nonphysiologic and could affect patients' quality of life.
Hypertension and heart failure can be treated with mineralocorticoid-receptor antagonists, although therapy is associated with an increased incidence of hyperkalemia. Data from three influential clinical trials—RALES, EPHESUS and 4E—are described and the findings discussed within the context of mineralocorticoid-receptor biology.
Gamma Knife® radiosurgery is widely used to treat patients with pituitary adenoma. Although this procedure has a high success rate, it is also associated with potential complications, including visual dysfunction. This Viewpoint considers whether the benefits of Gamma Knife®surgery outweigh the risks.
