Reviews & Analysis

The use of growth hormone to treat children with idiopathic short stature remains an area of controversy. The author of this Viewpoint discusses the possible etiology of idiopathic short stature, the efficacy and safety of the treatment regimen, and which children with this condition should be selected for therapy.

Premature ovarian failure (POF) generally occurs before 40 years of age and is characterized by amenorrhea and follicle-stimulating hormone levels within the menopausal range. Variations in the endogenous estradiol levels can also occur. The potential risks and benefits of hormone replacement therapy for women with POF are discussed in this Viewpoint.

The prevalence of obesity in the US is increasing at a rapid rate. The author of this Viewpoint asks whether the government should introduce public health policies to address the obesity epidemic and, if so, what are the justifications for such intervention in the personal lifestyle choices of the American public?

Three broad recommendations have been made for the management of children with intersex conditions: halt all infant cosmetic genital surgery until evidence-based guidelines are available; conduct further research on the necessity of such surgery; and practice complete honesty with parents and patients. The authors discuss whether clinical practice has changed in response to these recommendations.

High serum fibroblast growth factor 23 (FGF-23) levels are associated with phosphaturia in several inherited and acquired human diseases. As FGF-23 actively regulates phosphate homeostasis, the author proposes that modulation of components of the FGF-23 signal transduction pathway might provide a novel therapeutic strategy for diseases of abnormal mineral ion metabolism.

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.