Reviews & Analysis

Immune-mediated insulin resistance should be considered in patients with increasing hyperglycemia despite high-dose insulin treatment. This article illustrates the differential diagnosis of insulin resistance and describes the features and management of the type B insulin resistance syndrome.

As detailed here, the discovery of small, interfering RNA molecules and their naturally occurring counterpart, micro-RNA molecules, has greatly influenced modern research and has also given new insights into endocrine diseases. Therapeutic applications of RNA interference have now reached the stage of clinical trials.

Obesity rates are increasing alarmingly in children and infants, with predictable but devastating consequences for health. This article outlines the causes for these increases and suggests strategies to prevent and treat childhood obesity. These include a systematic approach from pediatricians and input from the family, school and community.

Thankfully, survival rates for cancer sufferers are improving all the time. One crucial issue affecting patients' quality of life is preservation or optimal enhancement of fertility, which can be compromised during treatment. This article outlines the impact of treatment, predictive markers of reproductive function and methods to prevent infertility among women.

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.

Women with Cushing's syndrome are often misdiagnosed as having polycystic ovarian syndrome. The authors highlight the importance of correctly diagnosing the two disorders and describe the clinical features and investigations that can help to distinguish them.

Replication of β cells is important in childhood expansion of β-cell mass, and offers a potential therapeutic strategy for diabetes. As discussed here, however, mechanisms of increased β-cell mass in adulthood in humans are not well understood, and the influence of mechanisms such as apoptosis might interfere with therapeutic approaches.

Although its performance-enhancing effects remain unclear, athletes are thought to be doping themselves with recombinant human growth hormone, which is banned by regulatory authorities for this context. This article describes the challenges faced in designing test methods to detect this abuse, and details the assays that are currently in use or development.

Bilateral adrenocortical hyperplasias (BAHs) are one cause of adrenocorticotropin-independent Cushing's syndrome. Until recently BAHs were relatively unknown and thought to be infrequent. This article reviews the molecular genetics of adrenocortical tumor development with an emphasis on BAHs. It also suggests a classification for BAHs that is based on their genetics and histology.

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.

Polycystic ovary syndrome adversely affects the reproductive phenotype of many women. This article describes the characteristic clinical symptoms and discusses the basis for altered reproductive physiology. It also details the ways in which androgens, estrogens, gonadotropins, insulin and obesity might interact to cause and/or perpetuate some of the manifestations of this condition.

Although it affects food intake and energy partitioning, the precise role of the various forms of ghrelin and its receptor(s) in energy balance remains unclear. As described here, its specific effects on glucose homeostasis mean that it is a potential target to prevent and treat obesity and type 2 diabetes.

The features that comprise the metabolic syndrome allow clinicians to identify people at risk of developing diabetes and cardiovascular disease. As outlined in this article, these features can affect the risk to women and men differently. In addition, several modifiers specific to women affect risk factor identification and clinical management.

Thyroid nodules are very common; however, their etiology is largely unknown. In this article the authors suggest mechanisms behind the high rates of thyroid tumors. These include the oxidative nature of thyroid hormone synthesis, which is exacerbated by iodine deficiency; this (along with other conditions) can also affect thyroid cell proliferation.

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.