Reviews & Analysis

Cyclic Cushing syndrome is a rare disorder characterized by periodic fluctuations in adrenal cortisol secretion, with phases of hypercortisolism alternating with periods of normal or low cortisol production. This Case Study discusses diagnostic challenges and treatment options in a patient with cyclic Cushing syndrome due to an ectopic pituitary adenoma.

Continuous glucose monitoring systems provide dynamic measurements of interstitial glucose levels, enabling patients with diabetes mellitus to act preemptively to reduce glycemic variability. The authors of this Viewpoint discuss the advantages of continuous glucose-monitoring systems over self-monitoring of blood glucose, as well factors that limit its availability and success.

Fine-needle aspiration cytology (FNAC) is a widely useed method for identifying malignant thyroid nodules. The main limitation of FNAC is the relatively high number of non-diagnostic specimens. The author of this Viewpoint suggests that the use of a stylet needle remarkably improves the diagnostic performance of FNAC and reduces health care costs.

Emotional stress might affect thyroid function by causing immunological perturbations and also via neural pathways. This article demonstrates a case in which both the onset of Graves disease and later exacerbations of hyperthyroidism were triggered by stressful events, and discusses management strategies for patients with stress-related Graves disease.

FDA approval of inhaled insulin offered the possibility of a new direction in diabetes care. Nonetheless, within a year of coming to market, the first inhaled insulin product was withdrawn by the manufacturer. Here, Mitri and Pittas examine the factors behind the failure of inhaled insulin to be adopted by patients and clinicians.

The gut hormone ghrelin is a putative signal of energy balance. In addition, ghrelin might act as a pleotrophic modulator of reproductive function. The experimental and clinical data that support a role for ghrelin in the hypothalamic–pituitary–gonadal axis are summarized by the author of this Review.

As genetic and imaging techniques advance, more is becoming known about the nature of various fetal disorders. Some of these disorders may be treated, with varying degrees of success, through the mother. This Review presents information particularly on fetal adrenal and thyroid disorders and discusses the various management approaches and their related risks and outcomes.

Use of the second-generation (atypical) antipsychotic agents has led to concerns about possible adverse metabolic effects, including an increased risk of diabetes mellitus. The potential mechanisms underlying treatment-emergent diabetes mellitus, and strategies for effective management of affected individuals, are explored by the author of this Viewpoint.

This article describes a patient with Cushing syndrome presumably attributable to an adrenocortical carcinoma arising from testicular adrenal rest cells. The authors discuss treatment options for adrenocorticotropic hormone-independent hypercortisolism and highlight the difficulties in determining the origin of ectopic cortisol production.

The prevalence of central hypothyroidism is unknown, but might be greater than reported. This disorder may arise from a variety of causes, from tumor-related hormonal disturbances, to mechanical problems related to traumatic brain injury, to being induced by drug therapy. This Review presents an overview of etiologies, diagnosis and management.

Aquaporin subtypes 7 and 9 have vital roles in the control of glycerol channels in adipocytes and hepatocytes, and thereby the balance between glycerol release and uptake by adipocytes and the liver, respectively. This Review discusses the pathophysiological importance of these channels in obesity and related disorders.

Cystic lesions of the pituitary region are quite common but present a challenge for diagnosis and treatment. Several types of cystic lesion are recognized, including cystic pituitary adenomas, Rathke cleft cysts, arachnoid cysts, and craniopharyngiomas. The clinical symptoms and diagnosis of these lesions, and the use of endoscopy for surgical intervention, are discussed in this Viewpoint.

Macrophages have important roles in the complex relationship between obesity, inflammation and insulin resistance that are determined by whether they are classically or alternatively activated by T-helper-1 or T-helper-2 cytokines, respectively. The former leads to insulin resistance and the latter to protection against this condition. This Review discusses this crosstalk between the immune and metabolic systems.

The prevalence of atherogenic forms of apolipoprotein B dyslipoproteinemias is high, but effective treatments are available. Quick, accurate diagnosis is, therefore, essential to providing the best care. In this Review an algorithm is proposed to help distinguish between disease subtypes, based on simple parameters that may be measured by low-cost tests widely available in clinical laboratories.

Current approaches to treat type 1 diabetes mellitus can be divided into three categories: insulin therapy, cell-based therapy and modification of the autoimmune process associated with type 1 diabetes mellitus. Comparing the benefits, risk and challenges of insulin therapy and cell-based therapy, the author of this Viewpoint discusses the prospects for these two therapeutic approaches.

Pituitary apoplexy, caused by infarction or hemorrhage within the pituitary gland, usually presents with headache, visual disturbance and decreased consciousness. The coincidence of these symptoms with those of more common medical emergencies might delay the diagnosis, as in the patient described here. The authors discuss diagnostic and management approaches for this potentially life-threatening syndrome.

A history of gestational diabetes mellitus predisposes women to the future development of type 2 diabetes mellitus. This Review discusses current guidelines for postpartum screening and how they might be implemented. In addition, the authors describe measures to prevent type 2 diabetes mellitus, focusing on lifestyle modifications, such as breast-feeding.

The global obesity epidemic is clearly driven by environmental factors; however, inherited factors can also influence human adiposity. In this Review, the authors focus on the genes implicated in monogenic obesity syndromes. These genes encode components of the leptin–melanocortin pathway, which is critical for regulation of food intake and body weight.

Although osteoporosis can be effectively treated with inhibitors of bone turnover or with bone forming agents, few data are available about an optimum approach. Here, Papapoulos and Makras discuss whether choices can be made based on the available evidence, addressing issues such as selection of patients for treatment, efficacy in lowering fracture risk and monotherapy versus combined therapy.

Treatment of thyroid cancer has not changed substantially for many years; however, few effective therapies are available for tumors that are metastatic or unable to take up radioiodine. The author of this Viewpoint, therefore, argues for the need to increase individual treatment efficacy through the introduction of novel targeted therapies.