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Pregnancy can exacerbate endocrinopathies and obscure their diagnosis in patients with parathyroid or thyroid disease. A large, population-based study published in Archives of Surgery demonstrates that pregnant women carry an increased risk of surgical complications, longer hospitalization and higher costs from parathyroid and thyroid surgery than nonpregnant patients.
Long-term adverse consequences of excess circulating glucocorticoids are gaining increasing recognition. The results of a study in children with endogenous Cushing syndrome now show that hypertension can persist even in remission, and raise important issues for the long-term management of these children's health, and potentially for the many children treated with glucocorticoids.
Agranulocytosis is the most severe adverse effect of antithyroid drug therapy. The findings of a novel study from Japan suggest that this complication occurs more frequently if higher rather than lower starting doses of the thionamide drug methimazole are prescribed. Has the time come to reassess current therapy regimens?
Screening of patients with paraganglioma revealed a high prevalence of germ line mutations in genes encoding subunits of the succinate dehydrogenase complex, according to a new study. Should gene testing become a routine part of the clinical management of patients with paraganglioma?
This review discusses newly recommended screening approaches for childhood acute malnutrition in low-income settings, using mid-upper arm circumference or weight for height Z-score and inspection for presence of bipedal edema. A treatment algorithm is provided to guide management of children with severe acute malnutrition and systemic complications who require inpatient therapy and for those with uncomplicated severe or moderate acute malnutrition who can be treated in the community using recently developed ready-to-use-therapeutic foods or other appropriately designed food blends.
Early foundations of the metabolic syndrome may be laid as a consequence of changes in dietary supply to the rapidly growing fetus and/or postnatal offspring. This review highlights fetal developmental plasticity in cellular homeostasis that may manifest in adult life as the metabolic syndrome particularly if followed by a period of accelerated postnatal growth.
Regulation of systemic phosphate homeostasis is strictly controlled by a limited number of factors, including FGF23 (a bone-derived protein) and Klotho (a membrane-bound protein). Dysregulation of FGF23 and Klotho is associated with altered phosphate turnover in several acquired and genetic human diseases. The endocrine effects of the FGF23–Klotho axis in normal physiology and disease are described by the author of this Review.
Estrogen therapy can reduce cognitive decline in aging women. However, the beneficial effects of estrogen on cognition are apparent only when treatment is initiated around the time of menopause; the same effect is not detected when estrogen therapy is started years later. The 'critical period' hypothesis attempts to explain this discrepancy. Here, Barbara Sherwin reviews studies in which the timing of estrogen therapy was provided and asks whether their findings support the critical period hypothesis.
Initial diagnosis of insulinoma requires demonstration of inappropriately elevated insulin levels and concurrent hypoglycemia in the absence of administration of exogenous insulin or sulphonylureas. This article presents the case of a patient with insulinoma, who presented with hypoglycemia without coinciding evident hyperinsulinemia according to current guidelines. The article details current diagnostic criteria and highlights the role of clinical judgment in the investigation and management of cases, which do not conform to an expected pattern.
The development of anti-obesity drugs has not been straightforward. With very few drugs on the market, and bad publicity related to adverse events, obesity remains a major challenge for the pharmaceutical industry. In light of past experience with endocannabinoid-system antagonists, such as rimonabant, the authors of this Perspectives article propose that a major paradigm shift in clinical practice might be necessary to justify the use of pharmacotherapy for obesity.
