Volume 5 Issue 6, June 2009

The advent of high-throughput molecular analysis has appreciably improved the diagnostic and prognostic workup of several types of cancer. A French study now offers hope that benign and malignant adrenocortical tumors can be distinguished on the basis of distinct differences in their gene-expression profiles.

Persistent hyperglycemia increases the risk of cardiovascular events in patients with type 2 diabetes mellitus who have a history of acute myocardial infarction. Whether clinicians should target prandial glucose levels rather than basal glucose levels to reduce this excess risk is keenly debated.

Trends in the presentation and management of insulinoma observed at the Mayo Clinic over the past 20 years have been reviewed in a new study. The findings shed light on poorly known and new findings of insulinoma and enable critical appraisal of current guidelines for the diagnosis and management of this condition.

The incidence of type 2 diabetes mellitus is rising, which increases the demand for cardiovascular prevention treatments. This situation raises an important question: should all individuals with this disorder be considered to have a high risk of cardiovascular events and be treated with preventative therapy, such as statins, or should risk-prediction regimens be used to guide therapy?

Obesity is associated with a systemic, chronic, inflammatory response that involves the production of various cytokines, such as tumor necrosis factor and interleukins. Several interleukins, in particular IL-6 and IL-1, have been suggested to contribute to the development of insulin resistance and type 2 diabetes mellitus, by acting both on insulin signaling pathways and on pancreatic beta and alpha cells. This article provides insights into the latest findings regarding the role of these interleukins in the pathology and physiology of obesity-related insulin resistance and type 2 diabetes mellitus.

This article provides an overview of the pathogenesis, diagnosis and management of Graves orbitopathy (GO), an inflammatory eye disease commonly associated with Graves disease. In the past few years, advances have been made regarding both the pathogenesis and the management of this condition, including an improved understanding of the role of TSH receptors and insulin-like growth factor I receptors in the development of GO, the publication of evidence-based guidelines on its diagnosis and management, and promising results from preliminary studies on novel treatment strategies.

Until recently, weight loss has been viewed as the principal determinant of success in obesity reduction. This Review details a growing body of evidence that links adoption of a healthy lifestyle (but minimal or no weight loss) with appreciable reductions in obesity, in particular abdominal obesity, and related cardiometabolic risk.

Down syndrome can be associated with major impairments in skeletal maturation and bone mass accrual, which increases the risk of fragility fractures. Here, the authors outline various endocrine and metabolic factors that could contribute to suboptimal bone health in children and adolescents with Down syndrome, review indications and limitations of bone density measurement in children and discuss available therapeutic strategies to improve bone health in such patients.

Trans fatty acids, which are largely consumed from partially hydrogenated vegetable oils, adversely affect circulating lipid and lipoprotein levels and endothelial function, trigger systemic inflammation, and might increase visceral adiposity, body weight, and insulin resistance. The authors provide an overview of these adverse effects and their relationships with clinical endpoints, with a focus on potential effects on insulin resistance and diabetes.

This article presents the case of a child with pseudohypoparathyroidism type 1a and associated endocrinopathies, namely, growth hormone deficiency, hypothyroidism, parathyroid hormone resistance and insulin resistance. The article details the natural history and management of these endocrinopathies, including the controversy over growth-hormone therapy, and potential mechanisms for insulin resistance in pseudohypoparathyroidism type 1a.