Volume 5 Issue 9, September 2009

Intensive insulin therapy is extensively used to lower blood glucose concentrations in critically ill patients hospitalized within the intensive care unit. The discovery by the NICE-SUGAR study investigators that tight glucose control in this setting might actually increase mortality has generated considerable discussion about the wisdom of this approach.

Exposure of the fetus to low levels of thyroid hormones for extended periods during pregnancy can lead to irreversible brain damage and potential delays in neurological and behavioral development. What are the exact mechanisms behind this abnormality, and can prompt initiation of maternal iodine supplementation prevent this adverse effect?

Despite the increasing implementation of iodization programs, benign nodular thyroid disease will remain a prevalent therapeutic concern for decades. Recent research suggests that nonsurgical therapy, including radioactive iodine, radiofrequency thermal ablation and percutaneous laser ablation, might have a role in the treatment of symptomatic patients.

A question often asked by health-care providers is whether metformin has added benefits if continued after patients with type 2 diabetes mellitus switch to insulin. Beneficial effects on macrovascular end points observed in response to sustained metformin therapy argue in favor of this approach, according to new research from The Netherlands.

Uncertainty exists about the best approach to manage levothyroxine dosage in women with hypothyroidism, once they become pregnant. The etiology of an individual's hypothyroidism might be a key determinant of the optimal time and duration of dose adjustments, say the authors of a retrospective review published in the journal Thyroid.

The progressive increase in the incidence of both type 1 diabetes mellitus (T1DM) and T2DM, which is associated with changing environmental conditions, highlights overlapping clinical and pathogenetic features of these diabetes stereotypes. The article proposes that the common thread is a proinflammatory environment that activates innate immunological and inflammatory pathways, which lead to β-cell dysfunction in T2DM, insulin resistance in both T1DM and T2DM, and enhanced adaptive immunity that kills β cells in T1DM.

Congenital adrenal hyperplasia (CAH) is a disorder of cortisol biosynthesis that is usually caused by a mutation in the gene that encodes steroid 21-hydroxylase. As this abnormality can lead to fatal shock, hyponatremia and hyperkalemia in early infancy, many countries include tests for CAH in their neonatal screening program. The author of this article provides an overview of the currently used methodologies for neonatal CAH screening and discusses their efficiency, limitations and cost-effectiveness.

Currently, controversy reigns over the effects of different antidiabetic agents on cardiovascular outcomes in type 2 diabetes mellitus (T2DM). This article reviews the findings of recent cardiovascular outcome trials that assessed the safety of various glucose-lowering strategies. Multifactorial interventions to improve glycemic control, hypertension, and dyslipidemia enhance survival and reduce macrovascular events in T2DM. Insulin-sensitization regimens may be preferred in patients with T2DM who have coronary disease.

When patients treated with HMG-CoA reductase inhibitors exhibit residual risk—including low levels of high-density lipoprotein cholesterol and elevated triglycerides—adjunctive therapy with a fibric-acid derivative (i.e. fibrate) may be appropriate. However, given the prospect of statin–fibrate-associated myopathy, major factors affecting the question of which fibrate to choose in this setting have not been systematically evaluated. This article discusses available pharmacokinetic, pharmacodynamic, clinical pharmacologic, and postmarketing surveillance issues that may inform such decision making.

Knowledge of the epidemiology, natural history, diagnosis, treatment, and rates of recurrence of nonfunctioning pituitary adenomas has greatly improved over the past few years. Wass and Karavitaki now highlight some of these advances and speculate on future avenues of research. In addition, they describe their own experience in the clinical management of patients with nonfunctioning pituitary adenomas.