There have been many exciting developments over the past 20 years in endocrinology and metabolism, from the recognition of new endocrine organs to the development of precision oncology for endocrine cancer and to paradigm shifts in our understanding of the pathogenesis of obesity. To celebrate the journal’s anniversary, we invited leading experts to explore the key milestones from their field over the past two decades.

Matthias Blüher considers how the obesity research landscape has changed. Advances have led to a greater understanding of the complex disease mechanisms underlying the development of obesity, with a broad range of treatment options becoming available as a result. Blüher concludes by noting that more research is needed to improve the health of people with obesity and to provide guidance on the societal changes that are required to prevent obesity.

Credit: Edward Byrne/Springer Nature Limited

Bulent Yildiz charts the changes that have occurred in the polycystic ovary syndrome (PCOS) field, highlighting how it has been redefined from a symptom-based condition to a biologically complex disorder. The past 20 years have witnessed a considerable shift in our understanding of the pathogenesis of PCOS, leading to new guidelines to standardize diagnosis and new approaches to subtyping the condition. Yildiz also highlights several papers that mark key innovations in PCOS research, which could lead to precision diagnostics, prevention and personalized care.

Laura Sterian Ward and Lucas Leite Cunha reflect on how the management of thyroid cancer has evolved. They note how the field has shifted from a surgery-centric approach to a more personalized and precise approach to treatment. Ward and Cunha highlight how thyroid oncology has benefited from technological advances, but note that more work is needed to ensure equitable access so that as many patients as possible can benefit from these advances.

John Hawley and Nolan Hoffman look at how our understanding of exercise metabolism has changed. New molecular and omics-based approaches have been instrumental in the development of the exercise metabolism field. Over the past 20 years, studies have shown that exercise has a broad range of effects on overall health, many of which are regulated by exercise-induced secretion of myokines and extracellular vesicles from skeletal muscle.

Thomas Kay and Jennifer Couper discuss 20 years of progress in the type 1 diabetes mellitus (T1DM) field. Landmark trials from the past 20 years have guided treatment goals for patients with T1DM, and there have been innumerable advances in the insulins, continuous glucose monitoring and automated insulin delivery systems being used for patient care. Advances have also taken place in approaches to delaying the onset of T1DM, with early treatment that aims to preserve endogenous insulin production. The future of T1DM research could see the development of disease-modifying drugs that prevent progression to clinical T1DM.

Patricia Ducy explores how our understanding of bone has developed, focusing on the crosstalk between bone and energy metabolism. The past 20 years have seen the recognition of bone as an endocrine organ and an increasing understanding of the role bone has in physiology. The identification of two bone-derived hormones, lipocalin 2 and osteocalcin, were key advances in this shift in understanding. Osteocalcin has a broad range of functions, including effects on liver gluconeogenesis and muscle function during exercise. Similarly, bone-derived lipocalin 2 regulates glucose tolerance, insulin production and appetite. Ducy notes that much more research is needed on the endocrine functions of bone and on what these effects could mean therapeutically.

“Nature Reviews Endocrinology is incredibly grateful to all of the authors and peer reviewers who have contributed to our coverage of these advances”

We hope that these articles, and others in this issue, give a range of perspectives on advances in the broad fields of endocrinology and metabolism. The editorial team of Nature Reviews Endocrinology is incredibly grateful to all of the authors and peer reviewers who have contributed to our coverage of these advances, and to the staff who work behind the scenes to make it all possible. It is a privilege and a pleasure to be able to be a part of Nature Reviews Endocrinology, and we look forward to continuing to help our readers keep up to date on all the latest developments.