Articles in 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.

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?

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.

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.

Nonvasive imaging of insulin-producing β cells, although not currently used in clinical practice, is a useful tool that can complement information gained by other methods to assess the insulin secretory response in patients with diabetes mellitus and in people at high risk of developing this condition. This Review discusses the currently available methods for noninvasive imaging and quantification of insulin-producing β cells.

SIRT1, a mammalian sirtuin that is known to be involved in the regulation of lifespan, DNA damage response and carcinogenesis, is also likely to influence insulin action. Moreover, increasing evidence suggests that decreased SIRT1 expression or activity might contribute to the pathogenesis of insulin-resistance-related diseases. This review explores the effects of SIRT1 on adiponectin and inflammation, the role of SIRT1 in insulin signaling, and the relationship between SIRT1 and mitochondrial function, which is a potential link with insulin resistance.

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.

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.

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.