Comment in 2024

Although science is becoming ever more complex, interdisciplinary and open, the scientific publication process has largely remained static, which affects the integrity and impact of articles. At the 2023 Danish Diabetes and Endocrine Academy Postdoc Summit, we identified five aspects of this process that need attention to enable reform.

Liothyronine treatment for some patients with hypothyroidism has preoccupied academics, clinicians and patients for decades, and is a controversial topic in thyroidology. Persistent symptoms are at the heart of this discourse and, contrary to scientific evidence, liothyronine use is increasingly common. Aetiologies and interventions beyond thyroid dysregulation and pharmacological approaches must be pursued.

Exploring the glymphatic system across neurological and metabolic diseases might help us to better define the link between obesity and neurological disorders. Recent studies have identified metabolic dysfunction as a risk factor for cognitive decline and neurological disorders through disruption of the glymphatic system.

Pharmacological therapies with incretin-based ‘multi-agonists’ are rapidly advancing the therapeutic landscape for obesity. The loss of skeletal muscle mass with these potent weight-loss agents is emerging as a possible side effect. It is therefore important to determine whether multi-agonists increase the risk of sarcopenia in susceptible patients.

Mechanistic and clinical data indicate that DNA damage contributes to the pathogenesis and progression of diabetic complications. Thus, DNA damage and its signalling are entering the field of diabetology.

Gene therapy holds tremendous promise for treating a wide range of hereditary and acquired diseases by delivering exogenous therapeutic nucleotide sequences into specific cells or tissues. Recent advances support the notion that gene therapy could offer a long-term cure for diabetes mellitus, something that current conventional pharmacotherapies cannot achieve.

Thermal injuries trigger stress-induced endocrine responses that are critical for survival. With age, these responses falter, which results in an inability to combat burn-induced dysfunction and greatly increased mortality. Current knowledge about the post-burn endocrine response in older adults is sparse, which leaves therapeutic gaps for this vulnerable and expanding demographic.

Despite the mounting evidence supporting the use of intermittent fasting as a safe and effective weight loss intervention, many myths about fasting persist in popular culture. Here, we review some common beliefs about intermittent fasting that are not supported by scientific evidence.

The recent Consensus Statement on the diagnosis and management of prolactin-secreting pituitary adenomas (prolactinomas) drew attention to molecular pathogenetic mechanisms. We comment that somatic screening for SF3B1 hotspot variants in select cases might alert to aggressive tumour behaviour and prompt the timely management and intense follow up of these challenging tumours.

Current guidelines for the delay and prevention of type 2 diabetes mellitus recommend for people with prediabetes to lose at least 7% of their body weight. Here, we advocate to use glycaemic remission as a goal of prevention in people with prediabetes and those who are at high risk for type 2 diabetes mellitus.

The introduction of teprotumumab for the treatment of thyroid eye disease has dramatically improved management of this life-changing condition; however, clinical trials and experience in the clinic have revealed associated hearing abnormalities.

The First International Congress on Head and Neck Paragangliomas in 2023 launched a global initiative directed towards improving the management of head and neck paragangliomas (HNPGLs), including prevention, treatment and research. The Congress highlighted a lack of international evidence-based consensuses and guidelines for HNPGLs. The Congress will now convene triennially to foster personalized medicine and research to advance patient care.

Daily levothyroxine (LT₄) is the standard of care for the treatment of hypothyroidism; however, a small number of patients experience residual symptoms of hypothyroidism. Guidelines indicate that a trial with LT₄ and liothyronine (LT₃) could be attempted once other conditions have been addressed or excluded. Even so, currently, treatment of hypothyroidism can still be suboptimal.

Alzheimer disease has a sex bias: women are twice as likely as men to be affected. Studies have linked elevated follicle-stimulating hormone (FSH) levels to worsened Alzheimer disease pathology and cognitive decline in mice. Exploring the interaction of FSH with APOE4 has uncovered new aspects of Alzheimer disease. The therapeutic potential of FSH and gonadotropin-releasing hormone have also been highlighted.

Applying a uniform reference range across all adults for serum levels of thyroid stimulating hormone and thyroid hormones makes establishing a diagnosis of thyroid dysfunction challenging and could lead to potentially unnecessary treatment. For the results of thyroid function tests to be meaningful, the reference ranges should reflect individual variation in thyroid function.

The European Society of Endocrinology (ESE), representing 20,000 endocrinologists, is concerned about the effect of endocrine disrupting chemicals (EDCs) on endocrine health, particularly thyroid and gonadal function. The policy strategies of the ESE aim to minimize overall exposure of humans to EDCs and to stimulate funding for research at the level of the European Union.

Gonadotropin-releasing hormone is implicated in cognitive functions, and its loss is a factor in pathological brain ageing. There are similarities between these processes and the neurological and cognitive deficits observed in patients with long COVID. Here, we explore the hypothesis that neuroanatomical and transcriptomic alterations associated with long COVID could stem from this neuroendocrine perturbation.