EUROPEAN ENDOCRINOLOGY – VOLUME 4 ISSUE 2 – WINTER 2008

In his foreword to the previous edition of European Endocrinology, my colleague and friend Sir George Alberti recalled that a mutual friend, Paul Zimmet, had referred to the current pandemic of diabetes as a ‘tsunami’. One year later, I believe that one should reflect for a moment on the theme. We all have in mind […]

Importantly, such interventions must also have the potential to be put into clinical practice in a range of settings and to be widely disseminated to people with diabetes and their communities. These projects fall into the category of ‘translational research’: they provide the opportunity to ‘translate’ the lessons learned from clinical research into benefits – […]

IGT is defined by a plasma glucose level of 140–199mg/dl two hours following ingestion of a 75g oral solution; IFG is defined by a fasting plasma glucose value that lies between 100 and 125mg/dl.1 Estimates from the Centers for Disease Control and Prevention (CDC)2 indicate that in 1988–1994, among US adults 40–74 years of age […]

In clinical care settings this means that out of 100 patients with diabetes, approximately 11–12 meet the diagnostic criteria for clinical depression and another 20 have mild or subthreshold depression. Thus, approximately every third patient with diabetes is affected by depression or elevated depressive symptoms. The reasons for this close association between diabetes and depression […]

Recent data indicate that restoration of insulin secretion after islet cell transplantation is associated with an improvement in quality of life, with a reduction in hypoglycaemic episodes and (potentially) long-term complications of diabetes. Once clinical islet transplantation has been successfully established, this treatment could even be offered to patients with diabetes long before the onset […]

While some newly developed antidiabetes therapies such as the glucagon-like peptide-1 (GLP-1) receptor agonists have the potential to limit the rate of disease progression,4 it nevertheless follows that exogenous insulin therapy is likely to become necessary for most patients. However, insulin is often regarded as the treatment ‘of last resort’ in type 2 diabetes, and […]

As many as 80–90% of patients with type 2 diabetes are overweight, and this negatively influences the existing physiological and metabolic disorders associated with the disease. In particular, hyperglycaemia, hyperlipidaemia and hypertension2,5 can greatly increase the risk of early death.6 The development of obesity promotes insulin resistance and impaired glucose tolerance (IGT), which are major […]

For decades only insulin, sulphonylureas and metformin were available, but in the last 10 years new classes of drugs have been approved for diabetes management. These include alpha glucosidase inhibitors, thiazolidinediones, glinides, incretin-based treatments such as glucagonlike peptide-1 (GLP-1) analogues and dipeptidyl peptidase-4 (DPP-4) inhibitors. Insulin analogues have been developed, enabling easier and more physiological […]

Insulin in the Brain

In order to overcome the barriers to better health outcomes while improving the balance between patient education and pharmacotherapy, a high-level systems approach to healthcare needs to be addressed. This article will focus on the role of self-management education and its position in pharmacotherapy within the healthcare delivery systems. Barriers

This so-called ‘incretin effect’ explains why a greater amount of insulin is released in response to an oral glucose load compared with that elicited by an isoglycaemic intravenous glucose challenge,1 and in healthy subjects it accounts for up to 70% of glucose-induced insulin secretion.1 The two incretin hormones have effects on the β-cell in addition […]

A second incretin hormone was discovered showing 50% homology with glucagon, and named glucagon-like peptide-1 (GLP-1).

Left ventricular (LV) diastolic dysfunction is a common and early finding that, particularly in the presence of cardiac ischaemia, may develop into overt heart failure.6 Although DCM is a multifactorial condition, diabetes-related metabolic derangements seem to be key contributors to the observed cardiac abnormalities.5,7 This article focuses on the potential role of myocardial metabolic changes […]

Data from the INTERHEART study, a case-control study involving participants from 52 countries, also indicate that nine traditional factors may account for as much as 90% of population-attributable risk for myocardial infarction in men and 94% in women.1 However, these figures should be interpreted with care and considered as rough estimates of a preventative potential […]

Improved understanding of the aetiology and pathogenesis of these complications is urgently needed. Effective screening strategies to identify individuals with diabetes most likely to develop complications could improve outcomes by focusing resources on those at highest risk. What Is Diabetic Nephropathy?

The prevalence of NAFLD has increased in parallel with the epidemics of obesity and type 2 diabetes, which are risk factors for NAFLD.3,6 Whereas the association of type 2 diabetes with microvascular complications and macrovascular disease is well established, the association of type 2 diabetes with NAFLD is more recently recognised and probably less well-known […]

When these treatments have failed, drugs represent the next step in therapy, although they do not play a role in primary therapy as in other types of secretory pituitary tumours such as prolactinomas or acromegaly. However, their utility is reflected by the necessity to treat glucocorticoid excess in order to reverse the metabolic consequences and […]

Despite an increasing incidence, the mortality from thyroid cancer in general and from papillary thyroid cancer in particular remained stable (0.5 deaths per 100,000 in both 1973 and 2002).1

NFPAs are usually asymptomatic until they become large enough to cause mass effects. Diagnosis is frequently made when they are at the macro-adenoma stage. Visual deficit is the most frequent symptom that leads a patient to discover a pituitary mass. Patients often show bi-temporal hemianopsia secondary to compression of the optic chiasm by suprasellar extension […]

Additionally, it can occur in association with other congenital abnormalities such as forebrain defects, optic nerve hypoplasia or cleft lip and palate. A threshold of height standard deviation score (SDS) equal to or below 2.0 (3rd percentile) will identify 14% of children with an organic cause of growth failure.4,5 After excluding chronic, non-endocrine causes of […]

The gene encoding hGRα (hGR gene) is one locus on the long arm of chromosome 5 (q31.3), and consists of nine exons spanning over 150kb. Expressed hGRα is a panel of eight amino terminal translational isoforms of varying lengths, each of which consists of three subdomains: the N-terminal (NTD), the DNA-binding (DBD) and the ligand-binding […]

Pituitary Adenomas

Hyperthyroidism is an important cause of secondary osteoporosis2 and the relationship between the hypothalamic–pituitary– thyroid (HPT) axis and bone is an important factor to consider in the management of sub-clinical hyperthyroidism and differentiated thyroid cancer. This article discusses animal models that provide insight into the underlying mechanisms that result in hyperthyroidism-associated bone loss. It will […]

Current therapies of Graves’ disease are aimed at reducing thyroid hormone synthesis and consist of thionamides, radioiodine and surgery.6 Thionamides block the thyroid hormone synthesis by inhibition of thyroid peroxidase, and are usually prescribed for at least one year. The major disadvantage of thionamides is the low remission rate of only 30-40% of patients after […]

Although much attention has been given to the study of post-menopause and the options in hormone replacement treatment (i.e. oestrogens and progestins), relatively little attention and awareness has been focused on the activity of endogenous or exogenous androgens in women. In fact, the life of a middle-aged woman is characterised by the co-existence of menopause […]