US ENDOCRINOLOGY VOLUME 11 ISSUE 2 WINTER 2015

Welcome to the latest edition of US Endocrinology, which features a wide variety of articles covering several topics of interest to endocrinologists, as well as the wider medical community. Following recent media coverage about the increasing prevalence of diabetes, this edition focuses on approaches to diabetes treatment. We begin with an article by Almehthel et […]

Diabetes mellitus (DM) is a global epidemic.1 In 2013, there were 382 million people with DM, and this number is expected to rise to 592 million by 2035.2 Type 1 diabetes (T1DM), which is caused mainly by an autoimmunemediated destruction of beta cells within the islet of Langerhans, accounts for 5–10 % of the total […]

Managing diabetes from a provider perspective has to do with how well a patient does with what we refer to as the ABCs (A1c, blood pressure, and cholesterol) of diabetes control. To reduce risk for diabetes complications, patients and providers discuss achieving an A1c level of about 7%; a blood pressure of

With multiple classes of glucose-lowering drugs now available, the opportunity to achieve effective diabetes control has never been brighter. The American Diabetes Association (ADA) and European Association for Study of Diabetes (EASD) list seven classes of drugs in their recommendation.1 Metformin, pioglitazone, sulfonylureas, dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 receptors agonists (GLP1RA), sodium glucose cotransporter-2 […]

South Asia—Diabetes Capital South Asia is known as the Diabetes Capital of the World, and justifiably so. Home to three of the world’s largest populations of people living with diabetes (India, Bangladesh, and Pakistan), it also includes nations with an equally high prevalence of diabetes (Bhutan, Maldives, Nepal, and Sri Lanka). With diabetes having entrenched […]

Necrotizing fasciitis is a soft tissue infections in addition to cellulitis and myositis, which is classified as being either type 1 or type 2.1 In type 1 necrotizing fasciitis, the infection is caused by multiple microorganisms that involve at least one anaerobic species (e.g. Peptostreptococcous, Clostridium, or Bacteroides) in combination with one or more members […]

The autoimmune thyroid diseases (AITD) comprise a series of interrelated conditions including Graves’ disease (GD) and Hashimoto’s thyroiditis (HT). AITD are the most prevalent diseases of the thyroid gland in the pediatric population, particularly in adolescence.1 HT is the leading cause of goiter and hypothyroidism in children and adolescents in countries with adequate iodine supplementation.2–3 […]

Moyamoya is a rare idiopathic cerebral vasculopathy characterized by stenosis of the terminal portion of the internal carotid arteries (ICAs) and the development of a thin collateral network of small vessels (“puff of smoke”), initially described as a primary disease in young individuals of Asian descent.1 Graves’ disease (GD) is an autoimmune hyperthyroid state in […]

Extrathyroidal production of the active form of thyroid hormone, T3, via deiodination of thyroxine (T4) provides physiologic justification for the treatment of hypothyroidism with levothyroxine (l-T4) “monotherapy”;1 T3 production outside of the thyroid gland is mediated largely by the type 2 deiodinase (D2). l-T4-treated patients exhibit stable levels of serum T32 and for decades clinicians […]

In 1932, Dr Harvey Cushing published his findings on a series of patients with what he called the “killing disease,” revealing that the median survival for most of his patients was less than 5 years from diagnosis.1 With advances in surgical techniques and medical management of comorbidities, the standardized mortality ratio for patients with Cushing’s […]

The steadily increasing knowledge concerning selenium (Se) involvement in chronic autoimmune and viral inflammatory disease along with the growing prospect of preventive and/or therapeutic Se intervention, via diet or compounds, are the focus of this brief review. Important data on inflammation are provided, while the link between Se status and disease is described through an […]

Bernard Zinman, Programme Committee Chair of the International Diabetes Federation (IDF) World Diabetes Congress 2015, talks about the scientific programme highlights, the experience of attending the Congress and his involvement in diabetes care and research. Bernard Zinman is Director of the Leadership Sinai Centre for Diabetes and holds the Sam and Judy Pencer Family Chair […]

In type 2 diabetes (T2D), the addition of basal insulin is an option when oral therapy does not maintain acceptable glycaemic control. For the 50–60 % of patients who become refractory to basal insulin therapy alone1,2 treatment intensification requires the addition of prandial insulin to target control of post-prandial hyperglycaemias. The resulting regimen of multiple […]

Diabetes-related macro- and microvascular complications contribute significantly to the increased morbidity, mortality, worsened quality of life and social and financial burden observed in patients with diabetes.1–5 Hence, reducing the development and/or the progression of these complications is one of the main aims of treatment in patients with diabetes. Over the last 2 decades, strategies resulting […]

The five surgical tenets of endocrine surgery were set out in the 1980s:1 Confirm the diagnosis; Render the patient safe; Consider localisation studies; Decide if surgery is indicated; and Decide which surgical approach to adopt. Confirmation of the diagnosis is based exclusively on biochemical tests and the surgeon should be able to interpret the results […]

The diagnosis of Turner syndrome (TS) is based on a complete or partial absence of the second X chromosome. Structural anomalies of the sex chromosome include isoXq (duplication of the long arm to form an isochromosome), rX (ring formation) and Xp-/Xq- (deletion of the short/long arm). Some individuals can present a mosaic karyotype (45,X/46,XX), also […]