Expert Review of Endocrinology & Metabolism最新文献

Introduction: Interlinkage between lipid and carbohydrate metabolism remains a key focus of research into the pathogenesis and novel management of obesity-related conditions like Type 2 Diabetes (T2DM), dyslipidaemia, and Metabolic-Associated Fatty Liver Disease (MAFLD). The activity of Brown Adipose Tissue (BAT) unifies these two facets of metabolism and holds great therapeutic potential.

Areas covered: Through a brief narrative review of the current literature using Pubmed, with the search terms 'batokines,' 'metabolism' and 'obesity,' we outline the diverse effects of batokines on metabolism, BAT functioning, and metabolic signaling pathways. We explore a future role of batokines in the management of obesity and T2DM, as a biomarker for BAT activity and predictor and monitor of therapeutic response to future novel mitochondrial uncoupling therapies.

Expert opinion: Through its key role in the metabolism of lipids and carbohydrates, the mechanisms of BAT activation shed light on the complex mechanisms that interlink obesity with T2DM and other dysmetabolic conditions. Signaling biomolecules derived from BAT ('batokines') regulate the metabolic functioning of white adipose tissue and skeletal muscle, including glucose, lipid and protein metabolism, insulin sensitivity, and energy expenditure. Insights into batokine physiology will guide the next generation of therapies for obesity and its related dysmetabolic conditions.

Introduction: Diabetes management in end-stage kidney disease (ESKD) presents unique challenges due to perturbations in renal physiology. ESKD influences the pharmacokinetics of insulin and glucose metabolism, while hemodialysis (HD) adds further complexity. There is an unmet need for adaptable therapies to help glucose management in ESKD. Automated insulin delivery (AID) may provide a solution to the dynamic, complex physiology of diabetes in ESKD on HD.

Areas covered: We provide a narrative review of the pathophysiology of diabetes in ESKD on HD and the role of AID in this setting. Literature search included PubMed/MEDLINE and Scopus. We included manuscripts published between 2000 and 2025 focussed on the pathophysiology of diabetes in people with ESKD on HD and 2015 to 2025 for AID use in the setting of ESKD on HD.

Expert opinion: Our review of the pathophysiology of diabetes in ESKD on HD and the utilization of AID in this setting highlights the need for further research to establish the evidence base for this technology in this high-risk population. The available data support the use of AID systems as they provide greater flexibility in insulin delivery, increase time within target range (3.9-10 mmol/L), and reduce glycemic variability and hypoglycemia, thus emerging as a promising treatment modality in people with insulin-treated diabetes and ESKD on HD.

Introduction: Female sexual dysfunction (FSD) at menopause is a group of prevalent and multifactorial conditions that significantly impair quality of life and well-being. Hormonal decline, particularly estrogen and androgen deprivation, along with aging-related changes, contribute to genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD), the two most relevant clinical entities.

Areas covered: This narrative review provides an updated revision of the literature regarding evidence-based strategies for FSD in menopausal women. Emphasis is placed on pharmacologic treatments, including systemic and local hormonal and non-hormonal therapies, selective estrogen receptor modulators (SERM), and centrally acting agents. Non-pharmacological interventions are also discussed, such as pelvic floor rehabilitation, laser therapies, and psychosexual approaches (cognitive behavioral therapy, mindfulness, couple therapy). The content draws mainly on recent clinical trials, consensus statements, and guideline-based recommendations, based on Pubmed search updated to July 2025.

Expert opinion: Management of FSD associated with menopause requires a multidimensional, individualized approach integrating biological, psychological, and relational factors. A proactive and structured clinical framework, supported by validated diagnostic tools, is essential. Healthcare providers (HCPs) should address sexual health openly, recognize the couple's dynamics, and tailor interventions to each woman's needs and preferences, while considering the evolving evidence and regulatory landscape.

Introduction: Immune checkpoint inhibitor (ICI) induced endocrinopathies are a commonly encountered immune-related adverse event during cancer treatment. Several oncology and endocrinology groups have put together guidelines on the management of these adverse events. However, the management is evolving as we learn more about the natural history of these entities.

Areas covered: A thorough literature search for articles pertaining to ICIs and endocrinopathies was performed and supplemented by expert opinions of the authors. Additionally, we present unanswered questions that need further research including ICI-mediated effects on diabetes and bone health.

Expert opinion: While there is a consensus on the management of endocrinopathies caused by ICI, there is a lot unknown. While ICI can be safely continued, conditions like adrenal insufficiency, primary hypothyroidism, and diabetes resulting from ICI require lifelong hormone replacement. However, there are several questions unanswered. Hence, the endocrinologists at our cancer center have come together as a working group to explore 'checkpoint inhibitor induced toxic endocrinopathies and diabetes' (CIITED). Future directions intended to explore are the long-term sequelae of ICI endocrinopathies as well as possible role for immune modulating therapies in their management.

Introduction: Post-bariatric surgery hypoglycemia (PBH) in pregnancy is an important yet likely under-recognized complication. It is associated with maternal and fetal risks, including lifestyle implications, reduced cognition, intrauterine growth restriction and premature delivery. Management is challenging, with no specific guidelines targeted to care in pregnancy published.

Areas covered: We conducted a scoping review, searching PUBMED, EMBASE, and CINAHL databases for all relevant studies of PBH in pregnancy between June 1974 and 2025. Our review identified 16 papers discussing 20 cases. Dietary management alone showed success in 9/20 cases. Several trialed pharmacological treatment alongside with mixed response: 1/20 cases trialed Nifedipine (partial improvement in symptoms), 3/20 Acarbose (variable success noted), 2/20 Octreotide (not tolerated) and 1/20 Diazoxide (improvement in symptoms noted). Complications reported include maternal nutritional deficiencies (3/20), neonatal hypoglycemia (3/20), fetal growth restriction (2/20), premature delivery (3/20), and neonatal death (1/20).

Expert opinion: PBH during pregnancy has great health and psychological implications, with risks to both mother and neonate. Mainstay management of dietary intervention leaves much to be desired, with continuation of recurrent PBH in the majority of cases. Randomized controlled trials investigating safety and efficacy of pharmacological intervention during pregnancy are essential.

Introduction: Fertility preservation has become increasingly important in the multidisciplinary care of women with gynecologic cancers, especially as delayed childbearing has contributed to a rise in cancer diagnoses during reproductive ages. In this context, advancements in fertility preservation have greatly enhanced the variety of strategies offered to women facing gynecologic cancers, offering both established and emerging options to women diagnosed with cervical, endometrial, and ovarian malignancies.

Areas covered: This review provides a comprehensive overview of current fertility-preserving approaches in gynecologic oncology, highlighting latest developments in surgical, medical, and assisted reproductive techniques. A literature search was conducted in PubMed, Scopus, EMBASE, and Web-of-Science (2010-2025). We examine the indications, oncologic safety, and reproductive outcomes of fertility-sparing procedures, including radical trachelectomy, hormonal therapy for early-stage endometrial cancer, and conservative management of borderline ovarian tumors. Additionally, we discuss the role and timing of oocyte/embryo and ovarian tissue cryopreservation, particularly in urgent gynecologic oncological case scenarios. Critical challenges such as optimal patient selection, individualized risk assessment, and coordination between gynecologic oncology and fertility specialists are addressed.

Expert opinion: Fertility preservation in gynecologic oncology has evolved considerably, yet several unmet needs remain, and future research with a focus on improving oncologic and reproductive outcomes is needed.

Background: Diabetes mellitus is a major public health challenge in Jordan. This study aimed to assess diabetes awareness and health behaviors among Jordanian adults and identify key sociodemographic predictors of knowledge.

Research design and methods: A national cross-sectional study was conducted, surveying 1,994 adults via online and in-person interviews. A validated questionnaire assessed diabetes knowledge and health behaviors. Data were analyzed using multivariate regression to identify predictors of knowledge.

Results: General diabetes awareness was high (98%), but specific knowledge gaps were identified. Only 52.3% understood glucose tolerance testing, and 38% recognized that diabetes control improves by avoiding smoking. Higher education (Bachelor's: β = 0.39, p = 0.004; Master's: β = 0.68, p < 0.001) and healthcare employment (β = 1.34, p < 0.001) strongly predicted better knowledge. Healthier behaviors like regular exercise (β = 0.24, p = 0.004) and balanced diets (β = 0.19, p = 0.001) correlated with higher scores, while smokers scored lower (β = -0.29, p = 0.002).

Conclusion: Despite high general awareness, critical gaps persist in diagnostics and lifestyle-related knowledge. Targeted interventions addressing smoking cessation, testing protocols, and culturally tailored education are needed to enhance diabetes management in Jordan.

Introduction: Pelvic floor dysfunctions (PFD) in women result from genetic and acquired factors such as pregnancy, aging, and menopause. Despite their high prevalence, PFD during midlife remain underdiagnosed and undertreated. PFD include urinary incontinence, prolapse, sexual dysfunction, and recurrent urinary tract infections, all of which significantly impair quality of life and require targeted evaluation and treatment.

Areas covered: This review examines how menopause and aging contribute to pelvic floor dysfunction through estrogen deficiency, muscle atrophy, and reduced collagen, resulting in urinary incontinence, prolapse, overactive bladder, and increased susceptibility to urinary infection. A detailed overview of clinical assessment is provided, including clinical assessment and an analysis of the various management and treatment options. A literature search was conducted in PubMed/MEDLINE and the Cochrane Library for studies published up to 1 March 2025, using keywords related to menopause, aging, pelvic floor disorders, and genitourinary symptoms.

Expert opinion: PFD in postmenopausal women are chronic, progressive conditions that benefit from early identification, and a multidisciplinary approach. Future management will rely increasingly on AI-driven diagnostic tools, personalized therapies using genomics and hormonal profiling, greater public awareness, and expanded access through telemedicine and digital tools, ultimately improving outcomes and reducing stigma.