Pub Date : 2025-06-24DOI: 10.1038/s41574-025-01134-8
Maria Fleseriu, Mark Gurnell, Ann McCormack, Hidenori Fukuoka, Andrea Glezer, Fabienne Langlois, Theodore H. Schwartz, Yona Greenman, Nidhi Agrawal, Amit Akirov, Irina Bancos, Cristina Capatina, Frederic Castinetti, Michael Catalino, Mirjam Christ-Crain, Liza Das, Andjela Drincic, Pamela U. Freda, Monica R. Gadelha, Andrea Giustina, Felicia Hanzu, Ken K. Y. Ho, Kristina Isand, Susana Mallea-Gil, Adam N. Mamelak, Hani J. Marcus, Meliha Melin Uygur, Mark Molitch, Lisa B. Nachtigall, Elisabeth Nowak, Alberto M. Pereira, Maria M. Pineyro, Ismat Shafiq, Luis Syro, Yutaka Takahashi, Elena V. Varlamov, Greisa Vila, Gabriel Zada, Niki Karavitaki, Shlomo Melmed, & The Pituitary Society International Incidentaloma Consensus Group
This Pituitary Society Consensus article presents an evidence-based consensus on the management of pituitary incidentaloma, defined as an unexpected sellar or parasellar finding incidentally discovered on an imaging study that was not performed for a clinically suspected pituitary lesion. Recommendations are offered for when endocrinology, neurosurgery and ophthalmology consultation, dedicated pituitary imaging, pituitary hormone testing and visual assessment are warranted for macroadenomas, microadenomas, cystic lesions and empty sella, as well as when surgical resection is indicated for incidental pituitary adenomas and cystic sellar lesions. Special considerations in patients with multiple endocrine neoplasia type 1, children and adolescents, older people, and pregnant women are addressed. The Consensus workshop concluded that diagnostic and management approaches should be individualized to the specific clinical context of an incidentally discovered pituitary lesion. Consultation with a multidisciplinary pituitary tumour centre of excellence should be considered in the presence of new or deteriorating lesion-specific signs or symptoms, particularly when surgical or other adjuvant interventions are being considered and when there is uncertainty about the most appropriate subsequent management. This international Consensus Statement provides guidelines on the management of pituitary incidentalomas.
{"title":"Pituitary incidentaloma: a Pituitary Society international consensus guideline statement","authors":"Maria Fleseriu, Mark Gurnell, Ann McCormack, Hidenori Fukuoka, Andrea Glezer, Fabienne Langlois, Theodore H. Schwartz, Yona Greenman, Nidhi Agrawal, Amit Akirov, Irina Bancos, Cristina Capatina, Frederic Castinetti, Michael Catalino, Mirjam Christ-Crain, Liza Das, Andjela Drincic, Pamela U. Freda, Monica R. Gadelha, Andrea Giustina, Felicia Hanzu, Ken K. Y. Ho, Kristina Isand, Susana Mallea-Gil, Adam N. Mamelak, Hani J. Marcus, Meliha Melin Uygur, Mark Molitch, Lisa B. Nachtigall, Elisabeth Nowak, Alberto M. Pereira, Maria M. Pineyro, Ismat Shafiq, Luis Syro, Yutaka Takahashi, Elena V. Varlamov, Greisa Vila, Gabriel Zada, Niki Karavitaki, Shlomo Melmed, & The Pituitary Society International Incidentaloma Consensus Group","doi":"10.1038/s41574-025-01134-8","DOIUrl":"10.1038/s41574-025-01134-8","url":null,"abstract":"This Pituitary Society Consensus article presents an evidence-based consensus on the management of pituitary incidentaloma, defined as an unexpected sellar or parasellar finding incidentally discovered on an imaging study that was not performed for a clinically suspected pituitary lesion. Recommendations are offered for when endocrinology, neurosurgery and ophthalmology consultation, dedicated pituitary imaging, pituitary hormone testing and visual assessment are warranted for macroadenomas, microadenomas, cystic lesions and empty sella, as well as when surgical resection is indicated for incidental pituitary adenomas and cystic sellar lesions. Special considerations in patients with multiple endocrine neoplasia type 1, children and adolescents, older people, and pregnant women are addressed. The Consensus workshop concluded that diagnostic and management approaches should be individualized to the specific clinical context of an incidentally discovered pituitary lesion. Consultation with a multidisciplinary pituitary tumour centre of excellence should be considered in the presence of new or deteriorating lesion-specific signs or symptoms, particularly when surgical or other adjuvant interventions are being considered and when there is uncertainty about the most appropriate subsequent management. This international Consensus Statement provides guidelines on the management of pituitary incidentalomas.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 10","pages":"638-655"},"PeriodicalIF":40.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41574-025-01134-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-24DOI: 10.1038/s41574-025-01147-3
Claire Greenhill
{"title":"Unpicking the effects of FGF21 on longevity","authors":"Claire Greenhill","doi":"10.1038/s41574-025-01147-3","DOIUrl":"10.1038/s41574-025-01147-3","url":null,"abstract":"","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 9","pages":"523-523"},"PeriodicalIF":40.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-23DOI: 10.1038/s41574-025-01142-8
Guan Wang, Anying Song, Qiong A. Wang
Adipose tissue, a pivotal player in whole-body energy homeostasis and insulin sensitivity, undergoes considerable remodelling throughout the ageing process, a facet that has garnered little attention until the past decade. This Review comprehensively summarizes the dynamic metabolic, cellular and functional changes that occur in white and thermogenic adipose tissue during distinct ageing stages, across different adipose tissue depots. We emphasize the influence of ageing on different cell types within adipose tissue, including adipocytes, adipocyte progenitors, immune cells and senescent cells, and their collective effect on adipose tissue function and systemic metabolism. We also decipher the correlation between adipose tissue ageing and prevalent age-related conditions such as metabolic dysfunction-associated fatty liver disease and cardiovascular diseases. Finally, the Review delves into the potential of current anti-ageing interventions to beneficially affect adipose tissue, encompassing caloric restriction, metformin, glucagon-like peptide 1 receptor agonists and senolytics. The discussion extends to the exploration of whether targeting adipose tissue through such interventions could emerge as a prominent therapeutic strategy for mitigating age-related diseases and enhancing the healthspan and lifespan of the ageing population. This Review outlines changes in endocrine and metabolic function that occur in various adipose tissue depots during ageing and explains how these alterations contribute to age-related decline in metabolic health. The Review also discusses how various treatments might slow this decline by improving adipose tissue function.
{"title":"Adipose tissue ageing: implications for metabolic health and lifespan","authors":"Guan Wang, Anying Song, Qiong A. Wang","doi":"10.1038/s41574-025-01142-8","DOIUrl":"10.1038/s41574-025-01142-8","url":null,"abstract":"Adipose tissue, a pivotal player in whole-body energy homeostasis and insulin sensitivity, undergoes considerable remodelling throughout the ageing process, a facet that has garnered little attention until the past decade. This Review comprehensively summarizes the dynamic metabolic, cellular and functional changes that occur in white and thermogenic adipose tissue during distinct ageing stages, across different adipose tissue depots. We emphasize the influence of ageing on different cell types within adipose tissue, including adipocytes, adipocyte progenitors, immune cells and senescent cells, and their collective effect on adipose tissue function and systemic metabolism. We also decipher the correlation between adipose tissue ageing and prevalent age-related conditions such as metabolic dysfunction-associated fatty liver disease and cardiovascular diseases. Finally, the Review delves into the potential of current anti-ageing interventions to beneficially affect adipose tissue, encompassing caloric restriction, metformin, glucagon-like peptide 1 receptor agonists and senolytics. The discussion extends to the exploration of whether targeting adipose tissue through such interventions could emerge as a prominent therapeutic strategy for mitigating age-related diseases and enhancing the healthspan and lifespan of the ageing population. This Review outlines changes in endocrine and metabolic function that occur in various adipose tissue depots during ageing and explains how these alterations contribute to age-related decline in metabolic health. The Review also discusses how various treatments might slow this decline by improving adipose tissue function.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 10","pages":"623-637"},"PeriodicalIF":40.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-23DOI: 10.1038/s41574-025-01145-5
Senegal Carty
{"title":"Nanoparticles help the spleen support pancreatic islet transplants","authors":"Senegal Carty","doi":"10.1038/s41574-025-01145-5","DOIUrl":"10.1038/s41574-025-01145-5","url":null,"abstract":"","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 8","pages":"457-457"},"PeriodicalIF":31.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144341227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-17DOI: 10.1038/s41574-025-01128-6
Francisca L. Henriques, Irina Buckle, Josephine M. Forbes
Type 1 diabetes mellitus (T1DM) is a chronic disease with an increasing global incidence. The mortality associated with T1DM complications emphasizes the urgency of developing therapeutic strategies to prevent or delay the onset of T1DM. Historically, T1DM was solely described as a T cell-mediated disease. However, the role of β-cells as active participants in the immune-mediated damage is now well appreciated. Indeed, heterogeneity, vulnerability to stressors and the ability of β-cells to act as antigen-presenting cells has altered the perspective of what is necessary for effective disease prevention and ongoing β-cell preservation. Currently, teplizumab, an Fc-receptor non-binding humanized CD3-specific monoclonal antibody, is the only therapy approved by the FDA for the delay of T1DM onset. The intravenous administration, generalized immunosuppression and adverse effects mean that the transition to routine clinical practice is not without challenges. However, teplizumab could lead to the development of more accessible therapies. In this Review, we explore current and potential therapeutics for T1DM prevention. We offer alternative approaches, such as targeting the receptor for advanced glycation end products (RAGE). RAGE is a pattern recognition receptor that engages a wide range of ligands, including advanced glycation end products (AGEs; a family of molecules that includes the well described marker of long-term glucose concentrations, HbA1c). This Review briefly outlines the pathophysiology of type 1 diabetes mellitus and discusses therapeutic targets that have reached clinical trials, including immunotherapy, and how these treatments might change the future of the disease.
{"title":"Type 1 diabetes mellitus prevention: present and future","authors":"Francisca L. Henriques, Irina Buckle, Josephine M. Forbes","doi":"10.1038/s41574-025-01128-6","DOIUrl":"10.1038/s41574-025-01128-6","url":null,"abstract":"Type 1 diabetes mellitus (T1DM) is a chronic disease with an increasing global incidence. The mortality associated with T1DM complications emphasizes the urgency of developing therapeutic strategies to prevent or delay the onset of T1DM. Historically, T1DM was solely described as a T cell-mediated disease. However, the role of β-cells as active participants in the immune-mediated damage is now well appreciated. Indeed, heterogeneity, vulnerability to stressors and the ability of β-cells to act as antigen-presenting cells has altered the perspective of what is necessary for effective disease prevention and ongoing β-cell preservation. Currently, teplizumab, an Fc-receptor non-binding humanized CD3-specific monoclonal antibody, is the only therapy approved by the FDA for the delay of T1DM onset. The intravenous administration, generalized immunosuppression and adverse effects mean that the transition to routine clinical practice is not without challenges. However, teplizumab could lead to the development of more accessible therapies. In this Review, we explore current and potential therapeutics for T1DM prevention. We offer alternative approaches, such as targeting the receptor for advanced glycation end products (RAGE). RAGE is a pattern recognition receptor that engages a wide range of ligands, including advanced glycation end products (AGEs; a family of molecules that includes the well described marker of long-term glucose concentrations, HbA1c). This Review briefly outlines the pathophysiology of type 1 diabetes mellitus and discusses therapeutic targets that have reached clinical trials, including immunotherapy, and how these treatments might change the future of the disease.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 10","pages":"608-622"},"PeriodicalIF":40.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-17DOI: 10.1038/s41574-025-01138-4
Sophie Monnerat, Mirjam Christ-Crain, Julie Refardt
Hyponatraemia is the most common electrolyte disorder in both inpatient and outpatient settings and mostly affects older adults, in whom intrinsic factors (such as chronic heart, liver or kidney diseases and malignancies) and extrinsic factors (such as polypharmacy and malnutrition) favouring hyponatraemia are highly prevalent. Importantly, its occurrence is expected to increase exponentially with global warming. Chronic hyponatraemia is associated with an increased risk of falling, osteoporosis and fractures, attention deficits, and even mortality. In the past two decades, a growing number of studies have suggested that correcting hyponatraemia improves clinical outcomes, outlining hyponatraemia management as a part of promoting healthy ageing. In addition, SGLT2 inhibitors and protein supplementation have been shown to be efficacious in treating hyponatraemia, both of which represent attractive and holistic treatment options in older adults. However, despite hyponatraemia being encountered in all medical specialties, its clinical burden is often overlooked, partly due to low awareness but also to low confidence in applying diagnostic and therapeutic algorithms. In this Review, we aim to depict the consequences of hyponatraemia, characterize the most common aetiologies in older individuals, and finally detail the diagnostic pathway as well as the benefits and limitations of the available treatment options. Hyponatraemia is associated with poor health outcomes and increased mortality, particularly for hospital inpatients. Risk of hyponatraemia increases with age due to comorbidities, polypharmacy and poor nutrition. This Review discusses the causes of hyponatraemia and its clinical management, with a particular focus on older populations.
{"title":"Hyponatraemia in ageing","authors":"Sophie Monnerat, Mirjam Christ-Crain, Julie Refardt","doi":"10.1038/s41574-025-01138-4","DOIUrl":"10.1038/s41574-025-01138-4","url":null,"abstract":"Hyponatraemia is the most common electrolyte disorder in both inpatient and outpatient settings and mostly affects older adults, in whom intrinsic factors (such as chronic heart, liver or kidney diseases and malignancies) and extrinsic factors (such as polypharmacy and malnutrition) favouring hyponatraemia are highly prevalent. Importantly, its occurrence is expected to increase exponentially with global warming. Chronic hyponatraemia is associated with an increased risk of falling, osteoporosis and fractures, attention deficits, and even mortality. In the past two decades, a growing number of studies have suggested that correcting hyponatraemia improves clinical outcomes, outlining hyponatraemia management as a part of promoting healthy ageing. In addition, SGLT2 inhibitors and protein supplementation have been shown to be efficacious in treating hyponatraemia, both of which represent attractive and holistic treatment options in older adults. However, despite hyponatraemia being encountered in all medical specialties, its clinical burden is often overlooked, partly due to low awareness but also to low confidence in applying diagnostic and therapeutic algorithms. In this Review, we aim to depict the consequences of hyponatraemia, characterize the most common aetiologies in older individuals, and finally detail the diagnostic pathway as well as the benefits and limitations of the available treatment options. Hyponatraemia is associated with poor health outcomes and increased mortality, particularly for hospital inpatients. Risk of hyponatraemia increases with age due to comorbidities, polypharmacy and poor nutrition. This Review discusses the causes of hyponatraemia and its clinical management, with a particular focus on older populations.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 9","pages":"564-579"},"PeriodicalIF":40.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-16DOI: 10.1038/s41574-025-01141-9
Bruna R. da Silva, Lorraine Brennan, Maria Aderuza Horst, David S. Wishart, Carla M. Prado
Precision nutrition is often used interchangeably with personalized nutrition, creating confusion and limiting progress. This Comment proposes a working definition of precision nutrition, outlines enabling frameworks such as artificial intelligence and highlights the need for consistent research standards and clinical validation to support and maximize precision nutrition’s potential in healthcare.
{"title":"Advancing precision nutrition: bridging mechanistic insight and clinical implementation","authors":"Bruna R. da Silva, Lorraine Brennan, Maria Aderuza Horst, David S. Wishart, Carla M. Prado","doi":"10.1038/s41574-025-01141-9","DOIUrl":"10.1038/s41574-025-01141-9","url":null,"abstract":"Precision nutrition is often used interchangeably with personalized nutrition, creating confusion and limiting progress. This Comment proposes a working definition of precision nutrition, outlines enabling frameworks such as artificial intelligence and highlights the need for consistent research standards and clinical validation to support and maximize precision nutrition’s potential in healthcare.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 9","pages":"515-517"},"PeriodicalIF":40.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-09DOI: 10.1038/s41574-025-01139-3
Aaron Novikoff, Timo D. Müller
Advances in biomedical research often result from a straightforward formula: a good working hypothesis, a set of dedicated investigators, and access to calorimetric chambers and a laboratory scale. The success of this approach has again been demonstrated in a new Cell Metabolism report showing that tirzepatide induces weight loss through partially distinct mechanisms in mice and humans.
{"title":"Tirzepatide differentially affects body weight in mice and humans","authors":"Aaron Novikoff, Timo D. Müller","doi":"10.1038/s41574-025-01139-3","DOIUrl":"10.1038/s41574-025-01139-3","url":null,"abstract":"Advances in biomedical research often result from a straightforward formula: a good working hypothesis, a set of dedicated investigators, and access to calorimetric chambers and a laboratory scale. The success of this approach has again been demonstrated in a new Cell Metabolism report showing that tirzepatide induces weight loss through partially distinct mechanisms in mice and humans.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"21 8","pages":"462-463"},"PeriodicalIF":31.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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