Nature reviews. Endocrinology
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The current obesity epidemic has led to a dramatic increase in insulin resistance and type 2 diabetes mellitus among adolescents, along with other obesity-related comorbidities, such as hypertension, hyperlipidemia, obstructive sleep apnea, psychosocial impairment and nonalcoholic fatty liver disease. Medical treatment of severe obesity is effective in only a small percentage of adolescent patients. In light of the potentially life-threatening complications of obesity, bariatric surgery can be considered a treatment option for adolescent patients with morbid obesity. ⋯ The risk associated with bariatric surgery in adolescents seems to be similar to that observed in adult patients in the short term. Data suggest that bypass procedures successfully reverse or improve abnormal glucose metabolism in the majority of patients and may be more effective in adolescents than adults. This improvement in glucose metabolism occurs before marked weight loss in patients undergoing bypass procedures, suggesting a direct effect on the hormonal control of glucose metabolism.
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Gastrointestinal surgery may ameliorate glycemic control in type 2 diabetes mellitus within days to weeks--an effect that cannot be explained solely by the changes in food intake and body weight following gastric bypass. should clinicians, therefore, implement bariatric procedures to treat type 2 diabetes mellitus in patients who do not meet current obesity-based criteria for surgery?
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Comparative Study
Therapy: nonhormonal treatment of hot flashes-a viable alternative?
A new study published in the Journal of Clinical Oncology has ascertained the efficacy of selective serotonin-reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and gabapentin to decrease menopausal hot flashes. Are these nonhormonal treatment options a viable alternative to hormone replacement therapy?
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Case Reports
Diagnosis of insulinoma in a patient with hypoglycemia without obvious hyperinsulinemia.
A 41-year-old Maltese woman with a 12-month history of severe, morning episodes of confusion, blurred vision and sweating was referred to a specialist center for evaluation of fasting hypoglycemia. She was not taking medication and did not report any prior personal or familial history of endocrinopathy or other relevant pathology. ⋯ The tumor was resected with cure of symptoms.