Eureka 2023! Part I: Top Endocrine Discoveries

For the ninth year running, Endocrine News talks to editors from Endocrine Society publications to unearth the endocrine nuggets of 2023. Here, the editors of the Endocrine Reviews weigh in on what they think qualify as the year’s biggest discoveries in endocrine science.

The endocrine Gold Rush of ’22 from last year’s issue might have seemed impossible to top, but we not only saw an abundance of fascinating and important research this year, we also add a new editor to the team of prospectors.

Their top studies touch on every facet of endocrinology, from how hormones affect cancers to more precise management of primary aldosteronism, secondary adrenal insufficiency, and type 2 diabetes. Growth disorders and other endocrinopathies are better understood mechanistically. The importance of growth hormone and gonadotropin-releasing hormone for cognition rescue was revealed. The socioeconomic toll of Cushing syndrome was explored.

Translational medicine was also big this past year, and even wearables got a nod. A promising lineup of pharmaceutical breakthroughs emerged: riluzole enhances therapy in breast cancer, batoclimab treats thyroid eye disease, canagliflozin and ertugliflozin are showing efficacy in various aspects of type 2 diabetes, and fezolinetant may finally be controlling hot flashes in menopause.

Their selections underscore the remarkable advancements researchers made in enhancing human health and well-being, signaling another landmark year in the field of endocrinology.

Part I: Endocrine Reviews

Endocrine Reviews Editor-in-Chief Ashley Grossman, FMedSci, emeritus professor of endocrinology, University of Oxford; senior research fellow, Green Templeton College; consultant NET endocrinologist, Royal Free London; Professor of Neuroendocrinology, Barts and the London School of Medicine; and consultant endocrinologist at the London Clinic Centre for Endocrinology, in the UK, chose “Recurrent Disease in Patients With Sporadic Pheochromocytoma and Paraganglioma”  from the February issue of JCEM by Li, M., et al. chiefly because it relates to his specific clinical practice, focusing on pheochromocytomas and paragangliomas and because he has worked with some of the authors.

“In essence, they examined a large series of patients with these tumors, 1,127 to be exact, and somewhat surprisingly (to me) found that of the group with purely apparent sporadic tumors, with no germline mutations according to current panels, 14.7% ultimately recurred, some even 15 years after the original diagnosis,” Grossman says. “This really implies that all patients with such tumors require follow-up for life, which I think will impact on our clinical practice, even if we rely on just annual check-ups. These are important new results.”

Grossman also selected two “honorable mentions.” He highlights “Changing the Name of Diabetes Insipidus: A Position Statement of the Working Group for Renaming Diabetes Insipidus,” by Arima, H. et al from the November 2022 issue of JCEM for “reasons of patient safety. We should be careful in our use of language, and the historically fascinating but clinically misleading disease referred to as ‘diabetes insipidus’ should be replaced by AVP-deficiency and AVP-resistance: less mellifluous perhaps, but we are in the business of saving lives and in inexperienced hands the wrong term can lead to serious mismanagement.”

“We should be careful in our use of language, and the historically fascinating but clinically misleading disease referred to as ‘diabetes insipidus’ should be replaced by AVP-deficiency and AVP-resistance: less mellifluous perhaps, but we are in the business of saving lives and in inexperienced hands the wrong term can lead to serious mismanagement.”

Ashley Grossman, FMedSci, editor-in-chief, Endocrine Reviews

Grossman selected “[¹¹C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial[KH3]” from the January issue of Nature Medicine to make clinicians more broadly aware of this non-invasive test in diagnosing primary aldosteronism caused by unilateral adenoma and thereby potentially curing a much greater proportion of these patients with resultant surgery. “I think we now increasingly accept that PA is a much more significant cause of hypertension than was previously considered, that aldosterone per se is directly harmful, and that surgical removal of any tumor identified is the optimal treatment. Using radionuclides such as ¹¹C-metomidate, and hopefully more widely available isotopes such as ¹⁸F linked to metomidate or similar agents, may ultimately obviate the necessity for the complex and expensive venous catheterization studies, and allow more patients to benefit from surgery,” Grossman explains.

More From the Editors of Endocrine Reviews

Lauren Fishbein MD, PhD, MTR, assistant professor in medicine at the University of Colorado School of Medicine in the Division of Endocrinology, Metabolism, and Diabetes also homed in on a primary aldosteronism study, but this time of bilateral disease in “Biomarkers to Guide Medical Therapy in Primary Aldosteronism,”  by Hundemer, G. L. et al. from the July issue of Endocrine Reviews. “This article is important because primary aldosteronism is underdiagnosed and often undertreated,” Fishbein says. “Although some cases are from unilateral adrenal disease and can be treated surgically, the majority are associated with bilateral disease and are treated medically. Many patients are undertreated and continue to have to take multiple medications to control blood pressure and serum potassium. This excellent review article discusses the goals of medical therapy for primary aldosteronism including normalizing blood pressure on the fewest agents, normalizing serum potassium without supplementation and seeing a rise in plasma renin activity. With proper medical treatment, normal physiology can be restored and risks for cardiometabolic and renal disease can be mitigated.”

Check out Eureka Part II!

Horvath is a Baltimore, Md.-based freelance writer, a frequent and prolific contributor to Endocrine News, and has compiled and written the annual “Eureka!” articles annually for nine years.