Endocrinology

Mitochondria: It is all About Energy

Mitochondria play a key role in both health and disease. Their function is not limited to energy production but serves multiple mechanisms, varying from iron and calcium homeostasis to the production of hormones and neurotransmitters, such as melatonin. They enable – and influence – communications at all physical levels through interaction with other organelles, the nucleus and the outside environment. The literature suggests crosstalk mechanisms between mitochondria and circadian clocks, the gut microbiota, and the immune system. Hence, they might be the (missing) link in both health and disease. This is a shortened version of the original article.

Modern Medicine – Issue 5 2024.

Chronic Kidney Disease:Doing Simple Things Well for Those Most at Risk

The incidence of chronic kidney disease (CKD) is increasing worldwide. A holistic approach to management that includes nonpharmacological and pharmacological strategies to manage risk factors, as well as advocating for patients, particularly those most at risk, can significantly slow the progression of CKD. Input from multidisciplinary team members, including a nephrologist, CKD nurse and allied health professionals, can further reduce the progression of CKD, delay kidney failure and avoid CKD-related mortality. Risk factors for developing CKD, including diabetes, hypertension, obesity and cardiovascular disease, should be managed aggressively with pharmacotherapy. The four pillars of medical management for patients with CKD are renin-angiotensin system inhibitors, sodiumglucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists.

Modern Medicine – Issue 3 2024

Management of Polycystic Ovary Syndrome: The Role of Primary Care

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with psychological challenges and cardiometabolic complications. The 2023 international guideline for PCOS assessment and management introduces several changes, including the addition of anti-Müllerian hormone levels to assess polycystic ovary morphology and differences in the diagnostic criteria between adults and adolescents. The updated guideline also emphasise holistic patient care that addresses the associated cardiometabolic risks and complications and psychosocial challenges. GPs are well placed to use a whole-person approach to management, which can include lifestyle interventions, weight and fertility management, optimising preconception health and addressing psychosocial aspects.

Modern Medicine – Issue 2 2024

Thyroiditis – Differentiating the Cause

Thyroiditis encompasses diverse diagnoses characterised by inflammation of the thyroid and is classified as painful or painless thyroiditis. They have varied causes and can be challenging to differentiate. Common features include the classic triphasic pattern of thyroid dysfunction of the thyrotoxic phase, followed by hypothyroidism secondary to depleted stores; and then a return to euthyroid state from recovery. General management of symptoms includes anti-inflammatories for pain (if present), beta blockers for the thyrotoxic phase and levothyroxine in cases of hypothyroidism.

Modern Medicine – Issue 1 2024

Timing of Therapy in Osteoporosis: Does it Matter?

Osteoporosis is a common condition encountered in general practice and is significantly undertreated. Tailoring the type and timing of treatment to the individual patient is important to improve outcomes and minimise potential side effects. Bisphosphonates, denosumab and hormonal therapies are effective in decreasing hip, vertebral and nonvertebral fractures. First-line treatment selection depends on individual patient factors and preferences.

Modern Medicine – Issue 5 2023

Don’t Over- or Under-treat Hypothyroidism

Hypothyroidism is a condition that is more frequent in women, particularly those older than 60 years of age. It is readily diagnosed by the measurement of blood levels of thyroid-stimulating hormone (TSH) and thyroxine (T4).

Modern Medicine – Issue 4 2023

A Clinical Approach to Managing Obesity in Adults

Obesity is a complex chronic disease that is strongly associated with an increased risk of all-cause mortality. Routine screening is required to assess the complications of obesity. Therapies for managing obesity should be guided by an individual’s body mass index, comorbidities and the presence and severity of obesity-related complications.

Modern Medicine – Issue 4 2023

Early Intervention Alters the Prediabetes Trajectory

Prediabetes is a high-risk state for progression to diabetes with an annualised conversion rate of 5–10%, with a similar proportion converting back to normoglycaemia. Proactive screening and a prompt lifestyle intervention in those with incident prediabetes is effective in preventing the progression to type 2 diabetes in many patients. The addition of metformin has a selectively greater impact in certain categories of patients.

Modern Medicine – Issue 4 2023

Obesity and Diabetes: (Un)comfortable Bedfellows

The term pandemic has been bandied about freely over the past three years with the advent of the COVID pandemic. Although the term refers to an “epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”, it may have had its origins in virology and infectious diseases, the description is equally as appropriate to describe the large numbers of people living with type 2 diabetes mellitus (T2DM) and people living with obesity.1 In fact, COVID highlighted the metabolic and pro-inflammatory states that are the hallmark of these two conditions.

Modern Medicine – Issue 2 2023