Endocrinology and Metabolism Clinics of North America RSS feed: Current Issue. Endocrinology and Metabolism Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in endocrinology and metabolism and is presented under the direction of an experienced guest editor.http://www.endo.theclinics.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Endocrinology and Metabolism Clinics of North America0889-8529391March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.endo.theclinics.com/article/PIIS0889852909001212/abstract?rss=yesContents10.1016/S0889-8529(09)00121-2Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1viixihttp://www.endo.theclinics.com/article/PIIS0889852909001224/abstract?rss=yesForthcoming Issues10.1016/S0889-8529(09)00122-4Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1xiixiihttp://www.endo.theclinics.com/article/PIIS0889852909001157/abstract?rss=yes Doping in sports has a long history, and Drs. Kamber and Mullis describe the history of the abuse and the establishment of world bodies that arose as anti-doping regulators. The World Anti-doping Agency (WADA) was created following years of scandals and controversy. Its job is to test and regulate doping in sport—a very challenging task! This historical perspective is a great introduction to the topic of this issue.ForewordDerek LeRoith10.1016/j.ecl.2009.11.006Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1xiiixvhttp://www.endo.theclinics.com/article/PIIS0889852909001145/abstract?rss=yesThe extensive use of drugs in society, and specifically in sport, is by no means a new phenomenon. What has changed, however, are the methods applied, and the drugs used are now more sophisticated. Throughout history there are plenty of indications that athletes have used “magic” potions to give them an extra punch to gain an unfair advantage and hopefully win.PrefacePrimus-E. Mullis10.1016/j.ecl.2009.11.005Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1xviixviihttp://www.endo.theclinics.com/article/PIIS0889852909000929/abstract?rss=yesThis article describes the worldwide endeavor to combat doping in sports. It describes the historical reasons the movement began and outlines the current status of this effort by international sports groups, governments, and the World Anti-Doping Agency. The purposes, strengths, and limitations of the various entities are illustrated; and recommendations for improvements are made.The Worldwide Fight Against Doping: From the Beginning to the World Anti-Doping AgencyMatthias Kamber, Primus-E. Mullis10.1016/j.ecl.2009.10.009Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-119http://www.endo.theclinics.com/article/PIIS0889852909000905/abstract?rss=yesHuman growth hormone (GH) is widely abused by athletes; however, there is little evidence that GH improves physical performance. Replacement of GH in GH deficiency improves some aspects of exercise capacity. There is evidence for a protein anabolic effect of GH in healthy adults and for increased lean body mass following GH, although fluid retention likely contributes to this increase. The evidence suggests that muscle strength, power, and aerobic exercise capacity are not enhanced by GH administration, however GH may improve anaerobic exercise capacity. There are risks of adverse effects of long-term abuse of GH. Sustained abuse of GH may lead to a state mimicking acromegaly, a condition with increased morbidity and mortality.Growth Hormone Administration: Is It Safe and Effective for Athletic PerformanceVita Birzniece, Anne E. Nelson, Ken K.Y. Ho10.1016/j.ecl.2009.10.007Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-11123http://www.endo.theclinics.com/article/PIIS0889852909000899/abstract?rss=yesCatching athletes abusing human growth hormone (GH) by official antidoping tests is challenging because of specific properties of the hormone. Furthermore, the chemical structure of recombinant GH (rGH) is identical to that of the main GH isoform secreted by the pituitary, making it difficult to discriminate between endogenous and injected GH molecules by biochemical tests. The approaches developed to solve the problem include the “marker approach,” which measures changes in concentration of GH-dependent proteins that are inappropriately elevated after rGH injection, and the “isoform approach,” which detects changes in the spectrum of circulating GH isoforms after administration of rGH. A more widespread use of these tests in out-of-competition controls will enhance the likelihood to detect GH doping.Detecting Growth Hormone Abuse in AthletesMartin Bidlingmaier, Jenny Manolopoulou10.1016/j.ecl.2009.10.006Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-12532http://www.endo.theclinics.com/article/PIIS0889852909000863/abstract?rss=yesIt is believed that insulin and insulin-like growth factor I (IGF-I) are abused by professional athletes, either alone or in combination with growth hormone (GH) and anabolic steroids. The recent introduction of IGF-I to clinical practice is likely to increase its availability and abuse. Insulin and IGF-I work together with GH to control the supply of nutrients to tissues in the fasted and fed state. The actions of insulin and IGF-I that may enhance performance include increased protein anabolism and glucose uptake and storage. The detection of IGF-I and insulin abuse is challenging. There are established mass spectrometry methods for insulin analogs. The feasibility of using GH-dependent markers to detect IGF-I use is being assessed.Insulin-like Growth Factor I and Insulin and Their Abuse in SportIoulietta Erotokritou-Mulligan, Richard I.G. Holt10.1016/j.ecl.2009.10.003Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-13343http://www.endo.theclinics.com/article/PIIS0889852909001108/abstract?rss=yesTestosterone is the principal male sex hormone. As with all natural steroids, it is biosynthesized from cholesterol. Phase I metabolism employs some very specific enzymes and pathways. Phase II metabolism and excretion follow more general patterns. The effects of testosterone are twofold: anabolic and androgenic. Because of its anabolic effects, testosterone is frequently abused in sports. Because of its endogenous nature, testosterone doping is difficult to detect. The standard procedure is based on the evaluation of the urinary steroid profile. Conspicuous samples then are submitted to compound-specific 13C/12C analysis. Synthetic and endogenous steroids differ in this measure. Numerous xenobiotic compounds have been derived from testosterone. The modifications typically aim at a reduction of the androgenic properties while maintaining the anabolic potential. Most of these compounds have been withdrawn from the legal market. However, they are found to be illicitly added to otherwise inefficient nutritional supplements. These products represent a major problem to doping control. Recently, clinical trials with selective androgen receptor modulators have been started.Sports-Related Issues and Biochemistry of Natural and Synthetic Anabolic SubstancesMaria K. Parr, Ulrich Flenker, Wilhelm Schänzer10.1016/j.ecl.2009.11.004Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-14557http://www.endo.theclinics.com/article/PIIS0889852909001091/abstract?rss=yesThe Athlete Biological Passport (ABP) is an individual electronic document that collects data regarding a specific athlete that is useful in differentiating between natural physiologic variations of selected biomarkers and deviations caused by artificial manipulations. A subsidiary of the endocrine module of the ABP, that which here is called Athlete Steroidal Passport (ASP), collects data on markers of an altered metabolism of endogenous steroidal hormones measured in urine samples. The ASP aims to identify not only doping with anabolic–androgenic steroids, but also most indirect steroid doping strategies such as doping with estrogen receptor antagonists and aromatase inhibitors. Development of specific markers of steroid doping, use of the athlete's previous measurements to define individual limits, with the athlete becoming his or her own reference, the inclusion of heterogeneous factors such as the UDPglucuronosyltransferase B17 genotype of the athlete, the knowledge of potentially confounding effects such as heavy alcohol consumption, the development of an external quality control system to control analytical uncertainty, and finally the use of Bayesian inferential methods to evaluate the value of indirect evidence have made the ASP a valuable alternative to deter steroid doping in elite sports. The ASP can be used to target athletes for gas chromatography/combustion/ isotope ratio mass spectrometry (GC/C/IRMS) testing, to withdraw temporarily the athlete from competing when an abnormality has been detected, and ultimately to lead to an antidoping infraction if that abnormality cannot be explained by a medical condition. Although the ASP has been developed primarily to ensure fairness in elite sports, its application in endocrinology for clinical purposes is straightforward in an evidence-based medicine paradigm.Endogenous Steroid Profiling in the Athlete Biological PassportPierre-Edouard Sottas, Martial Saugy, Christophe Saudan10.1016/j.ecl.2009.11.003Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-15973http://www.endo.theclinics.com/article/PIIS0889852909000887/abstract?rss=yesThe potential ergogenic effects of asthma medication in athletes have been controversially discussed for decades. The prevalence of asthma is higher in elite athletes than in the general population. The highest risk for developing asthmatic symptoms is found in endurance athletes and swimmers. In addition, asthma seems to be more common in winter-sport athletes. Asthmatic athletes commonly use inhaled β2-agonists to prevent and treat asthmatic symptoms. However, β2-agonists are prohibited according to the “Prohibited List of the World Anti-Doping Agency” (WADA). Until the end of 2009 an exception was only allowed for the substances formoterol, salbutamol, salmeterol, and terbutaline by inhalation, as long as a so-called therapeutic use exemption has been applied for and was granted by the relevant anti-doping authorities. From 2010 salbutamol and salmeterol are allowed by inhalation requiring a so called declaration of use.Ergogenic Effects of Inhaled β2-Agonists in Non-Asthmatic AthletesBernd Wolfarth, Jan C. Wuestenfeld, Wilfried Kindermann10.1016/j.ecl.2009.10.005Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-17587http://www.endo.theclinics.com/article/PIIS0889852909000942/abstract?rss=yesStimulants have been frequently detected in doping control samples and represent a structurally diverse class of compounds. Comprehensive sports drug-testing procedures have been developed using gas or liquid chromatography combined with mass spectrometric detection, and they have revealed various adverse analytical findings, as demonstrated with 2 examples, 4-methylhexan-2-amine and methoxyphenamine. Moreover, the necessity of controlling the use or misuse of stimulating agents is outlined by means of pseudoephedrine, a compound that was prohibited in sports until the end of 2003. Since the ban was lifted, monitoring programs proved a significant increase in pseudoephedrine applications as determined from urine samples collected in competition. As a consequence, a reimplementation of this drug in future doping controls was decided.Stimulants and Doping in SportMario Thevis, Gerd Sigmund, Hans Geyer, Wilhelm Schänzer10.1016/j.ecl.2009.10.011Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-189105http://www.endo.theclinics.com/article/PIIS088985290900084X/abstract?rss=yesCertain international sports federations are requesting that glucocorticoids (GCs) be removed from the World Antidoping Agency's list of banned products. Their arguments are based on the fact that GCs are in widespread use in sports medicine and have no demonstrated ergogenic activity. This article shows that there is scientific evidence that GCs mediate ergogenic effects in animals and humans. Moreover, the health risks of using GCs are well characterized. GCs are doping agents and should remain on the World Antidoping Agency's list of banned products.Glucocorticoids: A Doping Agent?Martine Duclos10.1016/j.ecl.2009.10.001Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1107126http://www.endo.theclinics.com/article/PIIS0889852909000917/abstract?rss=yesDehydroepiandrosterone (DHEA) is secreted by the zona reticularis of the adrenal cortex and is converted into potent sex steroids in peripheral target cells. As oral DHEA administration can lead to dose-dependent increases in circulating androgens, which may reach high supraphysiologic levels in women, it has been included in the list of prohibited substances by the World Anti-Doping Agency (WADA). However, evidence for an ergogenic activity of DHEA is still largely nonexistent. Randomized trials in elderly subjects with an age-dependent decrease in DHEA have provided little or no evidence for enhanced physical performance after long-term administration of DHEA, 50 mg/d, and smaller short-term studies in healthy male athletes using higher doses were completely negative. Thus the widely perceived performance-enhancing activity of DHEA is still more myth than reality. However, because studies in female athletes are still lacking, an ergogenic activity of high-dose DHEA in this population cannot be excluded but is expected to be associated with adverse events like hirsutism, acne, and alopecia.Dehydroepiandrosterone to Enhance Physical Performance: Myth and RealityStefanie Hahner, Bruno Allolio10.1016/j.ecl.2009.10.008Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1127139http://www.endo.theclinics.com/article/PIIS0889852909000875/abstract?rss=yesHemoglobin concentration is one of the principal factors of aerobic power and, consequently, of performance in many types of physical activities. The use of recombinant human erythropoietin is, therefore, particularly powerful for improving the physical performances of patients, and, more generally, improving their quality of life. This article discusses procedures for monitoring recombinant erythropoietin and its analogues in doping for athletic performance.Procedures for Monitoring Recombinant Erythropoietin and Analogs in DopingSéverine Lamon, Neil Robinson, Martial Saugy10.1016/j.ecl.2009.10.004Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1141154http://www.endo.theclinics.com/article/PIIS088985290900108X/abstract?rss=yesThe female athlete triad is an increasingly prevalent condition involving disordered eating, amenorrhea, and osteoporosis. An athlete can suffer from all 3 components of the triad, or just 1 or 2 of the individual conditions. The main element underlying all the aspects of the triad is an adaptation to a negative caloric balance. Screening for these disorders should be an important component of an athlete's care. Prevention and treatment should involve a team approach, including a physician, a nutritionist, and a mental health provider.Anorexia, Bulimia, and the Female Athlete Triad: Evaluation and ManagementFelicia A. Mendelsohn, Michelle P. Warren10.1016/j.ecl.2009.11.002Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1155167http://www.endo.theclinics.com/article/PIIS0889852909001078/abstract?rss=yesThis article discusses the inevitable use of growth factors for enhancing muscle strength and athletic performance. Much effort has been expended on developing a treatment of muscle wasting associated with a range of diseases and aging. Frailty in the aging population is a major socioeconomic and medical problem. Emerging molecular techniques have made it possible to gain a better understanding of the growth factor genes and how they are activated by physical activity. The ways that misuse of growth factors may be detected and verified in athletes and future challenges for detecting manipulation of signaling pathways are discussed.Growth Factors, Muscle Function, and DopingGeoffrey Goldspink, Barbara Wessner, Harald Tschan, Norbert Bachl10.1016/j.ecl.2009.11.001Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1169181http://www.endo.theclinics.com/article/PIIS0889852909000851/abstract?rss=yesEndurance athletes demonstrate an exceptional resistance to fatigue when exercising at high intensity. Much research has been devoted to the contribution of aerobic capacity for the economy of endurance performance. Important aspects of the fine-tuning of metabolic processes and power output in the endurance athlete have been overlooked. This review addresses how training paradigms exploit bioenergetic pathways in recruited muscle groups to promote the endurance phenotype. A special focus is laid on the genome-mediated mechanisms that underlie the conditioning of fatigue resistance and aerobic performance by training macrocycles and complements. The available data on work-induced muscle plasticity implies that different biologic strategies are exploited in athletic and untrained populations to boost endurance capacity. Olympic champions are probably endowed with a unique constitution that renders the conditioning of endurance capacity for competition particularly efficient.Training Modalities: Impact on Endurance CapacityMartin Flueck, Wouter Eilers10.1016/j.ecl.2009.10.002Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1183200http://www.endo.theclinics.com/article/PIIS0889852909000930/abstract?rss=yesHugh Montgomery's discovery of the first of more than 239 fitness genes together with rapid advances in human gene therapy have created a prospect of using genes, genetic elements, and cells that have the capacity to enhance athletic performance (to paraphrase the World Anti-Doping Agency's definition of gene doping). This brief overview covers the main areas of interface between genetics and sport, attempts to provide a context against which gene doping may be viewed, and predicts a futuristic legitimate use of genomic (and possibly epigenetic) information in sport.The Human Genome and Sport, Including Epigenetics, Gene Doping, and AthleticogenomicsN.C. Craig Sharp10.1016/j.ecl.2009.10.010Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1201215http://www.endo.theclinics.com/article/PIIS0889852909001236/abstract?rss=yesIndex10.1016/S0889-8529(09)00123-6Endocrinology and Metabolism Clinics of North America 39, 1 (2010)2010-03-01Endocrinology and Metabolism Clinics of North America2010-03-01391S0889-8529(09)X0007-1217241