Endocrine Today Editorial Board members take a look ahead at 2013

The top trends for 2013 include two new drugs for osteoporosis (a sclerostin inhibitor and a cathepsin inhibitor); further use of genetic testing to decide which patients with indeterminate thyroid nodules should be sent to surgery; and hopefully more about regenerating beta cells in diabetes.

Closed-Loop (fully automatic) insulin pumps will become part of the treatment options available for treating patients with type 1 diabetes. Prototype models are already being tested in clinical research centers and extended to "diabetes camp" settings. It's not far-fetched to believe that in-home therapy will begin undergoing trials in the near future; a process that likely has already begun, but is not yet widely known. Despite ongoing challenges, I believe these new automatic pumps will maintain glucose concentrations in the range of ~80-140 mg/dL and will revolutionize the care of children (and all ages for that matter) with type 1 diabetes by avoiding severe hypoglycemia, and possibly ketoacidosis. Rapid technological advances in electronics and circuitry, plus advances in glucose sensing devices are making this prediction possible.

Additionally, whole "exome" sequencing will become part of routine investigation for rare or unknown genetic mutations responsible for hitherto poorly understood syndromes involving the endocrine system. This approach has already been exploited and described in the literature; I expect a burgeoning field with new endocrine discoveries emanating from the ability to do these tests at reasonable cost.

In the end, in prophesying I keep in mind Yogi Berra's dictum: "No one can predict the future, cause it ain't been here yet."

I think the increasing use of clinical genomics will be a major new trend in endocrinology going forward to confirm or rule out hereditary endocrine disorders; predict which patients will respond best to pharmacologic agents for diseases that have many therapeutic options (e.g. type 2 diabetes); and identify new pathways that lead to the formation of endocrine tumors.

In the coming year, I foresee that we will be using more cocktails of combined receptor-targeted therapies for endocrine tumors. We will also be testing newer delivery modes for peptide therapies, including more long-acting, as well as oral, preparations. We will also be seeing more long-term gamma-knife results and safety profiles for therapy targeting pituitary tumors.