[Testosterone: a treatment for the prevention of cardiovascular disease]

Testosterone treatment was largely prescribed and marketed as a potential therapy to treat symptoms of aging. Testosterone levels decrease progressively with aging and low testosterone levels were associated with an increase risk of cardiovascular events and death. Controversies persist whether this association is causal or mediated by confounders of the general health. Systematic screening of testosterone is not recommended in a check-up visit, but only in case of suggestive symptoms. Furthermore a recent meta-analysis and large prospective cohort studies have reported a concern regarding the safety of testosterone therapy and the associated risk of major cardiovascular events. The decision to prescribe testosterone should be made with the patient after evaluating the risks and benefits.

[Non diabetic hypoglycemia: diagnosis and management]

Organic or non diabetic hypoglycemia (NDH) is a rare disease when it is confirmed, but is often confounded with low blood glucose concentration (between 3 and 4 mmol/I), which is much more frequent. NDH's definition requires the Whipple triad (plasma glucose level <2.8 mmol/l, symptoms of neuroglycopenia and their relief with administration of sugar). The diagnostic approach needs to differentiate the healthy from the sick patient, who's hypoglycemia causes are multiple and frequent, such as: toxic (medicament, OH), organ deficiency, denutrition and sepsis. When hypoglycemia is suspected, without evident causes in healthy persons, it should be investigated by a 72 h fast test, in order to guide the diagnosis. After confirmation of an endogen hyperinsulinism only, sophisticated imaging should be done to localize the tumor and/or to exclude alternatives diagnosis.

[Central diabetes insipidus: diagnosis and management]

Central diabetes insipidus (CDI) is caused by deficient secretion of antidiuretic hormone (ADH) due to different conditions that can affect the hypothalamic neurons. It results in an inability to retain normal quantities of free water, which leads to polyuria, including at night, and polydipsia. In adults, it is mostly due to the "idiopathic" form or present after pituitary surgery or a traumatic brain injury. In rare cases, an underlying systemic disease is found. The diagnosis of CDI is based on the water deprivation test. Pituitary MRI and specific clinical and biological work-up are recommended to precise etiology. Treatment of choice is desmopressin, a synthetic analogue of the endogenous ADH hormone. A multidisciplinary team generally provides management and monitoring of CDI.

[How to prevent severe hypoglycemia in older patients with type 2 diabetes]

Severe hypoglycemia is a feared complication of treatment in older diabetic patients (> 75 years) and a limiting factor for good glycemic control. Its real incidence is not well studied and probably underestimated. Cognitive impairment, malnutrition and/or cachexia, polypharmacy and a recent hospitalization are risk factors for severe hypoglycemia specific for older patients. Cognitive impairment screening can identify patients unable to manage their treatment. Simplification of treatment and/or transferring its execution to relatives must then be considered. Prevention also involves the detection of malnutrition and comorbidities, Age-adjusted therapeutic targets (HbA1c 7-8%) are important to avoid an exceedingly strict glycemic control. However, giving up on good glycemic control is not an adequate prevention strategy in itself.