Clinical Endocrinology in the near future: a post-modern challenge.

Abstract

Clinical Endocrinology is nowadays the clinical specialty specifically linked to translational research. Until the 1960s, endocrine clinical work-ups were based, especially in Europe, on bed-side examinations and on phenotype inspection, which was the main diagnostic tool for the diagnosis of endocrine disorders with a clinical approach strongly based on reductionism. Phenotype-based diagnosis might involve a decision delay with the risk that the organ or system damage could more often than not become irreversible. Thanks to advanced technologies, endocrinologists can now formulate a diagnosis and confirm it when the disorder is identified at a preclinical, rather than subclinical stage, without the obvious phenotypic features. The possibility of measuring very low amount of circulating chemical signals prior to and after the performance of provocative tests by stimulatory or inhibitory substances has detached Clinical Endocrinology from internal medicine, and endocrinologists have paid the price of a typical reductionist approach, as opposed to a holistic approach presumptuously adopted by non-endocrinologist internal medicine academics.