Book Review

Clinical Pediatric Endocrinology

N Engl J Med 1993; 328:979April 1, 1993

Article

Clinical Pediatric Endocrinology
Edited by Wellington Hung. 407 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $52. ISBN: 0-8016-6266-4

Hung and his colleagues have designed their textbook as a practical guide to the physiologic evaluation, diagnosis, and treatment of endocrine disorders in infants, children, and adolescents. It is written for pediatric house officers and practicing pediatricians and is intended as a preliminary resource for beginning fellows in pediatric endocrinology.

The text is comprehensive; each chapter begins with an introduction to physiologic principles. However, some chapters present a large number of concepts without providing a unified and simple summary which would make them easier to comprehend.

The issue that separates pediatric endocrinologists from their colleagues in internal medicine and gynecology is the matter of growth and sexual development. In a number of chapters, but especially “Normal Growth and Development,” most conditions affecting growth and development are considered. The differential diagnosis of these disorders could have been put into the context of probable common diagnoses -- for example, altered patterns of physiologic growth as opposed to pathologic causes.

The chapter on the anterior pituitary and its disorders is generally complete, but more detailed coverage of imaging of the hypothalamic-pituitary area is needed, since such techniques are now standard in many centers. In general, it would be helpful to increase the emphasis on endocrine-gland imaging; perhaps a second edition could devote an entire chapter to this evolving subject.

Much about polyglandular autoimmune endocrinopathies is discussed in chapter 4, “Parathyroid Glands, Calcium, Phosphorus, and Vitamin D Metabolism.” Additional references to this family of diseases are made in the chapters on the adrenal glands, thyroid, and diabetes mellitus. For ease of reading I would have preferred a major section (or small chapter) on this subject, with references to this section in each of the appropriate chapters.

The prenatal diagnosis and prediagnosis treatment of fetuses at risk for congenital virilizing adrenal hyperplasia is controversial. This subject could have been discussed more extensively, since the theoretical benefit of fetal treatment by administration of glucocorticoid to the mother is not always realized in practice.

The differential diagnosis of Cushing's syndrome is undergoing considerable change, although not without controversy. The use of ovine corticotropin-releasing hormone and intensive imaging and catheterization of the petrosal sinuses should be mentioned in more detail as this book is revised.

The chapter on hypoglycemia emphasizes the age-related differential diagnosis of this condition. Perhaps other chapters could share this emphasis, since this approach would be most helpful to the intended audience.

In the grand scheme of things, where does the book fit? Despite my criticisms, this book is well suited for its intended audience. Pediatric house officers, junior fellows in endocrinology, and especially practitioners of pediatrics and family medicine could easily find in it information to help them organize an approach to diagnosis and treatment. A revised edition with some alteration in organization, a more comprehensive section on imaging, and due attention to the reproduction of some of the tables (some of which have print that is far too small) would enhance this useful textbook.

Alan D. Rogol, M.D., Ph.D.
University of Virginia Health Sciences Center, Charlottesville, VA 22908