Book Review

Molecular Endocrinology: Basic concepts and clinical correlations

N Engl J Med 1995; 332:828-829March 23, 1995

Article

Molecular Endocrinology: Basic concepts and clinical correlations
Edited by Bruce D. Weintraub. 568 pp., illustrated. New York, Raven Press, 1994. $158. ISBN: 0-7817-0223-2

This book, which has contributions by some 70 leading authorities in molecular endocrinology, can be recommended as a detailed reference for clinical endocrinologists and investigators in basic science. Molecular Endocrinology maintains a high scientific standard throughout its 568 pages, has an up-to-date reference list, and is pedagogically well designed, with some 170 illustrations. This book is just as well written and authoritative as the classic Williams Textbook of Endocrinology (J.D. Wilson and D.W. Foster, eds. Philadelphia: W.B. Saunders, 1992), which was written mainly for clinicians, but better highlights pathogenetic mechanisms from a molecular perspective.

The book is well organized and consists of three parts. The first covers the basic terminology of cell and molecular biology and relevant methods, such as recombinant-DNA techniques. This part, which will serve to orient clinicians, contains excellent descriptions of methods for detecting mutations in the human genome, DNA sequence analysis, transgenic mice, and the interaction between intracellular signaling systems and the transcriptional regulation of endocrine genes. There is also a didactic description of the clinical applications of these methods.

The second part of the book covers the molecular mechanisms of action of hormones on peripheral target cells. There is a detailed and relatively theoretical account of the cloning and cellular expression of receptors for polypeptide and steroid hormones. One of the best chapters in this section is a comprehensive discussion of how the superfamily of receptors for vitamins and steroid and thyroid hormones is governed. There is also a brief survey of cytokines, insulin-like growth factors, and growth-factor–binding proteins, all of which may serve as modulators of hormonal actions. In recent years these polypeptides have attracted much clinical interest. The chapters on the molecular regulation of receptor expression, including response elements and transcriptional and post-transcriptional control, are too detailed and hard to digest and, in my opinion, have been given too much emphasis. However, considerable effort has been made to integrate the information about these control mechanisms, as exemplified in the chapter on thyroid hormones. In its entirety, however, this second part of the book may be more useful to basic scientists than to clinicians.

The third part of Molecular Endocrinology contains the chapters of greatest interest to clinicians. These chapters deal with genetically determined and acquired endocrinopathies. There is an extensive and authoritative description of insulin-dependent diabetes mellitus by George Eisenbarth. However, to my surprise, noninsulin-dependent diabetes mellitus, which is much more prevalent, is barely covered. The mutations in the insulin-receptor gene in patients with extreme insulin resistance are discussed, but the quantitative importance of these defects in non-insulin-dependent diabetes mellitus is still a matter of much debate. A comprehensive account of this common disease should have included the metabolic syndrome and the recently described aberrations in glucose transport and substrate metabolism in diabetic pancreatic beta cells. Despite this flaw, several well-written chapters in this section deal with molecular mechanisms of autoimmune thyroid disease, hypogonadism, androgen resistance, vitamin D resistance, and familial glucocorticoid resistance. The chapters on defects in receptors for thyroid hormones in peripheral target tissues and in thyroid hormone–binding serum proteins are worth reading. They explain why some patients with clinically clear-cut hypothyroidism fail to have low thyroid hormone levels in blood. The book ends with a mind-bending chapter on novel concepts of endocrine therapy with recombinant hormones and growth factors. Notably, however, gene therapy and other therapeutic considerations for the future are not mentioned.

This work will not be of much use in primary health care units, but it will surely have a place on the shelves of endocrinologists and internists. One of the book's major assets is that it successfully bridges the gap between basic science and clinical endocrinology and focuses on pathogenetic and therapeutic aspects of molecular endocrinology. This book will be useful chiefly as an up-to-date reference for endocrinologists and internists, and possibly also in the training of residents in endocrinology and internal medicine. The book may also prove useful as a review for basic scientists working in experimental endocrinology, although its value in this context may be short-lived because of the rapid expansion of knowledge in this scientific discipline.

Åke Sjöholm, M.D., Ph.D.
Karolinska Institute, S-171 Stockholm, Sweden