Book Review

The Pituitary

N Engl J Med 1995; 333:1789December 28, 1995

Article

The Pituitary
Edited by Shlomo Melmed. 729 pp., illustrated. Cambridge, Mass., Blackwell Science, 1995. $150. ISBN: 0-86542-126-9

The pituitary gland is considered the master gland for the regulation of endocrine function. It serves to integrate signals from the brain, transduced into endocrine signals by the hypothalamus, and from hormones and metabolites from the periphery, which enter the pituitary through the bloodstream. The pituitary not only integrates but also amplifies the signals it receives, and any dysfunction of the pituitary gland can have profound effects on adrenal, reproductive, thyroid, and metabolic functions, as well as on development and growth.

Over the past 25 years, there have been major advances in research on the pituitary, including the isolation and characterization of the hypothalamic regulatory hormones, as well as many of their receptors, and a better understanding of cell biology and molecular regulation of the synthesis and release of pituitary hormones. Along with this progress, there have been advances in the diagnosis of pituitary disease, such as the development of specific and sensitive hormone assays and improvements in neuroradiologic techniques and nuclear medicine. The management of pituitary tumors and abnormalities of pituitary function has been improved by these developments and by advances in microsurgical techniques and pharmacologic regulation of pituitary hormone secretion and cell function. From a clinical perspective, advances in our understanding of the pathological characteristics of the pituitary have been particularly important, allowing classification and understanding of the different types of pituitary tumors.

This book covers the pituitary in depth. The five sections of the book deal with normal hypothalamic–pituitary function, hypothalamic–pituitary dysfunction, pituitary tumors, pituitary disease in systemic disorders, and diagnostic procedures. Each chapter presents the views of experts and provides a detailed discussion of problems in the field.

The clinical chapters integrate physiology and cell biology, clinical manifestations, diagnostic strategies, and management. There are two important omissions. First, the book lacks a detailed discussion by a pituitary surgeon of the pathology of pituitary tumors and pituitary surgery. Surgery is the cornerstone of treatment for most pituitary tumors. Second, color illustrations would have greatly augmented the clinical photographs and the illustrations accompanying the discussions of neuro-ophthalmology and pathology.

I strongly recommend this book. It fills a void in the literature by providing in-depth coverage of the pituitary. The book will serve endocrinologists as a source of information on the various aspects of pituitary disease, blending clinical and basic science into a cohesive and comprehensive story.

Michael O. Thorner, M.B., D.Sc.
University of Virginia School of Medicine, Charlottesville, VA 22908