Book Review

Endocrinology: Basic and clinical principles

N Engl J Med 1997; 337:1479-1480November 13, 1997

Article

Endocrinology: Basic and clinical principles
Edited by P. Michael Conn and Shlomo Melmed. 448 pp. Totowa, N.J., Humana Press, 1997. $125. ISBN: 0-89603-349-X

The development and understanding of hormone physiology and its disturbances were initially based on bioassays, but from the mid-1960s the increasing accuracy of immunoassays heralded numerous rapid advances. The steroid era gave way to the peptide period, with the ability to test and understand complex features of hormonal interactions, such as feedback mechanisms, responses to physical signals in the internal and external environments, and the influences of endocrine changes on the mind and body. These advances were the foundation for the new knowledge of the pathophysiology of endocrine diseases and many of the physical manifestations of stressful experiences and primary psychiatric disorders. To understand hormonal diseases and to care properly for patients, the conscientious endocrinologist needed to be educated in these basic physiologic principles. And nonclinical scientists frequently wished to understand the clinical context of the systems in which they worked. There has always been a need for dialogue, communication, and mutual education among the nonclinical and clinical members of the endocrine fraternity.

How much greater is this need now? The revolution wrought by molecular biology has affected endocrinology dramatically, which makes it vital for clinical and nonclinical scientists to continue to understand each other. It is particularly difficult for established clinicians to understand the importance of the new discoveries, even though they are often desperate to do so. For some, it is hard even to understand the language.

Textbooks of clinical endocrinology usually introduce the basic science of the subject, but this introduction is often woefully inadequate and outdated. Therefore, this book, designed to describe the new basic science of endocrinology to clinicians, is timely. It does succeed in good part.

In the limited space it has, the book concentrates on principles of recent advances in molecular biology: receptors as mediators of signals, the molecular biology of receptors, structure and processing, intracellular messengers, signal transduction, and hormone-induced gene transcription. There is a much less thorough presentation of classic physiologic relations, even though they are just as “basic” in principle, but this material can be found in established textbooks of endocrinology.

The most successful chapters are those on prostaglandins, the neuroendocrine–immune interface, genes and tumorigenesis, the adrenal medulla, and the gastrointestinal tract. The section on stress in the chapter on the brain is excellent, but why is the role of endogenous opiates not given greater prominence here and elsewhere? And why is there only a 12-page chapter on the anterior pituitary hormones but a 23-page chapter on the posterior pituitary hormones that really only presents one hormone of importance? The chapters on insect and plant hormones are too brief to offer much value to the human physiologist or clinician. Most chapters contain too few or no specific references but simply, and helpfully, offer a few (10 to 15) sources for further reading. Some chapters, however, give large numbers of specific references (e.g., approximately 100 in the chapter on the gut). Stronger editorial direction was perhaps needed.

No section of this book would be adequate for any aspect of clinical practice, because the descriptions are too brief and discussions of aspects of management are largely absent. The pure scientist might find the clinical descriptions helpful; however, I suspect the science would not help a basic scientist but would certainly provide an adequate, relevant, and indeed excellent base for a clinician interested in endocrinology.

I am pleased to recommend the book.

Michael Besser, M.D., D.Sc.
St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom