Book Review

Diseases of the Pituitary: Diagnosis and treatment

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

Article

Diseases of the Pituitary: Diagnosis and treatment
(Contemporary Endocrinology.) Edited by Margaret E. Wierman. 405 pp., illustrated. Totowa, N.J., Humana Press, 1997. $125. ISBN: 0-896-03364-3

Pituitary diseases may present with a wide array of symptoms and signs, and patients with these disorders may initially contact a general practitioner, an ophthalmologist, a neurologist, or an orthopedist before they are finally referred to an endocrinologist or neurosurgeon. In the past 10 years, there have been many advances in the molecular biology and physiology of the hypothalamic–pituitary system, while clinical achievements have been mainly in improved imaging of the pituitary region and more effective drug treatment of pituitary tumors, especially prolactinomas, often obviating tumor excision.

Diseases of the Pituitary provides an overview of recent developments in basic research on hypothalamic–pituitary physiology and the diagnosis and treatment of disorders of the pituitary. The panel of authors was well chosen, and the thematic organization is systematic. The molecular and cellular ontogeny of distinct pituitary cell types is the subject of the first chapter, followed by a chapter on the clinical aspects of hypopituitarism. Thereafter, advances in the physiology and molecular biochemistry of the various hormonal axes of the pituitary are discussed and referenced separately and extensively; each discussion is followed by one or two chapters on the clinical aspects of the same hormonal axis. The concluding chapters take up imaging of the sella and perisellar regions, neurosurgical techniques (an excellent chapter), and the immunohistochemistry of pituitary adenomas. It is regrettable that vasopressin physiology, diabetes insipidus, and the syndrome of inappropriate vasopressin secretion were not found worthy of inclusion in this book, although the adenohypophysis and neurohypophysis are intimately interrelated physiologically and clinically. A separate chapter on the various methods of pituitary-tumor irradiation, their success rates, and their side effects is also missing. These topics would have perfectly completed a book on the pituitary.

Nevertheless, the various chapters on the anterior pituitary can be highly recommended to medical students and to physicians who need an update on the biology of pituitary hormones and on recent developments in the diagnosis and treatment of disorders of the pituitary.

Wolfgang K.H. Oelkers, M.D.
Freie Universität Berlin, 12200 Berlin, Germany