Book Review

Hormone Replacement Therapy

N Engl J Med 2000; 342:297-298January 27, 2000

Article

Hormone Replacement Therapy
(Contemporary Endocrinology.) Edited by A. Wayne Meikle. 439 pp. Totowa, N.J., Humana Press, 1999. $125. ISBN: 0-89603-601-4

Hormones (from the Greek word for messenger) . . . are among the most powerful substances known to man. In some instances their potency transcends credence. They govern such diverse and extraordinary phenomena as the rate of fuel utilization by the body, growth, physical activity, emotional configuration, sex, and the degree of maleness (or femaleness), among other things,” wrote the endocrinologist Fuller Albright more than 50 years ago (Fuller Albright and Read Ellsworth. Uncharted Seas. Edited by Lynn Loriaux. Portland, Oreg.: Kalmia Press, 1990). At the time, endocrinology was still in its toddler stage. Glandular extracts were being used for the treatment of hormone deficiencies; scientists were beginning to purify, identify, and synthesize hormones; and hormone action and feedback were just beginning to be understood.

Much has been accomplished. To name a few advances, in 1949 cortisone acetate was synthesized in large quantities for therapeutic use, and even though the insulin preparation developed by Frederick Banting and Charles Best was first given as an injection in 1922, purer formulations have been developed and marketed over the past two decades. Pituitary extracts were used for growth hormone replacement until the mid-1980s, when Creutzfeldt–Jakob disease was reported as a complication of their use. Since then, synthetic growth hormone has become available for clinical use. Parathyroid hormone was isolated in the 1950s but became available for the treatment of patients with hypoparathyroidism only in the 1990s.

Hormone Replacement Therapy is the 13th of 21 textbooks published over the past three years as part of a series entitled Contemporary Endocrinology, edited by P. Michael Conn. Whereas classic reference textbooks in endocrinology comprehensively review the physiology, pathophysiology, differential diagnosis, and treatment of endocrine disorders, this textbook is unique in its focus on current hormone-replacement therapy for endocrine diseases. The seven sections of Hormone Replacement Therapy deal with hormone therapy with respect to disorders of the pituitary; disorders of the parathyroid glands and therapy with vitamin D; thyroid diseases; diabetes; disorders of the adrenal glands; and gonads both male and female. The sections on disorders of the pituitary, diabetes, and gonadal dysfunction are the most developed, accounting for more than two thirds of the textbook, whereas those pertaining to adrenal, thyroid, and parathyroid disorders are relatively short. The length of the former sections comes at the cost of some overlap in the chapters that cover diabetes insipidus and male hormone-replacement therapy. The discussion of the male gonads is more extensive than that of the female gonads — appropriately so, however, since a whole textbook entitled Menopause: Endocrinology and Management was published as part of this series in 1999.

Each section of the book contains one to five chapters, which are similar in structure. Each chapter covers, with some variation in length, the physiology, differential diagnosis, and diagnosis of classic hormone-deficiency states but focuses on replacement therapy with a specific hormone of interest. The chapters are written clearly and provide up-to-date, practical, well-balanced reviews of the state of knowledge of hormone therapy. In addition, this book provides an objective overview of studies that explore potential novel indications for hormone therapy. These include the use of growth hormone and adrenal androgens in conditions associated with aging; growth hormone and androgens in the acquired immunodeficiency syndrome; and androgen replacement in matters related to sexual behavior. Noteworthy features include helpful dosing algorithms for replacement therapy, with a wealth of tables that describe the indications for, effects of, and composition of various forms of hormone therapy available to date. Other useful features include tables that summarize the results of studies on controversial or new topics as well as extensive, up-to-date references.

“In the final analysis very little is known about anything, and much that seems true today turns out to be only partly true tomorrow,” Albright wrote, reflecting on the state of affairs of medicine in general and endocrinology in particular, in his 1948 textbook (Fuller Albright and Edward Reifenstein. The Parathyroid Glands and Metabolic Bone Disease. Baltimore: Williams and Wilkins, 1948). Hormone Replacement Therapy illustrates how far hormone-replacement therapy has come since the days of Albright and his insightful description of hormones. This textbook is a welcome addition to the references used by physicians faced with the challenging task of treating patients with hormone deficiencies.

Ghada El-Hajj Fuleihan, M.D., M.P.H.
American University of Beirut, Beirut, Lebanon