Book Review

Principles and Practice of Pediatric Endocrinology

N Engl J Med 2006; 354:2519-2520June 8, 2006

Article

Principles and Practice of Pediatric Endocrinology
Edited by Michael S. Kappy, David B. Allen, and Mitchell E. Geffner. 939 pp., illustrated. Springfield, Ill., Charles C Thomas, 2005. $129.95. ISBN: 0-398-07554-9

The father of the subspecialty of pediatric endocrinology is Lawson Wilkins. In 1935, at the request of Edwards Park, who directed the Harriet Lane Home of Johns Hopkins University, Wilkins, a private pediatric practitioner in Baltimore, established the Pediatric Endocrine Clinic at the Harriet Lane Home. In 1950, Wilkins edited the first textbook on endocrinology, The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence (Springfield, Ill.: Charles C Thomas). Since then, at least 10 other outstanding comprehensive books have delved into the molecular underpinnings of endocrine disorders and have included chapters on diabetes. Nevertheless, Wilkins's textbook remains indispensable for pediatric endocrinologists more than 50 years after its publication.

Wilkins knew that a visual demonstration of clinical experience and case presentations were exemplary teaching tools. Indeed, what distinguishes his original book and its subsequent editions from other books is the abundance of carefully chosen photographs, tables, graphs, and case presentations that illustrate the common and the not-so-common endocrine disorders. Over the years, these vignettes have provided countless students, house officers, nurses, residents, fellows, clinical investigators, and academics with the opportunity to grasp the clinical manifestations of endocrine disorders.

Principles and Practice of Pediatric Endocrinology is the newest legacy of Wilkins's work. It furthers its predecessor's goals with an outstanding collection of new illustrations. Moreover, in the atlas sections and case presentations that follow most chapters, it retains many of the original contributions of Wilkins and his colleagues. The editors, Michael S. Kappy, David B. Allen, and Mitchell E. Geffner, have gathered an accomplished group of pediatric endocrinologists who provide well-balanced descriptions of the major childhood and adolescent endocrine disorders. They articulate clearly the molecular and cellular, genetic, and biochemical bases of these processes.

Truly exceptional is the first chapter, by Allen W. Root and Alan D. Rogol, on the organization and function of the endocrine system. Root and Rogol have written a straightforward description of current knowledge about hormone synthesis, types of receptors, and hormone actions. They conclude their chapter with a timely review of the regulation of appetite at the cellular level. The chapter that follows, entitled “Normal Growth and Growth Disorders,” is replete with excellent graphics and clearly addresses new issues in the classification and pathophysiology of growth disorders in childhood and adolescence.

Nearly all the chapters outline treatment options in practical terms. The chapter entitled “Puberty and Its Disorders” gives a thorough review of the hormones responsible for normal development in puberty and presents current data relating to precocious and delayed puberty. It also defines current treatment paradigms for these states. Another chapter, entitled “The Thyroid Gland and Its Disorders,” provides the reader with an impressive and focused overview of the embryology, ontogeny, and function of the thyroid gland. This chapter also includes excellent suggestions for treatment regimens.

Although there is some redundancy in the chapters on the adrenal gland and on errors of sexual differentiation, the historical background and discussions of the general physiology of adrenal hormone synthesis are exceptional. The section on dynamic testing of adrenal-gland function — often confusing to practitioners — is a very useful inclusion. Similarly, practitioners can rely on a discussion of those issues they should consider when counseling the family of a child with a disorder of sexual differentiation. The chapter on disorders associated with calcium, phosphate, parathyroid hormone, and vitamin D elucidates the recent understanding of the many genetic and biochemical controls of mineral metabolism. The chapter on disorders of the posterior pituitary gland serves as an excellent guide for diagnosing these disorders. Likewise, the final chapter provides an integrative approach to the evaluation of endocrine dysregulation in children with chronic diseases. It also provides a comprehensive review of endocrine treatments for children after therapy for various cancers.

Pediatric endocrinology clearly has advanced from a descriptive clinical subspecialty to one in which the identification and characterization of underlying genetic, molecular, or biochemical mechanisms of many disorders have prompted the development of targeted treatment regimens. Of course, the cures for many of the disorders described in this book await future discovery. Molecular characterization of these disorders probably will lead to the use of gene therapies. By building on the successful aspects of Wilkins's original book on pediatric endocrinology and adeptly integrating the newer points of bench-based research, the editors of Principles and Practice of Pediatric Endocrinology have produced an excellent resource for all those who will be involved in these upcoming challenges.

Sharon E. Oberfield, M.D.
Columbia University Medical Center, New York, NY 10032