Williams _ Giáo trình nội tiết

Trong hơn 65 năm, Williams giáo trình nội tiết trở thành tiêu chuẩn vàng trong lĩnh vực này, hướng dẫn mọi khía cạnh rối loạn của hệ thống nôi tiết ở người lớn cũng như trẻ em Phiên bản này cập nhật kỹ lưỡng, mang lại cho bạn kiến thức toàn diện và cập nhật về bệnh tiểu đường, hội chứng chuyển hoá, béo phì, tuyến giáp…giúp bạn chăm sóc tối ưu cho mỗi bệnh nhân. Thu hẹp khoảng cách giữa khoa học và thông tin lâm sàng, là tham khảo hàng đầu dành cho các bác sĩ nội tiết, phụ khoa và nhi khoa

Larsen: Williams Textbook of Endocrinology, 10th ed., Copyright © 2003 Elsevier

Section 1 - Hormones and Hormone Action

1 - Principles of Endocrinology

2 - The Endocrine Patient

3 - Genetic Control of Peptide Hormone Formation

4 - Mechanism of Action of Hormones That Act on Nuclear Receptors

5 - Mechanism of Action of Hormones That Act at the Cell Surface

6 - Laboratory Techniques for Recognition of Endocrine Disorders

Section 2 - Hypothalamus and Pituitary

12 - Hypothyroidism and Thyroiditis

13 - Nontoxic Goiter and Thyroid Neoplasia

Section 4 - Adrenal Cortex and Endocrine Hypertension

14 - The Adrenal Cortex

15 - Endocrine Hypertension

Section 5 - Reproduction

16 - The Physiology and Pathology of the Female Reproductive Axis

17 - Fertility Control: Current Approaches and Global Aspects

18 - Disorders of the Testes and the Male Reproductive Tract

19 - Sexual Dysfunction in Men and Women

Section 6 - Endocrinology and the Life Span

20 - Endocrine Changes in Pregnancy

21 - Endocrinology of Fetal Development

22 - Disorders of Sex Differentiation

23 - Normal and Aberrant Growth

24 - Puberty: Ontogeny, Neuroendocrinology, Physiology, and Disorders

25 - Endocrinology and Aging

Section 7 - Mineral Metabolism

26 - Hormones and Disorders of Mineral Metabolism

27 - Metabolic Bone Disease

27 - Metabolic Bone Disease

28 - Kidney Stones

Section 8 - Disorders of Carbohydrate and Lipid Metabolism

29 - Type 2 Diabetes Mellitus

30 - Type 1 Diabetes Mellitus

31 - Complications of Diabetes Mellitus

32 - Glucose Homeostasis and Hypoglycemia

33 - Obesity

34 - Disorders of Lipid Metabolism

Section 9 - Polyendocrine Disorders

35 - Pathogenesis of Endocrine Tumors

36 - Multiple Endocrine Neoplasia

37 - The Immunoendocrinopathy Syndromes

Section 10 - Paraendocrine and Neoplastic Syndromes

38 - Gastrointestinal Hormones and Gut Endocrine Tumors

39 - Endocrine-Responsive Cancer

40 - Humoral Manifestations of Malignancy

41 - Carcinoid Tumors, Carcinoid Syndrome, and Related Disorders

Appendix: Reference Values

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Larsen: Williams Textbook of Endocrinology, 10th ed., Copyright © 2003 Elsevier

Harvard Medical School

Chief, Division of Endocrinology, Diabetes and Hypertension

Brigham and Women's Hospital

Boston, Massachusetts

Henry M Kronenberg MD

Professor of Medicine

Harvard Medical School

Chief, Endocrine Unit

Massachusetts General Hospital

Boston, Massachusetts

Shlomo Melmed MD

Senior Vice President, Academic Affairs

Cedars Sinai Research Institute

Professor of Medicine and Associate Dean

University of California, Los Angeles, School of Medicine Los Angeles, California

Kenneth S Polonsky MD

Adolphus Busch Professor and Chairman

Department of Medicine

Professor, Department of Cell Biology and Physiology

Washington University School of Medicine

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Larsen: Williams Textbook of Endocrinology, 10th ed., Copyright © 2003 Elsevier

II

SAUNDERS

An Imprint of Elsevier Science

The Curtis Center

Independence Square West

Copyright 1950 by W.B Saunders Company

Copyright renewed 1990 by A.B Williams, R.I Williams

Copyright renewed 1983 by William H Daughaday

Copyright renewed 1978 by Robert H Williams

All rights reserved No part of this publication may be reproduced or transmitted in any

form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the

publisher

Medicine is an ever-changing field Standard safety precautions must be followed, but

as new research and clinical experience broaden our knowledge, changes in

treatment and drug therapy may become necessary or appropriate Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and

duration of administration, and contraindications It is the responsibility of the treating physician, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient Neither the publisher nor the editor assumes any liability for any injury and/or damage to persons or property arising from this publication

Library of Congress Cataloging-in-Publication Data

Williams textbook of endocrinology/P Reed Larsen [et al.].10th ed

Acquisitions Editor: Catherine Carroll

Senior Developmental Editor: Faith Voit

Project Manager: Norman Stellander

Designer: Steven Stave

PIT/MVB

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

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Larsen: Williams Textbook of Endocrinology, 10th ed., Copyright © 2003 Elsevier

III

Contributors

Eli Y Adashi

Presidential Professor of Obstetrics and Gynecology

and John A Dixon Professor and Chair,

Department of Obstetrics and Gynecology,

University of Utah Health Sciences Center,

Salt Lake City, Utah

The Physiology and Pathology of the Female Reproductive Axis;

Fertility Control: Current Approaches and Global Aspects

Lloyd P Aiello

Associate Professor of Ophthalmology,

Harvard Medical School;

Assistant Director,

Beetham Eye Institute;

Investigator and Head,

Section of Eye Research,

Joslin Diabetes Center,

Boston, Massachusetts

Complications of Diabetes Mellitus

Andrew Arnold

Murray-Heilig Chair in Molecular Medicine

and Professor of Medicine and Genetics,

University of Connecticut School of Medicine;

Director, Center for Molecular Medicine,

and Chief, Division of Endocrinology and Metabolism,

UCLA Medical Center;

Co-Director, Female Sexual Medicine Center at UCLA,

Los Angeles, California

Sexual Dysfunction in Men and Women

IV

Laura Berman

Assistant Professor,

Department of Urology,

David Geffen School of Medicine at University of California, Los Angeles; Co-Director, Female Sexual Medicine Center at UCLA,

Los Angeles, California

Sexual Dysfunction in Men and Women

Los Angeles, California

Sexual Dysfunction in Men and Women

Andrew J M Boulton

Professor of Medicine,

University of Manchester;

Consultant Physician,

Manchester Royal Infirmary,

Manchester, United Kingdom

Complications of Diabetes Mellitus

Gastrointestinal Hormones and Gut Endocrine Tumors

Glenn D Braunstein

Professor of Medicine,

University of California, Los Angeles,

School of Medicine;

Chairman, Department of Medicine,

The James R Klinenberg, MD, Chair in Medicine,Cedars-Sinai Medical Center,

Los Angeles, California

Endocrine Changes in Pregnancy

F Richard Bringhurst

Associate Professor of Medicine,

Harvard Medical School;

Albert Einstein College of Medicine,

Bronx, New York

Complications of Diabetes Mellitus

Serdar E Bulun

Associate Professor of Obstetrics-Gynecology and Molecular Genetics; Director, Division of Reproductive Endocrinology and Infertility,

University of Michigan Hospitals,

Ann Arbor, Michigan

Type 2 Diabetes Mellitus

John B Buse

Associate Professor of Medicine;

Chief, Division of General Medicine and Clinical Epidemiology;

Director, Diabetes Care Center,

University of North Carolina School of Medicine,

Chapel Hill, North Carolina

Type 2 Diabetes Mellitus;

Type 1 Diabetes Mellitus

David A Bushinsky

Professor of Medicine and of Pharmacology and Physiology,

University of Rochester School of Medicine and Dentistry;

Chief, Nephrology Unit,

Strong Memorial Hospital,

Rochester, New York

Oregon National Primate Research Center,

Oregon Health and Science University,

Michigan Diabetes Research and Training Center,

University of Michigan Medical School,

Ann Arbor, Michigan

Mechanism of Action of Hormones That Act at the Cell Surface

Roger D Cone

Senior Scientist,

Vollum Institute;

Associate Professor,

Department of Cell and Developmental Biology,

Oregon Health and Science University,

San Francisco, California

Disorders of Sex Differentiation

Diabetes and Bone Diseases,

Mount Sinai School of Medicine;

Attending Physician,

Mount Sinai Hospital,

New York, New York

Thyroid Physiology and Diagnostic Evaluation of Patients with Thyroid Disorders; Thyrotoxicosis;

Hypothyroidism and Thyroiditis

Marie B Demay

Associate Professor of Medicine,

Harvard Medical School;

University of Toronto Faculty of Medicine;

Director, Banting and Best Diabetes Centre,

Toronto General Hospital,

Toronto, Ontario, Canada

Gastrointestinal Hormones and Gut Endocrine Tumors

George S Eisenbarth

Professor of Pediatrics, Medicine, and Immunology,

University of Colorado School of Medicine;

Executive Director,

Barbara Davis Center for Childhood Diabetes,

Denver, Colorado

Type 1 Diabetes Mellitus;

The Immunoendocinropathy Syndromes

Joel K Elmquist

Associate Professor of Medicine and Neurology,

Harvard Medical School,

Gladstone Institute of Cardiovascular Disease,

San Francisco, California

Disorders of Lipid Metabolism

Professor of Pediatrics and Medicine Emeritus,

University of California, Los Angeles,

School of Medicine;

Vice President, Science and Innovation,

Quest Diagnostics Inc.,

Nichols Institute,

San Juan Capistrano, California

Endocrinology of Fetal Development

Eli Friedman

Distinguished Teaching Professor of Medicine,

State University of New York;

Chief, Division of Renal Disease,

Robert F Gagel

Professor of Medicine,

Division of Internal Medicine,

University of Texas/M.D Anderson Cancer Center;

Adjunct Professor of Medicine, Internal Medicine, and Cell Biology, Baylor College of Medicine,

Houston, Texas

Multiple Endocrine Neoplasia

Peter A Gottlieb

Assistant Professor of Pediatrics and Medicine,

Barbara Davis Center for Childhood Diabetes,

University of Colorado Health Sciences Center,

Denver, Colorado

The Immunoendocrinopathy Syndromes

James E Griffin

Professor of Internal Medicine

and Diana and Richard C Strauss Professor in Biomedical Research, The University of Texas Southwestern Medical Center,

Dallas, Texas

Disorders of the Testes and Male Reproductive Tract

IX

Melvin M Grumbach

Edward B Shaw Emeritus Professor of Pediatrics

and Emeritus Chairman, Department of Pediatrics,

University of California, San Francisco,

San Francisco, California

Disorders of Sex Differentiation;

Puberty: Ontogeny, Neuroendocrinology, Physiology, and Disorders

Joel F Habener

Professor of Medicine,

Harvard Medical School;

Associate Physician and Chief,

Laboratory of Molecular Endocrinology,

Massachusetts General Hospital;

Mayo Medical School;

Consultant in Endocrinology and Internal Medicine,

and Chief, Section of Andrology and Male Dysfunction,

Tulane University Health Sciences Center,

New Orleans, Louisiana

Sexual Dysfunction in Men and Women

Cambridge, United Kingdom

Disorders of Sex Differentiation

Michael Kafrissen

Adjunct Professor,

Maternal and Child Health,

University of North Carolina School of Medicine, Chapel Hill, North Carolina; Vice President,

Ortho-McNeil Pharmaceutical Co.,

Raritan, New Jersey

Fertility Control: Current Approaches and Global Aspects

X

George G Klee

Professor of Laboratory Medicine,

Department of Laboratory Medicine,

Mayo Medical School;

Consultant in Clinical Pathology,

Department of Laboratory Medicine and Pathology,

Mayo Clinical Hospitals,

Rochester, Minnesota

Laboratory Techniques for Recognition of Endocrine Disorders

Professor of Medicine and Director,

Neuroendocrine Research Medicine,

New York University School of Medicine;

Attending, Medicine, New York University Medical Center;

Consultant in Medicine, New York Harbor Healthcare Veterans Administration Hospital,New York, New York

Anterior Pituitary

Barbara E Kream

Professor, Departments of Medicine and Genetics and Developmental Biology,

University of Connecticut Health Center,

Chief, Endocrine Unit,

Massachusetts General Hospital,

Erasmus University Rotterdam,

Rotterdam, The Netherlands

Endocrinology and Aging

XI

P Reed Larsen

Professor of Medicine,

Harvard Medical School;

Chief, Division of Endocrinology, Diabetes and Hypertension,

and Senior Physician,

Brigham and Women's Hospital,

South Georgia Medical Center,

University of Pennsylvania School of Medicine;

Chief, Division of Endocrinology, Diabetes, and Metabolism,

Hospital of The University of Pennsylvania,

Department of Behavioral Neuroscience,

Oregon Health and Science University;

Scientist, Vollum Institute,

Oregon Health and Science University,

Portland, Oregon

Neuroendocrinology

Robert W Mahley

Professor of Pathology and Medicine,

University of California, San Francisco;

Director, Gladstone Institute of Cardiovascular Disease,

San Francisco, California

Disorders of Lipid Metabolism

XII

Stephen J Marx

Chief, Metabolic Diseases Branch,

and Chief, Genetics and Endocrinology Section,

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health,

Cedars Sinai Medical Center;

Professor of Medicine and Associate Dean,

University of California, Los Angeles,

Assistant Professor of Medicine,

University of Rochester School of Medicine and Dentistry; Head, Urolithiasis Clinic,

Strong Memorial Hospital,

Rochester, New York

Kidney Stones

Richard W Nesto

Associate Professor of Medicine,

Harvard Medical School, Boston;

Chairman, Department of Cardiovascular Medicine,

Lahey Clinic Medical Center,

Type 2 Diabetes Mellitus;

Type 1 Diabetes Mellitus

Tufts University School of Medicine, Boston;

Chairman, Department of Pediatrics,

Baystate Medical Center,

and Executive Associate Dean and Professor of Medicine,

University of California, Los Angeles,

School of Medicine,

Los Angeles, California

Posterior Pituitary Gland

Johannes A Romijn

Professor of Medicine and Endocrinology,

Credit Union Endowment Professor and Chairman,

Department of Pediatrics, and

Professor, Cell and Developmental Biology,

Oregon Health and Science University;

University of Virginia School of Medicine;

Member, Division of Endocrinology,

Department of Internal Medicine,

University of Virginia Health System,

Charlottesville, Virginia

Endocrine-Responsive Cancer

XIV

Martin-Jean Schlumberger

Professor,

University of Paris, Sud;

Chief, Department of Nuclear Medicine and Endocrine Tumors,

Institute Gustave Roussy,

National Institute of Diabetes and Digestive and Kidney Diseases,

National Institutes of Health,

Queen Elizabeth Hospital,

Birmingham, United Kingdom

The Adrenal Cortex

Gordon J Strewler

Professor of Medicine and Master,

Walter Bradford Cannon Society,

Harvard Medical School;

Physician,

Beth Israel Deaconess Medical Center,

Boston, Massachusetts

Humoral Manifestations of Malignancy

Hopewell, New Jersey

Mechanism of Action of Hormones That Act at the Cell Surface

XV

Joseph G Verbalis

Professor of Medicine,

Department of Medicine,

Georgetown University School of Medicine;

Chief, Division of Endocrinology and Metabolism,

Georgetown University Medical Center,

Washington, D.C

Posterior Pituitary Gland

Aaron I Vinik

Deputy Director and Senior Investigator,

Gladstone Institute of Cardiovascular Disease, San Francisco, California

Disorders of Lipid Metabolism

General Clinical Research Center

and Center for Clinical Investigation,

Brigham and Women's Hospital,

Boston, Massachusetts

Endocrine Hypertension

Jean D Wilson

Charles Cameron Sprague Distinguished Chair in Biomedical Research, The University of Texas Southwestern Medical Center,

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XVII

Foreword

Robert H Williams

The publication of the tenth edition comes 52 years after the first edition of Williams'

Textbook of Endocrinology There had been other large textbooks of endocrinology,

such as Biedl's Innere Sekretion in 19161 and Rolleston's The Endocrine Organs in

Health and Disease in 1936,2 but only a handful of physicians could be identified as endocrinologists by the middle of the twentieth century Consequently, Robert H

Williams exercised "powerful persuasion" to overcome the reluctance of the sales staff

of the W B Saunders Company to publish a book that had no visible audience.3 In fact, however, Williams was correct in predicting a large readership, because its publication coincided with an explosive increase in basic endocrine science and in the application of this basic information to patients, and with the evolution of endocrinology into a

recognized subspecialty of several branches of medicine Indeed, the book has had a

profound impact on endocrine science and on the development of the clinical discipline, and it is appropriate at this time to remember Robert Williams and his contributions to

the field and to Textbook of Endocrinology.

Williams described in a memoir the training and the background that led to his

development of the textbook.4 After his graduation from Washington and Lee University,

he obtained the M.D degree at Johns Hopkins University Medical School in 1934 His house staff training was spread between the Mallory Institute of Pathology at the Boston City Hospital, the Department of Medicine at Vanderbilt (where he did research with Tinsley R Harrison), and the Department of Medicine at Johns Hopkins (where he worked with Warren Longcope) He finished his training at the Massachusetts General Hospital as an endocrine fellow at a time when there were "many quacks in this area throughout the world."4 He and his mentor, Fuller Albright, became good friends and maintained close contact over the years

In 1940, Williams was appointed to the staff of the Endocrine Unit of the Thorndike Laboratory in the Harvard Medical Unit at the Boston City Hospital In 1942, he became head of the Unit, where his research focused principally on the biochemistry and

physiology of thyroid disease, including pioneering work on the treatment of

thyrotoxicosis with thionamide drugs and with radioactive iodine In addition, he

described the syndrome of biotin deficiency and published papers on adrenal

physiology, obesity, and nephrogenic diabetes insipidus

To attract students and fellows into the field, he developed the concept that

"endocrinology is the backbone of metabolism and metabolism is the interstitium of medicine." His students and trainees included at least three future contributors to his textbook, Sidney Ingbar, Peter Forsham, and William H Daughaday Daughaday

describes Williams as a man of extraordinary exuberance and enthusiasm who took great pleasure in lecturing and in bedside teaching and whose motto was "B(bright) and E(early) and on the B(ball)."5

Williams considered himself first and foremost an educator, and in 1948 he moved to the University of Washington as Chairman of the Department of Medicine, where his extraverted and outgoing personality made him a superb teacher, recruiter,

administrator, and institution builder The Endocrine Division in Seattle was very broad and encompassed diabetes mellitus, clinical nutrition, and metabolism, as well as

endocrinology Williams served as President of the Endocrine Society, the American Society for Clinical Investigation, and the Association of American Physicians, and he was the founder of the Association of the Professors of Medicine In brief, he was an academic giant of twentieth century medicine

The founding of the Textbook of Endocrinology evolved from his interest in education:

"In view of the rapid progress in endocrinology and metabolism, and the fact that our unit at Boston City Hospital had registered very high in undergraduate, graduate, and postgraduate teaching, I decided that there was a great need for a new textbook in endocrinology."4 The arrangements for the textbook were completed before Williams left Boston, and the aims were clearly described in the preface to the first edition:

The rapidity and extent of advances in endocrinology have made it increasingly difficult for the student and physician to take full advantage of information available for

understanding, diagnosis and treatment of clinical disorders It is the realization of these difficulties that prompted the writing of this book The main

XVIII

objective is to provide a condensed and authoritative discussion of the management of clinical endocrinopathies, based upon the application of fundamental information

obtained from chemical and physiologic investigations

The product was a book that over the years has served as an effective bridge between clinical medicine and the science of endocrinology There may be no other arena of medicine in which the basic and clinical sciences are so tightly interwoven into one discipline On the one hand, the clinical discipline profits immensely from scientific

advances; on the other hand, clinical observations often raise important questions for investigation and on occasion provide answers that have an impact on basic science

By reflecting advances in both areas, the Williams Textbook was designed to convey the

intellectual excitement of a rapidly changing scientific base and, at the same time, to promote the integration of a spectrum of disciplines ranging from molecular genetics to patient care into a unified discipline The achievement of this aim was possible because, from the initial edition, Williams chose contributors who were at the forefront of the field, thereby ensuring the freshness of each edition

Now, of course, there are several textbooks of endocrinology, but Williams' pioneering book continues to enjoy a growing readership of both the English and the foreign

language editions Williams edited the first five editions, and Edwin L Bierman

completed the editing of the sixth edition after Williams' death in 1979 Jean D Wilson and Daniel W Foster edited the seventh and eighth editions and were joined by Henry

M Kronenberg and P Reed Larsen as editors for the ninth edition For the tenth edition, Larsen and Kronenberg are joined by editors Kenneth S Polonsky and Shlomo

Melmed, and continuing the tradition set by Williams, the editors of the tenth edition have enlisted an outstanding group of new and former contributors Saunders continues

as publisher

Endocrinology has changed in many ways during the past 50 years, and the editorial challenges likewise change with each edition On one level, these challenges reflect scientific advances, such as the explosion of knowledge about hormone action, the development of new and improved diagnostic techniques and imaging modalities, and the application of molecular genetics to biology On another level, the concept that the discipline of endocrinology was defined by the concept of humoral control mechanisms has become blurred by recognition that the endocrine, immune, and neurologic

signaling systems constitute a single integrated system rather than separate control mechanisms The most significant challenge now, however, is the same as that faced

by all textbooks at a time when the volume of published information is rapidly

increasing, namely the dilemma of how to take full advantage of developments in

electronic publishing and the evolving revolution in information retrieval systems to devise effective learning systems for the near and remote futures The fundamental educational issues are the same that Williams faced in 1948, namely the need to

integrate rapidly evolving basic and clinical science in a cohesive format appropriate for undergraduate, graduate, and continuing medical education Now, however, the prose text can be enhanced by multimedia additions, and updating can be done in a

continuum How these tools will be utilized to create new types of teaching materials by academicians faced with multiple demands on their time is not entirely clear, but the

response to this challenge will determine whether Williams Textbook of Endocrinology

will continue to have the same impact over the next 50 years

5 Daughaday WH Personal communication

MD Consult L.L.C http://www.mdconsult.com

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XIX

Preface

This tenth edition of Williams Textbook of Endocrinology is a milestone in many

respects A tenth edition per se is testimony to the enduring accomplishments of our

predecessors, who have consistently created a product that remains the most popular textbook in this field It is also now a half century since the publication of the first edition

of Williams, a landmark suitably celebrated in a foreword by our coauthor and former

editor, Dr Jean Wilson Two internationally renowned endocrinologists, Drs Shlomo Melmed and Kenneth Polonsky, have joined Drs Reed Larsen and Henry Kronenberg

to formulate, co-edit, and assemble this volume We will strive to meet the high

standards maintained by Drs Wilson and Daniel Foster during their editorial leadership

Our goal for this first edition of the new millennium was to emulate the achievements of our predecessors by producing a definitive and fresh approach to the presentation of the essentials of clinical endocrinology Accordingly, we invited a number of new authors, including several European colleagues, to prepare 23 of the 41 chapters Our challenge

to them and to those updating their material was to distill the burgeoning molecular and physiological knowledge into a complete, but relevant, scholarly presentation Where appropriate, this would include a practical experienced guide as to how the author uses this information in the diagnosis and management of his or her own patients Achieving

such relevance, thoroughness, and practicality requires a unique combination of

scientific knowledge and total clinical familiarity best encapsulated in the term

"physician-scientist." We believe that our physician-scientist authors have again met Robert Williams' stipulation that this text should provide "a condensed and authoritative discussion of the management of clinical endocrinopathies based upon the application

of fundamental information obtained from chemical and physiologic investigation." We hope our readers will agree

Both new and revised chapters are replete with tables and figures Highlights of this edition include a new and expanded diabetes section, new chapters on many old and new topics including endocrinology and aging, female reproduction and fertility control, sexual function and dysfunction, kidney stones, the adrenal cortex, endocrine

hypertension, endocrine-responsive tumors, and non-insulin-secreting tumors of the gastroenteropancreatic system A largely new, concise introductory section includes several new chapters discussing mechanisms of hormone action and the clinical

approach to the endocrine patient, as well as a thorough guide to the intricacies of the rapidly changing laboratory techniques The entire section containing chapters on the hypothalamus and both anterior and posterior pituitary disorders is original, and the thyroid section has been thoroughly revised and divided into expanded disorder-based presentations

Stylistic innovations include page numbers in the introductory outlines for each chapter, which we hope will permit the reader ready access to specific topics We have also introduced algorithms and clinical guidelines for diagnostic and treatment strategies to crystallize recommendations for each disease Readers will also note that this edition is published only five years following its predecessor, reflecting the all-too-familiar rapidity with which new knowledge is accumulating in the biomedical disciplines Its timely appearance despite so much new material reflects the diligent efforts of our editorial staff and especially the new authors

We would like to express our deep gratitude to the coworkers in our offices, Anita Nichols, Debra Hession, Lynn Moulton, Grace Labrado, Linda Walker, Louise Ishibashi, and Sherri Turner, without whose dedication this project could not have been

completed We also wish to thank our colleagues at Elsevier, Richard Zorab and Cathy Carroll, and our tireless and effective developmental editors, Faith Voit and Joanne Husovski Their painstaking attention to every detail is a major contribution to this new edition

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Section 1 - Hormones and Hormone Action

Roughly a hundred years ago, Starling coined the term hormone to describe secretin, a

substance secreted by the small intestine into the blood stream to stimulate pancreatic secretion In his Croonian Lectures, Starling considered the endocrine and nervous systems as two distinct mechanisms for coordination and control of organ function Thus, endocrinology found its first home in the discipline of mammalian physiology