Synopsis
An up-to-date and concise guide to the clinical management of pediatric endocrine disorders. The text covers the most common and challenging conditions seen by practicing endocrinologists and primary care physicians, including growth, hypothalamic, pituitary, adrenal, thyroid, calcium and bone, and reproductive disorders, as well as metabolic syndromes. Each chapter contains an introductory discussion of the problem, a review of the clinical features that characterize it, the criteria needed to establish a diagnosis, and a comprehensive therapy section delineating the risks and benefits of the best therapeutic options available. Invaluable tables summarize the critical factors in etiology, clinical presentation, diagnosis, and therapeutic dosages.
Reviews
This new book is aptly named. The editors have assembled a multiauthored book that is focused on specific clinical guidelines for the evaluation and treatment of diverse endocrine disorders. For the sake of brevity and to fulfill its objective as a "practical clinical guide," the book contains few photographs or figures, and the discussions of pathophysiology and complex therapeutic issues are limited. Instead, the book incorporates a number of useful tables and flowcharts of diagnostic algorithms, specific protocols for specialized endocrine testing, and recommended therapeutic regimens. The chapters are scholarly, well written, and relatively cohesive in organizational structure, starting with pathophysiology, proceeding to clinical features and evaluation, and concluding with a detailed discussion of recommended interventions. The choice and designation of the subjects of the chapters are less consistent; chapters range from detailed descriptions of a rare condition to discussions of a particular clinical manifestation or organ-specific disease process. The section on growth disorders, comprising 8 of the 30 chapters, includes chapters on hypopituitarism, glucocorticoid-induced growth failure, and new indications for the use of growth hormone. The remaining sections have a broader focus, encompassing general topics such as delayed puberty, hypoglycemia, adrenal insufficiency, and calcium homeostasis. The emphasis is on classical endocrine diseases, with only two chapters on metabolic disorders, one on hypoglycemia and the other on diabetes mellitus. The book includes an excellent chapter on contraception, which has not traditionally fallen within the purview of pediatric endocrinology, but it does not include other timely topics, such as obesity and osteoporosis. Most of the chapters were undoubtedly penned by academic pediatric endocrinologists who bring extensive clinical experience to their recommendations for evaluation and treatment. Some chapters by more junior contributors or by endocrinologists with limited pediatric experience, however, offer didactic discussions that lack the conviction and sagacious insights that can be gleaned from experience. In the light of the emphasis on providing clinical guidelines for the treatment and management of pediatric endocrine disorders, it is puzzling that the editors chose a few contributors who have excellent academic credentials but minimal direct experience of the treatment of children with these disorders. As with all such books, some of the content is dated. This is of particular importance in the chapter entitled "Growth Hormone Therapy in Prader-Willi Syndrome," which does not address recent concern regarding the safety of growth hormone in this syndrome; such concern arose from reports of several deaths due to respiratory compromise. A minor inconvenience of the book is the inadequacy of the index. On the one hand, I was unable to find congenital hyperinsulinism or septo-optic dysplasia anywhere in the index, despite searching under various possibilities, even though these topics are discussed in the chapters on hypoglycemia and hypopituitarism, respectively. On the other hand, the index includes cryptococcus, which is mentioned as a rare cause of adrenal insufficiency, and "CT" (for adrenal insufficiency and Cushing's syndrome). The listing of estradiol cypionate, the injectable contraceptive, under "cypionate" rather than under "estradiol" or another more relevant term illustrates the ineffectiveness of the index. Despite these minor shortcomings, this book is a superb clinical resource for pediatric residents, pediatricians, and other primary care providers for children as well as for adult and pediatric endocrinologists who need a reliable clinical guide to the management of pediatric endocrine disorders. Most other books on these disorders are much larger and less portable than this one and lack the practical details of medication regimens and testing protocols that this book includes. The chapters are superbly written and edited, so that the book flows and is easy to read and digest from cover to cover. The editors, Sally Radovick and Margaret H. MacGillivray, have successfully achieved their goal of producing a concise clinical compendium of pediatric endocrine disorders that provides detailed guidelines for diagnosis and management. Mary M. Lee, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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