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编号:11327182
Pediatric Endocrinology: Mechanisms, Manifestations, and Management
http://www.100md.com 《新英格兰医药杂志》
     Evidence that pediatric endocrinology has really come of age is the number of multiauthored books on the subject now on the market. Scientific progress inevitably makes many of the books outmoded, even when editors diligently strive to produce regular editions every five years or so. Probably the first major textbook to be published on pediatric endocrinology was the magnificent Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence, edited by Lawson Wilkins, in 1957. Now long out of date and out of print, it was a classic and was essential reading for the trainees of the day. No longer can such a reference work be produced by just a few people, and so it is left to editors to put their stamp on a multiauthored textbook to ensure its success. Pescovitz and Eugster had that opportunity in producing a new textbook on pediatric endocrinology. Have they succeeded?

    The goal of the editors was to underpin the clinical management of pediatric endocrine disease with a firm knowledge of the basic science pertaining to this specialty. There are 11 sections, which are based mainly on the traditional approach to the endocrine organ system and amount to 47 chapters and 2 appendixes. There is a pronounced emphasis on molecular mechanisms, and the novice reader in this area is given one of the clearest tutorials on concepts and techniques that I have seen in a major textbook. Future editions will have to provide the same kind of emphasis with the next generation of "-omics" — proteomics and metabonomics. Pediatric endocrinology is suffused with genetics, and for me the chapter on genetic disorders is the best. There are no weak chapters in this book, but a few deserve to be highlighted for their level of interest and innovation.

    The quality of life associated with short stature is critically appraised, and the alleged morbidity that results from being short is not given much support by the authors. The chapters on Turner's syndrome, the control of puberty, gynecomastia, hypoglycemia, thyroid nodules, and several on diabetes deal with standard topics in a refreshingly clear way. The editors had the foresight to include an excellent chapter on endocrine disrupters and on disorders related to adipose tissue, including the usual eating disorders. It is inevitable that the modern endocrinology textbook must now devote a large section to obesity, and in this book, the generic chapter on childhood obesity generated 473 references. As a sign of the times, the subsequent chapter in this section has an obesity-gene map. Another chapter of interest is that on the endocrinology of stress. I was surprised not to see a chapter on transitional care, which now seems to consume increasing amounts of time and resources of clinical services.

    The book is packed with facts. Did you know that 1 percent of the young male Danish population has testicular cancer and that 40 percent of these young men have a low sperm count? What's going on in Denmark? In some centers, 8 to 45 percent of new childhood cases of diabetes are of the type 2 variety, and this outnumbers the annual incidence of the type 1 (insulin-dependent) form in Japan. On a less serious note, Bartolomeo Eustachio not only described the connecting tube of the middle ear that bears his name but also first described the adrenal glands, in 1563. And an allostatic load? In the context of stress, this is an adaptive response, which may be detrimental if overreactive or underreactive.

    A new textbook has the advantage of representing a fresh start, untainted by the baggage of previous books. The editors of Pediatric Endocrinology have capitalized on that approach and produced a potential winner. Yes, there is much that can be done to improve subsequent editions, not least the substandard illustrations in many chapters. What is the point of reproducing a Western blot that is smudgy and difficult to interpret from an original article or of including black-and-white, low-power micrographs of thyroid nodules? These and other relatively minor issues can be addressed in future editions, because Pescovitz and Eugster now have the chance to make theirs the premier textbook in pediatric endocrinology.

    Ieuan A. Hughes, M.D.

    University of Cambridge

    Cambridge CB2 2QQ, United Kingdom

    iah1000@cam.ac.uk(Ora Hirsch Pescovitz and )