Detailed contents xi
Contributors xiv
Symbols and abbreviations xix
1 Principles of endocrinology 1
2 Thyroid hormone metabolism 25
3 Pituitary gland 60
4 Posterior pituitary gland 122
5 Pineal gland 130
6 Adrenal gland 134
7 Female hormone metabolism 204
8 Male hormone metabolism 238
9 Disorders of gender and fertility 263
10 Endocrine disorders in pregnancy 283
11 Mineral metabolism 297
12 Bone 330
13 Endocrine oncology and neuroendocrine
disorders 362
14 Inherited endocrine syndromes and multiple
endocrine neoplasia 393
15 Endocrinology of metabolism 414
Brief contents

Hormone resistance syndromes 434
17 Endocrinology of different age groups 450
18 Endocrine investigation, nursing, and dietetics 457
19 Patient advice and reference 467
20 Speedy reference 480
21 Medico- legal aspects

Contributors xiv
Symbols and abbreviations xix
1 Principles of endocrinology 1
1.1 Hormones, receptors, and signalling 2
1.2 Hormone measurements: Assays 4
1.3 Hormone measurements:
Hormone- binding proteins 9
1.4 Hormone measurements: Biological
matrices for hormone measurement 11
1.5 Autoimmunity and the endocrine
system 13
1.6 Genetic endocrine disorders 17
1.7 Geographic and ethnic variation in
endocrine disorders 22
2 Thyroid hormone
metabolism 25
2.1 Physiology 26
2.2 Thyroid investigations 31
2.3 Imaging and localization of the
thyroid 36
2.4 Approach to the assessment of
disorders of thyroid hormone
homeostasis 39
2.5 Hyperthyroidism 41
2.6 Thyroiditis 48
2.7 Hypothyroidism 52
2.8 Thyroid nodules and cancer 56
3 Pituitary gland 60
3.1 Anatomy and physiology 61
3.2 Genetic testing for pituitary
adenomas 64
3.3 Pituitary imaging and localization 70
3.4 Approach to the assessment of
disorders of pituitary hormone
homeostasis 74
3.5 Prolactinomas 81
3.6 Acromegaly 84
3.7 Cushing’s disease 87
3.8 Non- functioning pituitary tumours 90
3.9 Gonadotroph adenomas 94
3.10 Thyrotrophinomas 96
3.11 Pituitary incidentalomas 98
3.12 Pituitary carcinoma 100
3.13 Craniopharyngioma and parasellar
cysts 102
3.14 Pituitary apoplexy 106
3.15 Surgical treatment 109
3.16 Pituitary radiotherapy 113
3.17 Parasellar pituitary conditions 115
4 Posterior pituitary gland 122
4.1 Diabetes insipidus 123
4.2 Hyponatraemia 125
4.3 Syndrome of inappropriate anti- diuretic
hormone secretion 128
4.4 Disorders of hypothalamic
dysfunction 129
5 Pineal gland 130
5.1 Melatonin and pineal tumours 131
6 Adrenal gland 134
6.1 Adrenal anatomy and physiology 135
6.2 Laboratory investigation of adrenal
disease 140
6.3 Imaging the adrenal glands 147
6.4 Primary aldosteronism 157
6.5 Mineralocorticoid hypertension 164
6.6 Liddle syndrome 169
6.7 Bartter and Gitelman syndromes 171
6.8 Cushing’s syndrome and autonomous
cortisol secretion 174
6.9 Adrenal incidentalomas 179
6.10 Adrenal carcinoma 182
6.11 Addison’s disease 184
6.12 Glucocorticoid replacement 186
6.13 Autoimmune polyglandular
syndrome 188
6.14 Phaeochromocytoma 192
6.15 Adrenal surgery 201
7 Female hormone
metabolism 204
7.1 Anatomy and physiology 205
7.2 Investigation 207
7.3 Imaging of functional ovarian
tumours 209
7.4 Polycystic ovary syndrome 214
7.5 Congenital adrenal hyperplasia 221
xii Detailed contents
xi
7.6 Androgen- secreting tumours 225
7.7 Primary ovarian failure and premature
ovarian insufficiency 229
7.8 Turner syndrome 231
7.9 Approach to the assessment of
disorders of menstrual function 234
8 Male hormone
metabolism 238
8.1 Anatomy and physiology 239
8.2 Investigation 243
8.3 Primary hypogonadism 248
8.4 Secondary hypogonadism 252
8.5 Erectile dysfunction 256
8.6 Gynaecomastia 260
9 Disorders of gender and
fertility 263
9.1 Disorders of sex development 264
9.2 Gender dysphoria 273
9.3 Male and female infertility 275
10 Endocrine disorders in
pregnancy 283
10.1 Thyroid disorders in pregnancy 284
10.2 Adrenal disease in pregnancy 291
10.3 Pituitary adenomas in pregnancy 295
11 Mineral metabolism 297
11.1 Anatomy and physiology 298
11.2 Investigations 304
11.3 Hypercalcaemia 310
11.4 Inherited primary
hyperparathyroidism 315
11.5 Hypocalcaemia 319
11.6 Disorders of phosphate homeostasis:
Hypophosphataemia, including X- linked
hypophosphataemic rickets 323
11.7 Disorders of phosphate
homeostasis: Hyperphosphataemia,
including tumoural calcinosis 326
11.8 Disorders of phosphate
homeostasis: Chronic kidney disease–
mineral and bone disorder 328
12 Bone 330
12.1 Anatomy and physiology 331
12.2 Investigation of metabolic bone
disease: Biochemical markers of bone
turnover 334
12.3 Investigation of metabolic bone
disease: Bone densitometry 336
12.4 Investigation of metabolic bone
disease: Bone imaging 339
12.5 Investigation of metabolic bone
disease: Bone biopsy 341
12.6 Osteoporosis 342
12.7 Focal bone disorders 347
12.8 Osteogenesis imperfecta 354
12.9 Sclerosing bone disorders 358
12.10 Fibrodysplasia ossificans
progressiva 361
13 Endocrine oncology
and neuroendocrine
disorders 362
13.1 General introduction 363
13.2 Neuroendocrine imaging 365
13.3 Small bowel neuroendocrine tumours
(‘carcinoids’) 370
13.4 Insulinomas 377
13.5 Gastrinomas 379
13.6 Glucagonomas 381
13.7 VIPomas 382
13.8 Somatostatinomas 383
13.9 Ectopic hormone production 384
13.10 Endocrine function following
chemotherapy and radiotherapy 388
14 Inherited endocrine
syndromes and multiple
endocrine neoplasia 393
14.1 McCune– Albright syndrome 394
14.2 Endocrine tumours in
neurofibromatosis type 1 396
14.3 Von Hippel– Lindau disease 398
14.4 Carney complex 400
14.5 Cowden syndrome 404
14.6 POEMS syndrome 407
14.7 Multiple endocrine neoplasia type 1 409
14.8 Multiple endocrine neoplasia types 2
and 4 411
15 Endocrinology of
metabolism 414
15.1 Hypoglycaemia 415
15.2 Obesity 419
15.3 Eating disorders and starvation 424
15.4 Sports and endocrinology 426
15.5 Possible endocrine syndromes 429
Detailed contents xiii
16 Hormone resistance
syndromes 434
16.1 Resistance to thyroid hormone 435
16.2 Androgen insensitivity syndrome 438
16.3 Primary generalized glucocorticoid
resistance, or Chrousos syndrome 441
16.4 Adrenocorticotrophic- hormone
resistance syndromes 444
16.5 Aldosterone resistance 448
17 Endocrinology of different
age groups 450
17.1 Adolescents in endocrinology 451
17.2 Endocrinology and ageing 455
18 Endocrine investigation,
nursing, and dietetics 457
18.1 Laboratory investigations in endocrine
disorders 458
18.2 The role of the endocrine specialist
nurse 461
18.3 Endocrine dietetics 463
19 Patient advice and
reference 467
19.1 Diagrams for explanation to
patients 468
19.2 Bone and mineral metabolism 472
19.3 Clinical genetics 473
19.4 Patient support and information
resource 478
20 Speedy reference 480
20.1 Indications for treatment of subclinical
hyperthyroidism 481
20.2 Differentiated thyroid cancer
follow- up 483
20.3 Indications for growth- hormone
treatment 486
20.4 Follow- up of pituitary tumours 488
20.5 Management of osteoporosis 492
20.6 Autoimmune polyglandular
syndromes 494
20.7 Hyperglycaemia 496
20.8 Hyperlipidaemia 498
20.9 Hypertension 503
21 Medico- legal aspects 506
21.1 Medico- legal issues: Confidentiality,
documentation, risk explanation, and
consent 507
21.2 DVLA regulations 508
Index 509
xiv
xiv

S Faisal Ahmed Samson Gemmell Chair of Child
Health, University of Glasgow Royal Hospital for
Children, Greater Glasgow and Clyde Health Board,
Glasgow, UK
TV Ajithkumar Consultant Clinical Oncologist,
Cambridge University Hospitals, Cambridge, UK
Krystallenia Alexandraki Consultant
Endocrinologist, Department of Pathophysiology,
Laiko University Hospital Medical School, National
and Kapodistrian University of Athens, Greece
Josephine Arendt Professor Emeritus, Endocrinology,
Faculty of Health and Medical Sciences, University of
Surrey, Guildford, UK
Wiebke Arlt William Withering Chair of Medicine,
Institute of Metabolism and Systems Research,
University of Birmingham, and Consultant
Endocrinologist, Centre for Endocrinology, Diabetes
and Metabolism, Birmingham Health Partners,
Birmingham, UK
Paul Arundel Consultant in Paediatric Metabolic Bone
Disease, Academic Unit of Child Health, Sheffield
Children’s Hospital, Sheffield, UK
Simon Aylwin Consultant Endocrinologist, King’s
College Hospital London, UK
Ravikumar Balasubramanian Assistant Professor
of Medicine, Reproductive Endocrine Unit and
Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, USA
Stephen Ball Professor of Medicine and
Endocrinology, Department of Endocrinology,
Manchester University Hospitals NHS Trust,
Manchester, UK
Birke Bausch Internist, Department of Medicine II,
Freiburg University Medical Center, Albert– Ludwigs
University, Freiburg, Germany
Paolo Beck- Peccoz Professor Emeritus, University
of Milan, Italy
John S Bevan Consultant Endocrinologist and
Honorary Professor of Endocrinology, Department
of Endocrinology, Aberdeen Royal Infirmary,
Aberdeen, UK
Kristien Boelaert Reader in Endocrinology, Institute
of Metabolism and Systems Research, University
of Birmingham, and Consultant Endocrinologist,
Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Birmingham, UK
Michael Brada Professor of Radiation, Oncology
Department of Molecular and Clinical Cancer
Medicine, University of Liverpool and Department
of Radiation Oncology, Clatterbridge Cancer Centre
NHS Foundation Trust, Bebington, Wirral, UK
Karin Bradley Consultant Endocrinologist, University
Hospitals Bristol NHS Foundation Trust, Bristol Royal
Infirmary, Bristol, UK
Marcello D Bronstein Professor of Endocrinology,
Division of Endocrinology and Metabolism, Hospital
das Clinicas, University of São Paulo Medical School,
São Paulo, SP, Brazil
James V Byrne Professor of Neuroradiology,
Nuffield Department of Surgical Sciences, University
of Oxford, UK
Matilde Calanchini Oxford Centre for Endocrinology,
Diabetes and Metabolism, Churchill Hospital, Oxford
University Hospitals NHS Trust, UK
Dominic Cavlan Consultant Endocrinologist,
Department of Endocrinology, St Bartholomew’s
Hospital, Barts Health NHS Trust, London, UK
Harvinder Chahal Consultant Endocrinologist,
Department of Endocrinology, Imperial College
Healthcare NHS Trust, London, UK
Roland Chapurlat Professor of Rheumatology,
Université de Lyon, Hôpital E Herriot, Lyon, France
Evangelia Charmandari Professor of Pediatric and
Adolescent Endocrinology Division of Endocrinology,
Metabolism and Diabetes, First Department of
Pediatrics, National and Kapodistrian University of
Athens Medical School, ‘Aghia Sophia’ Children’s
Hospital, Athens, Greece
Tim Child Associate Professor in Reproductive
Medicine, University of Oxford, Honorary Consultant
Gynaecologist, John Radcliffe Hospital, Oxford,
and Founding Director, The Fertility Partnership,
Oxford, UK
George Chrousos Professor and Chairman of the
Department of Paediatrics, Greece First Department
of Pediatrics, University of Athens Medical School,
‘Aghia Sophia’ Children’s Hospital, Athens, Greece
Adrian Clark Emeritus Professor of Endocrinology,
St George’s University of London, and Honorary
Professor of Endocrinology, Queen Mary University
of London, UK
Roderick Clifton- Bligh Consultant Endocrinologist,
Head, Department of Endocrinology, and Co- Head,
Cancer Genetics Unit, Kolling Institute, Royal North
Shore Hospital, St Leonards, Sydney, Australia
Gerard S Conway Professor of Reproductive
Endocrinology, Reproductive Medicine Unit,
Institute for Women’s Health, University College
London, UK
Mark S Cooper Professor of Medicine, ANZAC
Research Institute, University of Sydney, Concord
Repatriation General Hospital, Sydney, Australia
Kathryn Cox Paediatric Registrar, Royal Hospital for
Sick Children, Edinburgh, UK
Simon A Cudlip Consultant Neurosurgeon,
Department of Neurosurgery, John Radcliffe
Hospital, Oxford University Hospitals NHS
Foundation Trust, UK