Main description:

It is unclear, and really no longer relevant, whether the information explosion that we now contend with has been fostered by the growth of specialization and subspecialization in medicine, or vice versa. What is clear is that the two are mutually supportive and constitute what would be in endocrine parlance a short-loop positive feedback system. As a result, for most areas of medicine, even the subspecialist in that area has a problem in maintaining currency, the more general specialist has substan tial difficulty in doing so, and the generalist is tempted to abandon the effort altogether. Nevertheless, for all, both the internal pressures of conscience and self-esteem and the external pressures generated by peer review, recertifi cation, and subspecialty boards create the need for continuous self-educa tion. We are, therefore, in an era in which the means of dissemination of new information deserves as much creative attention as does its acquisition.

Contents:

1 Neuroendocrinology.- 1.1. Introduction.- 1.2. Neural Regulation of Endocrine Function.- 1.2.1. Characterization of CNS Factors Acting on the Anterior Pituitary Gland.- 1.2.2. Anatomical Localization of Hypophysiotropic Factors.- 1.2.2.1. Thyrotropin-Releasing Factor.- 1.2.2.2. Gonadotropin-Releasing Factor.- 1.2.2.3. Somatostatin.- 1.2.2.4. Neurotransmitter Localization.- 1.2.3. Neurotransmitter Regulation of Releasing Factors.- 1.2.3.1. Corticotropin-Releasing Factor.- 1.2.3.2. Gonadotropin-Releasing Factor.- 1.2.3.3. Prolactin.- 1.2.3.4. Thyrotropin-Releasing Factor.- 1.2.4. Role of Prostaglandins in the Regulation of Hypophysiotropic Factors and Pituitary Hormones.- 1.2.5. Brain and Pituitary Growth Factors.- 1.3. Hormone-Nervous System Interactions.- 1.3.1. Catechol Estrogens.- 1.3.2. CNS Uptake of Steroids.- 1.3.2.1. Corticosteroids.- 1.3.2.2. Androgens.- 1.3.3. Peptide Hormone-Nervous System Interactions.- 1.3.3.1. Effect of Peptide Fragments on Learning and Memory.- 1.3.3.2. Effect of Peptides on Opiate Receptors.- 1.3.3.3. Effect of Releasing Factors on Brain Excitability and behavior.- 1.4. Releasing Factors.- 1.4.1. Interrelationships.- 1.4.2. Therapeutic Uses of Gonadotropin-Releasing Factor.- 1.4.2.1. Anovulation.- 1.4.2.2. Hypogonadism.- 1.5. Neuroendocrine Disease.- 1.5.1. Acromegaly.- 1.5.1.1. Anomalous Responses to Testing.- 1.5.1.2. Response to Medical Therapy.- 1.5.2. Galactorrhea.- 1.5.3. Cushing's Disease.- 1.5.4. Anorexia Nervosa.- 1.6. The Pineal Gland.- 1.6.1. Regulation of Gonadotropic Function.- 1.6.2. Neurotransmitter-Receptor-Enzyme Interactions.- References.- 2 Anterior Pituitary.- 2.1. Introduction.- 2.2. Corticotropin and Melanocyte-Stimulating Peptides.- 2.3. Thyrotropin.- 2.4. Gonadotropins.- 2.4.1. Plasma and Urine Gonadotropins.- 2.4.2. Gonadotropins in Mother and Fetus.- 2.4.3. Gonadotropins in Children.- 2.4.4. Gonadotropin Responses to Luteinizing Hormone-Releasing Hormone.- 2.5. Prolactin.- 2.6. Somatotropin.- 2.6.1. Chemistry.- 2.6.2. Regulation of Secretion.- 2.6.3. Effects on Carbohydrate Metabolism.- 2.6.4. New Therapeutic Applications.- 2.6.5. Acromegaly.- 2.6.6. Hypopituitarism.- References.- 3 The Thyroid.- 3.1. Introduction.- 3.2. Neuroendocrine Regulation of Thyroid Function.- 3.3. Thyroid Hormones.- 3.3.1. Synthesis and Secretion.- 3.3.2. Peripheral Metabolism.- 3.3.3. Metabolic Action.- 3.4. Clinical Aspects of Thyroidology.- 3.4.1. Thyrotoxicosis.- 3.4.2. Hypothyroidism.- 3.4.3. Thyroid Cancer.- 3.5. Miscellaneous Aspects of Thyroidology.- References.- 4 The Ovary.- 4.1. Introduction.- 4.2. Estrogen Secretion Rates.- 4.2.1. Normal Women.- 4.2.2. Anovulatory Bleeding.- 4.2.3. Hyperthyroidism.- 4.2.4. Oral Estrogens.- 4.2.5. Catechol Estrogens.- 4.2.5.1. Estriol.- 4.3. Regulation of Follicular Growth.- 4.3.1. Intrafollicular Steroid Concentrations.- 4.3.2. Protein Hormones in the Follicles.- 4.3.3. Prostaglandins.- 4.4. The Postmenopausal Ovary.- 4.4.1. Follicle-Stimulating Hormone Regulation.- 4.4.2. Androgen Secretion.- 4.5. Idiopathic Hirsutism.- 4.5.1. The Ovary.- 4.5.2. Therapy.- 4.5.3. Antiandrogens.- 4.5.4. Skin Androgen Metabolism.- 4.6. Side Effects of Estrogen.- 4.6.1. Liver Tumors.- 4.6.2. Gall Bladder Disease.- 4.6.3. Uterine Cancer.- 4.6.4. Stroke.- References.- 5 The Testis.- 5.1. Introduction.- 5.2. Intrauterine and Neonatal Function.- 5.2.1. Embryonic Sex Differentiation.- 5.2.1.1. Normal Controls.- 5.2.1.2. Defects in Testicular Function in Utero.- 5.2.2. Testicular Function in Childhood.- 5.3. Puberty.- 5.4. Adult Physiology.- 5.4.1. The Hypothalamus and Pituitary.- 5.4.2. The Testis.- 5.4.2.1. Steroidogenesis.- 5.4.2.2. Spermatogenesis.- 5.4.2.3. Effect of Age on Human Testicular Function.- 5.5. Adult Pathophysiology.- 5.5.1. Gonadotropin Deficiencies.- 5.5.2. The Testis.- 5.5.2.1. Steroidogenesis.- 5.5.2.2. Tubular Defects.- 5.6. Influence of Other Disease on Testicular Function.- 5.6.1. Uremia.- 5.6.2. Cirrhosis.- 5.7. Conclusions.- References.- 6 The Adrenal Cortex.- 6.1. Introduction.- 6.2. Corticosteroid Biosynthesis.- 6.3. Mechanism of Action of ACTH.- 6.4. Diseases of the Adrenal Cortex.- 6.4.1. Enzymatic Defects in Steroidogenesis.- 6.4.2. Adrenal Hypofunction.- 6.4.3. Cushing's Syndrome.- 6.4.4. Adrenocortical Neoplasms.- References.- 7 Aldosterone and the Renin-Angiotensin System.- 7.1. Introduction.- 7.2. Increased Aldosterone Production.- 7.2.1. Renin Suppressed.- 7.2.1.1. Syndrome of Primary Hyperaldosteronism.- 7.2.1.2. Location of Adrenocortical Adenoma with [131I] 19-Iodocholesterol.- 7.2.2. Renin Increased.- 7.2.2.1. Malignant or Accelerated Hypertension.- 7.2.2.2. Unilateral Renovascular Disease.- 7.2.2.3. Renin-Secreting Tumors.- 7.2.2.4. "Banter's Syndrome".- 7.3. Normal Aldosterone Production-Low-Renin Hypertension.- 7.4. Reduced Aldosterone Production.- 7.4.1. Renin Suppressed.- 7.4.1.1. Hyporeninemic Hypoaldosteronism.- References.- 8 Catecholamines and the Sympathoadrenal System.- 8.1. Introduction.- 8.2. Familial Pheochromocytoma and Multiple Endocrine Adenomatosis (MEA).- 8.2.1. Incidence and Importance.- 8.2.2. Sipple's Syndrome (MEA-II).- 8.2.2.1. Background.- 8.2.2.2. Presentation.- 8.2.2.3. Pheochromocytoma in MEA-II.- 8.2.2.4. Medullary Carcinoma of the Thyroid.- 8.2.2.5. Hyperparathyroidism.- 8.2.2.6. Management of Patients and Families with MEA-II (Sipple's Syndrome).- 8.2.3. Mucosal Neuroma Syndrome (MEA-III).- 8.2.4. Multiple Endocrine Adenomatosis-Theories of Pathogenesis.- 8.2.4.1. The APUD Cell Concept.- 8.2.4.2. Nerve Growth Factor.- 8.2.4.3. Nesidioblastosis.- 8.3. Clinical Assessment of the Functional State of the Adrenal Medulla and the Sympathetic Nervous System.- 8.3.1. The Nature of the Problem.- 8.3.2. Assay of Catecholamines in Plasma and Urine.- 8.3.2.1. Plasma Catecholamines.- 8.3.2.2. Urinary Catecholamines.- 8.3.3. Dopamine-?-Hydroxylase Activity in Plasma- A Measure of Sympathetic Activity?.- 8.3.3.1. The Enzyme Dopamine-?-Hydroxylase (DBH).- 8.3.3.2. DBH Activity as a Measure of Sympathetic Activity.- 8.4. Hyperthyroidism and the Sympathoadrenal System.- 8.4.1. Effect of Thyroid Hormones on Catecholamine Biosynthesis, Metabolism, and Excretion.- 8.4.2. Effect of Thyroid Hormones on Sensitivity to Catecholamines.- 8.4.2.1. Thyroid Hormones and the Cardiovascular Effects of Catecholamines.- 8.4.2.2. Metabolic and Calorigenic Effects of Catecholamines in Relation to Thyroid Status.- 8.4.3. Adrenergic Blocking Agents in the Treatment of Hyperthyroidism.- 8.4.3.1. The Choice of an Antiadrenergic Agent.- 8.4.3.2. Effects of Adrenergic Blocking Agents in Hyperthyroidism.- 8.4.3.3. Clinical Usefulness of Adrenergic Blocking Agents in Thyrotoxicosis.- 8.4.3.4. An Open Question: Why Are Adrenergic Blocking Agents Efficacious in the Symptomatic Treatment of Hyperthyroidism?.- References.- 9 Calcitonin.- 9.1. Introduction.- 9.2. Calcitonin.- References.- 10 Ectopic Hormone Syndromes.- 10.1. Introduction.- 10.2. Etiology and Mechanisms of Ectopic Hormone Production..- 10.3. Characteristics of the Ectopic Hormone Syndromes.- 10.4. Recent Developments in Specific Hormone Syndromes.- 10.4.1. Ectopic Production of Corticotropin (ACTH).- 10.4.2. Ectopic Production of Melanocyte-Stimulating Hormone (MSH).- 10.4.3. Ectopic Production of Growth Hormone.- 10.4.4. Ectopic Production of Human Placental Lactogen (HPL) or Human Chorionic Somatomammotropin (HCS).- 10.4.5. Ectopic Production of Prolactin.- 10.4.6. Ectopic Production of Gonadotropins.- 10.4.7. Ectopic Production of Thyrotropin.- 10.4.8. Ectopic Production of Antidiuretic Hormone (ADH).- 10.4.9. Hypoglycemic Syndromes and Tumors.- 10.4.10. Ectopic Production of Parathyroid Hormone (PTH) and Other Calcium-Mobilizing Substances.- 10.4.11. Ectopic Production of Other Hormones.- 10.4.11.1. Calcitonin.- 10.4.11.2. Erythropoietin.- 10.4.11.3. Renin-Secreting Tumors.- 10.4.11.4. Other Prostaglandins.- 10.4.11.5. Osteomalacia, Hypophosphatemia, and Hyperphosphaturia.- 10.4.11.6. Glucagon and Skin Disease; Vasoactive Intestinal Peptide (VIP).- 10.5. Production of Nonhormonal Proteins and Other Syndromes by Malignant Disorders.- 10.5.1. Ectopic Production of Other Proteins.- 10.5.2. Tumor Syndromes Not Known to Be Associated with Definite Humoral Substances.- References.- 11 Current Concepts in Steroid Hormone Action.- 11.1. Introduction.- 11.2. Autoradiography.- 11.3. Receptor-Mediated Steroid Translocation to Nuclei.- 11.4. Quantitation of Nuclear Receptors by Nuclear Exchange..- 11.5. Cell-Free Binding Studies.- 11.6. Nature of the Nuclear Acceptor Site.- 11.7. Hormone Dependency of Nuclear Binding Receptors.- 11.8. Receptor Activation for Nuclear Binding.- 11.9. Correlation of Nuclear Binding with Biological Response.- 11.10. Cell Genetic Variants in Hormone Response.- 11.11. Quantitation of Transcriptional Events in Vitro.- 11.12. Gene Expression in the Chick Oviduct Model System.- 11.13. In Vivo Steroid-Induced Alterations in Chromatin Transcription Assayed in Vitro.- 11.14. Purification and Characterization of Chick Oviduct Progesterone Receptor.- 11.15. In Vitro Studies of Receptor-Mediated Alterations in Chromatin Transcription.- 11.16. Induction of Specific Gene Sequences by Progesterone Receptors in Vitro.- 11.17. Relationship of the Progesterone Receptor Subunit Structure to Its Effects on Differential Gene Expression.- 11.18. A Model for Steroid Hormone Action.- 11.19. Medical Relevance.- References.