Medico-legal aspects

This chapter focuses on the clinician’s role in briefing the patient on medical practice. It discusses risk explanations of drugs and investigations; consent; confidentiality; and required documentation. It also discusses the Driver and Vehicle Licensing Agency (commonly abbreviated as DVLA) and its role in assuring that patients with hypoglycaemia and visual disorders are fit to drive. It is important to remember that a mistake is not necessarily a negligent mistake and you cannot be held responsible for every adverse outcome. One of the key ways to avoid disputes is to ensure that you communicate well with your patient and that your explanation of risk is as clear and precise as possible.

Endocrine disorders in pregnancy

This chapter discusses thyroid, adrenal, and pituitary diseases that occur during pregnancy. A series of changes in thyroid hormone economy take place in normal pregnancy. As a result of these changes, thyroid hormone levels in pregnancy differ from those in the non-pregnant state. This chapter includes a description of normal thyroid physiology and thyroid pathophysiology, including hyperemesis gravidarum, post-partum thyroiditis, hypothyroidism, and hyperthyroidism. Changes in the hypothalamo-pituitary–adrenal axis during normal and abnormal pregnancies are also described, with syndromes such as Cushing’s syndrome and Addison’s disease listed. Finally, pituitary adenomas in pregnancy, and their respective features and management strategies, are listed, including acromegaly, hypopituitarism, TSH-secreting adenomas, and prolactinoma.

Principles of endocrinology

This chapter discusses the principles of endocrinology, starting with a description of the anatomy of endocrine glands, hormone structures, and hormone receptors. It similarly provides information on hormone measurements, such as immunoassays, mass spectrometry, hormonal-binding proteins, and biological matrices from serum, urine, and saliva. It relates autoimmunity to the endocrine system, and provides examples of studies of genetic endocrine disorders, such as linkage studies, complex endocrine disease-related case control studies, and genome-wide association studies. Providing information on the endocrine epidemiology, this chapter describes ethnic and geographic variation in disorders such as iodine deficiency, thyroid cancer, vitamin D deficiency, pituitary disease, diabetes, and multiple endocrine neoplasia.

Speedy reference

This chapter is a quick-reference tool for clinicians, for those moments in the clinic when time is very short and a rapid answer to a query is needed. It aims to provide rapid, practical and easily accessible algorithm/guidelines for common clinical scenarios.

Endocrinology of different age groups

This chapter discusses endocrine care for adolescents and the ageing. It discusses timing of transitional periods and associated changes in hormones, such as those that take place during puberty. It describes disorders in hormones during puberty, such as hyper-/hypogonadotrophic hypogonadism, craniopharyngiomas, microphallus, scoliosis, midline defects, anosmia, gonadotropin-releasing hormone deficiency, abnormal uterine bleeding, gynaecomastia, growth-hormone deficiency, and polycystic ovary syndrome (commonly abbreviated as PCOS). It also describes disorders accompanied with ageing, such as declines in growth hormone and insulin-like growth factor, or ‘somatopause’, as well as andropause and menopause. Differentiating what is normal physiology from pathology is important to prevent over-investigation.

Disorders of gender and fertility

This chapter discusses disorders of sex development, listing terminology, proper communication, family history, hormonal assessment, genetic assessment, and management strategies like surgery and psychosocial therapy. Disorders of sex development are a wide range of conditions with diverse pathophysiology that most often present in the newborn or the adolescent. Affected newborns usually present with atypical genitalia, whereas adolescents present with atypical sexual development during the pubertal years. The chapter also describes gender dysmorphia, its physical symptoms, hormonal causes, and drug-related or surgical treatment options. It finally discusses the epidemiology, clinical features, and management of infertility in both sexes, and the causes behind infertility, like hypogonadism, endometriosis, intrauterine factors, autoimmunity, primary testicular disease, varicocele, and ejaculatory disorders.

Female hormone metabolism

This chapter discusses the female-specific endocrine system anatomy and function. It discusses reproductive physiology in terms of follicles and associated hormones, such as oestradiol and progesterone. The chapter investigates biochemical processes related to female endocrinology as well as singular genetic features, such as a karyotype for premature ovarian insufficiency and fragile X syndrome. It also describes female-specific endocrine disorders, such as polycystic ovary syndrome, androgen secreting tumours, primary ovarian failure, and Turner syndrome, defining the disorders as well as outlining disorder prevalence, symptoms, biochemistry, and management. It relates endocrinology to menstrual function, documenting clinical features of menstrual disorders as one approaches menopause and suggesting treatments such as hormone replacement therapy (commonly abbreviated as HRT) and alternative methods.

Pineal gland

This chapter describes the pineal gland’s structure, related hormones, and physiology. The pineal gland (epiphysis cerebri) is a small (100–150 mg in humans), unpaired central structure. The mammalian pineal is a secretory organ, whereas in fish and amphibians it is directly photoreceptive (the ‘third eye’) and in reptiles and birds it has a mixed photoreceptor and secretory function. The main mammalian cell type is the pinealocyte, considered to have evolved from photoreceptor cells. This chapter discusses melatonin’s metabolism, and the pineal gland’s function in seasonal rhythms and circadian rhythms. It discusses pineal gland-related pathology, including tumours and cancer. The chapter also discusses the use of melatonin, in clinical practice, describing the hormone’s therapeutic benefits in circadian rhythm disorders.

Endocrine investigation, nursing, and dietetics

This chapter documents laboratory procedures in testing and diagnosing endocrine disorders. The diagnosis and monitoring of endocrine disorders depend largely on measurements of circulating hormones and growth factors. These measurements can often be made using serum or urine. This chapter also describes the role of endocrine specialist nurses and includes information on dynamic tests, somatostatin analogue treatment, patient education, patient support, and societies and meetings designed for endocrinology clinicians. In addition, the chapter describes dietetic and dietary assessments for disorders such as amenorrhoea, hypoglycaemia, and polycystic ovary syndrome (commonly abbreviated as PCOS).

Hormone resistance syndromes

This chapter discusses clinical features, epidemiology, and management/treatment strategies for resistance to hormones such as thyroid receptor alpha and beta resistance to thyroid hormone (TR-alpha RTH and TR-beta RTH, respectively). It also discusses androgen insensitivity, as in resistance to testosterone and dihydrotestosterone, which can result in complete, partial, and mild forms of androgen insensitivity. It describes Chrousos syndrome, which is a type of glucocorticoid resistance, and its clinical manifestations, molecular mechanisms, and clinical evaluation. The chapter also describes resistance to adrenocorticotrophin hormone, and the potentially resulting familial glucocorticoid deficiency (FGD) and triple A syndrome. It also discusses aldosterone resistance, describing potential manifestations such as generalized pseudohypoaldosteronism type 1 (PHA1) and renal PHA1.