Leading researchers and experienced clinicians join forces not only to illuminate today's understanding of the endocrinology of menopause, but also to provide a sound basis for its successful management. These seasoned experts review in detail the cardiovascular, bone, brain, and genitourinary changes that accompany menopause and spell out the risks, benefits, and alternatives of conventional hormone replacement therapy. Selective estrogen receptor modulators (SERMs), androgen replacement, calcium supplementation, and the role of phytoestrogens are also fully reviewed. Menopause: Endocrinology and Management offers practicing physicians a comprehensive understanding of the menopause process, as well as an evidence-based approach to optimizing treatment strategies for the challenging medical problems accompanying this important period in women's lives.

Etienne-Emile Baulieu, the discoverer of neurosteroids, and a panel of distinguished scientists and clinical researchers exhaustively and critically review all facets of neurosteroids involved in behavior, stress, memory, depression, anxiety, aging of the brain, and neurodegenerative diseases. These contributors illuminate the role of neurosteroids in brain development and plasticity and detail their neuromodulatory influence on GABAA, ionotropic glutamate receptors, acetylcholine receptors, sigma receptors, and calcium channels. Clearly pointing the way toward novel pharmaceutical agents that may be of significant therapeutic value, particularly with regard to aging mental functions, Neurosteroids: A New Regulatory Function in the Nervous System offers neurobiologists, psychiatrists, neurosurgeons, pharmacologists, and geriatricians the first comprehensive, state-of-the-art review of these important bioactive molecules.

The objective of this book is to provide recent information on neural regulation in the endocrine system in vertebrates. Classical studies have revealed that certain neurons synthesize and release chemical messengers into the vascular system. These neurons are endocrine devices that link the brain with the endocrine glands and other target organs. In vertebrates, the hypothalamus is the seat for chemical coordination and integration of en- vironmental and hormonal cues to modulate function of the pituitary gland, and conse- quently, the functions of other endocrine glands. Exciting information generated during the past few decades has resulted in profound alterations in the conceptual fabric of endo- crinology. From the wealth of information that emerged on neuropeptides of the central nervous system, and on the other connectivities of various brain centers, its has become clear that several extra-hypothalamic sites are also involved in regulation of hypophysial hormones. The brain has assumed a greater importance in the regulation of the endocrine sys- tem. However, recent studies have revealed varying degrees of functional autonomy in hy- pophysial hormone secretion, which may be due to intrapituitary cytokines. Although gonadotropin-releasing hormone (GnRH) is a key regulator of gonadotropin secretion, there exists a GnRH receptor diversity in vertebrates such as the receptor presence in can- cer cells. Recent studies have demonstrated the multifactorial nature of the neuroendo- crine factors involved in growth hormone regulation in fish. On the other hand, in birds, thyrotropin-releasing hormone plays a major role in growth hormone release.

This volume summarizes the proceedings of the Reisensburg workshop which took place at Reisensburg Castle in November 1997." The castle is built on the site of an - cient Roman compound and situated in the south of Germany at the Danube river. Sci- tists from Australia, Austria, Belgium, Estonia, Germany, Italy, Netherlands, South Africa, Switzerland, and the United States participated in the workshop. Like the 1996 workshop, the proceedings of which will be published in Medicine and Science in Sports and Ex- cise in 1998, the 1997 workshop also focused on the topic of overtraining in its widest sense to deepen our knowledge in this particularly sensitive field of sports science and sports practice. The authors see the present volume in a context with the proceedings p- sented by Guten (ed. ) "Running Injuries"; Saunders, Philadelphia (1997) and Kxeider, Fry, and O'Toole (eds. ) "Overtraining in Sport"; Human Kinetics, Champaign IL (1997). Overtraining, that is, too much stress combined with too little time for regeneration, can be seen as a crucial and threatening problem within the modern athletic community, of which significance can already be recognized reading daily newspapers: ." . . During the 1996 European championships, a gymnast shook his head almost imperceptibly, closed his eyes briefly and left the arena without looking up. He was fatigue personified. 'Suddenly, I just couldn't do any more. I just wanted to rest'." A look at his schedule showed why.

A. Wayne Meikle and a distinguished panel of expert clinicians bring to bear their extensive knowledge and experience in managing adults and children undergoing hormone replacement therapy for the pituitary, parathyroid, thyroid, pancreas, adrenal glands, and gonads. Emphasizing proper patient management, the book provides to specialists and general practitioners alike time-tested, cutting-edge guidelines on the use, monitoring, and dosage of hormone therapeutics in the treatment of disorders of endocrine function, while giving an exhaustive analysis of each therapy. Comprehensive and eminently practical, Hormone Replacement Therapy captures the most recent advances in hormone replacement therapeutics and is certain to serve endocrinologists, gynecologists, pediatricians, urologists, internists, and family practitioners as today's standard reference for managing and monitoring their patients.

Dr. Robert Volpe and his distinguished contributors comprehensively review the latest thinking about the theoretical, experimental, and clinical aspects of autoimmune endocrine disorders. These world-renowned experts examine the pathogenesis and immunogenetics of these diseases, discuss the role of sex hormones in autoimmunity, and elucidate the nature of autoantigens. They also provide clinical detail on a wide variety of autoimmune endocrinopathies, including autoimmune thyroid disease, Graves' ophthalmopathy and dermopathy, human insulin-dependent diabetes mellitus, and autoimmune adrenocortical failure. Postpartum autoimmune endocrine syndromes, autoimmune hypophysitis, and the polyglandular autoimmune syndromes are also discussed in detail. Comprehensive and authoritative, Autoimmune Endocrinopathies provides today's most up-to-date understanding of the etiology and pathogenesis of autoimmune endocrine diseases.

The maintenance of arterial blood pressure and the distribution of blood flow to the various organs of the body depends on the control of the pumping action of the heart and of the resistance of the vascular beds in the individual organs in accordance with their metabolic needs. These controls are achieved through the integrated actions of circulat ing hormones, humoral factors that are synthesized and released in the heart and blood vessels, and the autonomic nervous system. The heart, however, is not only the target for the direct and indirect actions of a number of hormones and humoral factors, it is also an endocrine organ in the traditional sense, synthesizing and secreting into the circulation chemical factors that act at distant sites. In this treatise, Hormones and the Heart in Health and Disease, we interpret "endocrinology" broadly and consider traditional hormones as well as autocoids that are secreted by the heart or that act on it. In this overview, the relevant chapters are indicated in parentheses. The discovery of atrial natriuretic peptide (ANP; atrial natriuretic factor, ANF) in the 1980s indicated that the heart does indeed function as an endocrine organ in the classic sense. ANP (Chapter I) is synthesized in the heart and secreted into the circulation for actions on the kidney, where it is a potent natriuretic agent, and on the vasculature, where it causes vasodilation. ANP can also affect myocardial contractility."

Male Reproductive Function gives an up-to-date review on the physiology and disease processes associated with the male reproductive system. The first few chapters describe the regulation of the functions of the testis and the integration of its components: germ cells, Sertoli cells and Leydig cells. This is followed by a description of puberty and aging, and the disorders or dysfunction that may be associated with these physiological processes. Discussions on the current methods for the diagnosis and treatment of male hypogonadism, male infertility and male sexual dysfunction follow, with detailed descriptions of types of androgen replacement and the benefits and risks of such treatment. The book concludes with the development of male contraception and the possible influence of the environment on the male reproductive system. Male Reproductive Function represents a conglomeration of the efforts of experts in andrology from all over the world, both in basic cellular/molecular biology as well as in clinical science and practice. This book is suitable for endocrinologists, urologists, general internists, gynecologists and other students in the field of male reproduction.

Growth Hormone is a fitting addition to the Endocrine Updates Series. The aim of these publications is to provide the clinician with cutting-edge, yet succinct, access to the latest advances in endocrinology. Current interest in this rapidly evolving area of endocrinology makes this a timely and important update. Growth Hormone joins Dr. Fagin's Thyroid Cancer in continuing the standard of excellence as the fourth volume in this series of topical updates. Shlomo Melmed, MD, Series Editor, Endocrine Updates Ten years ago, many endocrinologists were still skeptical that growth hormone (GH) played an active role in adult metabolism. This is, perhaps, surprising given that GH deficiency (GHD) in adulthood had been recognized' as long ago as the 1960s. During the last ten years studies have shown that GHD in adulthood is a far-reaching syndrome associated with abnormal body composition, reduced bone mineral density with an increased fracture rate, increased cardiovascular morbidity and impaired cardiac function, as well as reduced exercise performance and decreased psychological well-being. Importantly, it is also clear, from placebo-controlled trials, that GH replacement therapy can normalize body composition, increase bone mineral content and improve the cardiovascular risk factor profile. GH replacement therapy also improves cardiac performance and exercise capacity, increases muscle strength and improves well-being and quality of life. The aim of Growth Hormone is to provide a critical update of current knowledge about adult GHD and the future role of GH/IGF-1 in adult medicine. For this purpose, contributions from a number of research groups have been invited. It is my hope that the book may not only serve as an introduction to the field, but also stimulate further research within this exciting area.

The hematopoietic system plays roles that are crucial for survival of the host: delivery of oxygen to tissues, arrest of accidental blood leaking from blood vessels, and fending off of invading microbes by humoral, cell-mediated, and phagocytic immunity. The activity of the hematopoietic system is staggering: daily, a normal adult produces approximately 2.5 billion erythrocytes, 2.5 billion platelets, and 1 billion granulocytes per kilogram of body weight. This production is adjusted in a timely fashion to changes in actual needs and can vary from nearly none to many times the normal rate depending on needs which vary from day to day, or even minute to minute. In response to a variety of stimuli, the cellular components of the blood are promptly increased or decreased in production to maintain appropriate numbers to optimally protect the host from hypoxia, infection, and hemorrhage. How does this all happen and happen without over or under responding? There has been extraordinary growth in our understanding ofhematopoiesis over the last two decades. Occupying center stage is the pluripotent stern cell and its progeny. Hematopoietic stern cells have been characterized by their capacity for self renewal and their ability to proliferate and differentiate along multiple lineages. Few in number, the stern cell gives rise to all circulating neutrophils, erythrocytes, lymphoid cells, and platelets. In hematopoietic transplantation, the stern cell is capable of restoring long-term hematopoiesis in a lethally irradiated host.

Modern society is altering the lifestyle and longevity of its members much more quickly than evolutionary adaptation to these changes can take place. The problem of calcium deficiency in the population is compounded by the growing percentage of aged individuals with relatively fragile, less massive skeletons. Current-day civilizations are much more effective in prolonging human life in a state of relative debility than even a few decades ago. This reality is unlikely to change and mandates that we develop strategies to prevent aging-related diseases like osteoporosis before they become manifest. Osteoporosis: Genetics, Prevention and Treatment places emphasis on the (1) genetic predisposition, (2) early recognition and (3) prevention of osteoporosis. The intent is not to move the practitioner's attention away from intervention therapy of osteoporosis, but rather to expand their view of this disease as one beginning at birth and one in which susceptibility is manifest at the conclusion of adolescence, not at menopause. The book concludes with an informed view of the future in terms of the recognition, prevention and management of osteoporosis.

Gerald Reaven, the discoverer of Syndrome X, and a panel of world-class investigators thoughtfully summarize our current understanding of how insulin resistance and its compensating hyperinsulinemia play a major role in the pathogenesis and clinical course of high blood pressure and cardiovascular disease-the so-called diseases of Western civilization. These distinguished authorities detail, for the first time, the pathophysiological consequences and the clinical syndromes, excluding Type 2 diabetes, related to insulin resistance. They also examine the genetic and lifestyle factors that contribute to the wide differences in insulin action that exist in the population at large. Timely and authoritative, Insulin Resistance: The Metabolic Syndrome X illuminates the full importance of insulin resistance as a major cause of hypertension, heart disease, and polycystic ovary syndrome.

Stuart Handwerger, MD and a distinguished panel of clinicians and experts review the most significant recent developments in molecular and cellular biology, powerful advances that have produced new diagnostic methods and improved treatments for many pediatric endocrine diseases. Topics range from the growth hormone/prolactin/placental lactogen gene family and their regulation of growth, to steroid hormones, sexual development, and mineral corticoid action. Additional chapters examine the pathophysiology of insulin-dependent diabetes mellitus, the molecular genetics of thyroid cancer, the molecular basis of hypophosphatemic rickets, and inherited diabetes insipidus. Molecular and Cellular Pediatric Endocrinology offers today's clinicians and researchers not only the latest findings on endocrine diseases in their pediatric manifestations, but also highly practical insights into today's cutting-edge diagnostics, treatment strategies, and powerful new therapeutics.

Leading clinicians review in depth the clinical and molecular aspects of the hormone resistance syndromes caused by receptor mutations. These mutations are involved in a large number of disorders, including dwarfism, Laron syndrome, pseudohypoparathyroidism, insulin resistance, resistance to thyroid hormone, glucocorticoid resistance, hereditary resistance to vitamin D, and estrogen resistance. Throughout, the book's distinguished contributors not only summarize the clinical features of these and related disorders, but also illuminate their molecular bases. Hormone Resistance Syndromes provides an authoritative summary and standard reference for all those clinicians and researchers actively studying these mutations today and affords a unique opportunity to understand hormone action in normal physiology.

A cutting-edge review of how derangements in the hormonal and growth factor mechanisms controlling normal mammary development lead to breast cancer. Drawing on the multidisciplinary expertise of leading authorities, the book highlights the roles of oncogenes and tumor suppressor genes, spelling out the importance of autocrine/paracrine loops (e.g., stromal epithelial interactions) in supporting breast cancer cell proliferation and the progression to hormone independence. The book's many prominent contributors also illuminate significant recent advances in the biochemistry and physiology of hormone receptors and review the state-of -the-art in the endocrine therapy of breast cancer. Endocrinology of Breast Cancer provides a unique integrated overview of the most significant basic and clinical developments concerning the hormonal aspects of breast cancer.

Leading clinical and basic science researchers present the latest molecular and cellular findings on key gut peptides, illuminating their physiology and pathophysiology, as well as highlighting the regulatory mechanisms underlying their action in the intestinal tract. The book focuses on gut peptide physiology and receptor pharmacology, gut processing and receptor biology, and on regulatory mechanisms in the gut, including pancreatic feedback mechanisms. Also included are chapters on the trophic effects of gut peptides on GI and pancreatic cancer; the regulation of gut peptide gene expression; and gastric secretion, especially in diseased states.

Because of its relative rarity and favorable outcome, it has not been feasible to assess medical interventions for thyroid cancer using randomized prospective trials. The approach to diagnosis and treatment relies to a great extent on information derived from retrospective studies. Overall prognosis and survival rates have been edging upward over the past two decades. This is attributed to a wider acceptance of total thyroidectomy as the primary surgical strategy. The appropriate indication of radioiodine therapy remains controversial, and physicians must be familiar with staging criteria to make educated decisions. We are now beginning to understand the genetic mechanisms of thyroid tumor initiation and progression. There are still major challenges ahead. Thyroid Cancer provides comprehensive updates on the epidemiology, pathogenesis, diagnosis and treatment of thyroid neoplasms. Although the material should be of particular interest to scholars in the field, the contributors have striven to make it of practical use to physicians who treat patients with thyroid disease.

Bone Marrow Pathology has been extensively revised to reflect the significant advances which have occurred in the application of cytogenetics and in particular, molecular genetics in the diagnosis, classification and understanding of haematological disorders. This comprehensive book not only provides information on all common disease entities, but also covers rare disorders in which bone marrow examination is useful. It is designed as a practical resource with "problems and pitfalls" highlighted throughout to aid laboratory diagnosis.

Endocrinology of Cardiovascular Function is a fitting inauguration to the Endocrine Update Series. The aim of these publications is to provide the clinician with cutting edge, yet succinct, access to the latest advances in endocrinology. Historically, our understanding of hormonal disturbances was restricted to the classical secretory glands and their targets. As Endocrinology of Cardiovascular Function so aptly indicates, endocrinology is no longer constrained by our early physiologic understanding of glandular disorder. Endocrinology of Cardiovascular Function has set the standard of excellence for the future volumes in this series. Shlomo Melmed, M.D. Series Editor, Endocrine Update Growth factors such as IGF-1 play important roles in cardiovascular cell hypertrophy and the response to acute vascular injury. From another perspective, traditional endocrine hormones, such as estrogen, have been found to participate in preventing the development of atherosclerosis in women, acting through novel mechanisms on target vascular cells. Other endocrine' hormones, such as PTHRP and adrenomedullin, also modulate cardiovascular and renovascular dynamic states, suggesting new roles for these peptides as vasodilators. This multi-authored text is dedicated to highlighting emerging and important new information regarding the endocrinology of the cardiovascular system. Ellis R. Levin, M.D.

After a decade or longer, approximately one-third of individuals with either type 1 or type 2 diabetes commence a downhill course in which decreasing renal function and failing vision define a Renal-Retinal Syndrome, dominating all aspects of life and presaging early death. Only a generation ago, survival after onset of end-stage renal disease (ESRD) in diabetes was limited because rehabilitation was preempted by blindness, limb amputation, stroke, and heart disease. By 1998, however, team management has improved the outlook, with preserved sight and return to work and home responsibilities, usually for a decade or longer, following kidney transplantation and laser photocoagulation. Recognition of the critical requirement for blood pressure regulation and metabolic control are central themes in management. In this unique book, the accomplishments of ophthalmologists, nephrologists, diabetologists, transplant surgeons, and basic scientists are blended into a strategic approach that may be readily applied by all those caring for diabetic patients. Each of twenty-one presentations suitable for primary care physicians, as well as for subspecialists concerned with macrovascular and microvascular complications of diabetes, is placed in perspective by an introductory editorial analysis. Promising near-term innovative therapies, including insertion of genetically engineered beta cells or polymer-coated islets of Langerhans, interdiction of kinins that promote retinal angiogenesis, and prevention of synthesis of advanced glycosylated endproducts (AGEs), are presented in detail. While comprehensive care of diabetic patients reflects multiple incremental advances that in sum afford major benefit, this text envisions further remarkable changes likely to suppress and possibly entirely prevent the Diabetic Renal-Retinal Syndrome.

Organised into Breakfasts, Light Bites, Soup & Lunch, Main Meals, Sweet Things & Drinks and Sides & Dressings, the recipes are accompanied by nutritional analysis and at-a-glance traffic light labelling, as well as being arranged into Menu Plans. They include delicious dishes such as Squash, Feta & Hazelnut Salad and Roast Butterfly Chicken with Pomegranate, Lemon, Garlic & Mint, and cakes and desserts such as Banana Pinenut Cake and Easy Chocolate Mousse. With advice on achieving (and maintaining) a healthy weight, practical tips on eating less refined carbohydrates, smaller portions, and nutrient dense ingredients, Phil makes eating sensibly easier and more appealing than ever.

Leading medical specialists critically review for the general practitioner the latest techniques for the clinical management of diabetic neuropathy. These authoritative contributors focus on the practical aspects of diabetic neuropathy and describe in detail the treatments that are currently available or expected to become available in the near future. They also include concise discussions of the causes of diabetic neuropathy and highlight the relatively unknown features of neuropathy that can significantly impact a patient's life. Comprehensive, up-to-date bibliographies at the end of each chapter provide an opportunity for the interested physician to gain a more detailed picture of a particular topic. This book offers family physicians, internists, endocrinologists, podiatrists, cardiologists, neurologists, and gastroenterologists an authoritative practical guide and a vital day-to-day reference source for the management of their neuropathic diabetic patients.

A comprehensive, cutting-edge review of the complex interactions between maternal and fetal-placental tissues that control the establishment and maintenance of pregnancy, the proper development of the fetus, the birth process, and the behavioral aspects of bonding between mother and newborn. Expert researchers review the endocrine and physiological events that culminate in the delivery of offspring, and provide a solid base of comparative information on the menstrual cycle of primates, including humans. They also discuss the sources and functions of both steroid and protein hormones from the placenta and the details of their effects on uterine function, placental development, fetal growth and well-being, and maternal responses to pregnancy. This book will become the standard reference source not only for reproductive scientists, but also for those clinicians who want better to understand the complex factors that affect pregnancy-and their pregnant patients.

Given the rapid increase in the worldwide incidence of gestational diabetes, the need for defining the risks and effects associated with raised glucose concentrations in pregnancy is great. Recent large studies are helping to define the risks, as well as identify the benefits of reducing glucose intolerance. Written by an esteemed list of international authors, Gestational Diabetes: Origins, Complications, and Treatment presents timely reviews relating to some of the most important aspects of gestational diabetes, specifically its causes, consequences, and treatments. Divided into five sections, the book begins with a section on metabolism in pregnancy and gestational diabetes, dealing with maternal and foetal glucose metabolism and the controversial area of what actually constitutes gestational diabetes. The next section examines risk factors and causes of gestational diabetes, including the obvious but often overlooked factors-being female and pregnant. The text also outlines environmental and genetic risk factors. The third section deals with the potential complications of gestational diabetes for both mother and offspring, considering short-term and long-term effects. The largest section in the book addresses treatments in an effort to improve the outcome for the mother and the baby. Chapters describe the nutritional approach, considered the cornerstone of treating gestational diabetes, as well as evidence for the role of exercise in its treatment and a useful strategy for treating gestational diabetes pharmacologically. The final section discusses future prospects in screening, diagnosis, prevention, pathophysiology, and treatment of gestational diabetes.

As an endocrinologist and research scientist--and a diabetic for over 29 years--Dr. Joseph Juliano has devoted his life to understanding the disease. Now, he shows the millions of Type I, insulin-dependent diabetes sufferers how to avoid complications and overcome them if they occur, empowering readers with the motivation and information to control their disease.