This book contains the necessary knowledge and tools to incorporate nutrition into primary care practice. As a practical matter, this effort is led by a dedicated primary care physician with the help of motivated registered dietitians, nurses, psychologists, physical therapists, and office staff whether within a known practice or by referral to the community. It is essential that the nutrition prescription provided by the physician be as efficient as possible. While many team members have superior knowledge in the areas of nutrition, exercise, and psychology, the health practitioner remains the focus of patient confidence in a therapy plan. Therefore, the endorsement of the plan rather than the implementation of the plan is the most important task of the physician. This book proposes a significant change in attitude of primary health care providers in terms of the power of nutrition in prevention and treatment of common disease. It features detailed and referenced information on the role of nutrition in the most common conditions encountered in primary care practice. In the past, treatment focused primarily on drugs and surgery for the treatment of disease with nutrition as an afterthought. Advanced technologies and drugs are effective for the treatment of acute disease, but many of the most common diseases such as heart disease, diabetes, and cancer are not preventable with drugs and surgery. While there is mention of prevention of heart disease, this largely relates to the use of statins with some modest discussion of a healthy diet. Similarly, prevention of type 2 diabetes is the early introduction of metformin or intensive insulin therapy.

The European School of Oncology came into existence to respond to a need for informa tion, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Univer sities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and its seminars on new techniques or on the principal therapeutic controversies, it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the Uni versity and Industry and between these two and daily medical practice. One of the more recent initiatives of the ESO is the Intercity Meetings. The concept of Inter city Meetings was first put forward with the idea of creating total coverage throughout Europe of certain tumours at the forefront of research and, in some cases, controversy."

International experts are brought together in this book to give basic as well as clinical data on obesity and cachexia, and an integrated picture of the regulation of intermediary metabolism in both situations. The data provide evidence that tissue catabolism and anabolism are regulated by similar mechanisms, which again are the target of different hormonal and metabolic factors. This joint discussion of the similarities evident in both areas will greatly benefit future understanding and research in obesity and cachexia.

1.1 Outline of the Study In this study the influence of psychotropic drugs on anterior pituitary hormone (APR) secretion was investigated in healthy subjects and in depressed patients. The basis for this study is formed by pharmacological investigations which indicate that the therapeutic effect of psychotropic drugs can be attributed to their functional influence on central nervous aminergic impulse transmission (stimuli) as well as by endocrinological investigations which show that central nervous aminergic neurons influence APR secretion in man. The purpose was to frod out if psychotropic drugs with differing pharmacological actions also influence APR secretion differently, even though the complex processes of central nervous stimuli transmission, the effect of psychotropic drugs on these processes, as well as the action of aminergic neuronal systems on APR secretion are not completely understood. Furthermore, it was investigated if it is possible to reach conclusions on the effects of drugs on central nervous aminergic neurons based upon APR secretion data. Specifically, the effects of various antidepressants, neuroleptics, and benzodiazepine-type tranquilizers on the secretion of growth hormone (GR), prolactin (PRL), adrenocorticotropic hormone (ACTR), and cortisol were investigated in healthy male subjects. The first part of this study presents in detail the results of these experiments and also incorporates the results of other investigators. It is endeavored to answer the question whether and to what extent the different psychotropic drugs influence APR secretion and whether the APR secretion profiles of the different psychotropic drugs can serve as a possible pharmacoendocrinological model in humans.

Starting with the morphology of the myoendocrine cell and the biochemistry and physiology of cardiac hor mones, the book describes pathophysiological findings and discuss their clinical relevance in congestive heart failure, arterial hypertension, renal insufficiency, and cirrhosis of the liver. Furthermore, evidence is presented for the role of the heart as a target organ for various endocrine factors such as thyroid hormones, catecholamines, renin-angiotensin, growth hormones and endogenous opioids.

Ein Screening auf angeborene endokrine und metabole Stoerungen ermoeglicht die Fruherkennung von Krankheiten wie Hypothyreose, AGS (adrenogenitales Syndrom), Phenylketonurie, Galaktosamie, Biotinidasemangel, Cystische Fibrose oder Homocystinurie. Je nach Land und politischen Bestimmungen unterscheiden sich jedoch die routinemassig durchgefuhrten Untersuchungen. Dieses Handbuch beschreibt praxisbezogen die biochemischen Grundlagen, die Grundsatze der Labor- und Bestatigungsdiagnostik sowie Therapiemoeglichkeiten zu insgesamt zwoelf Krankheiten. Daruber hinaus werden praanalytische Fragen, wie Zeitpunkt und Art der Blutentnahme oder moegliche Stoerfaktoren, umfassend behandelt. Der allgemeine Teil geht auf ethische und psychosoziale Aspekte des Screenings ein. Ein Verzeichnis der Screeningzentren und jener Labors, die fur die Bestatigungsdiagnostik Dienste anbieten, sowie ein Adressenverzeichnis von Elterngruppen und Informationsquellen im Internet komplettieren dieses Buch.

A number of clinical and epidemiological studies have shown that disorders of lipoprotein metabolism constitute one of the most important risk factors for the development of atherosclerosis and coronary heart disease. This volume examines the state of the art of lipoprotein subclass metabolism and its relation to these diseases. The authors also report on new developments concerning the role of lipoprotein recptors, macrophages and apolipoprotein E polymorphism in cholesterol homeostasis. The combination of general outline form and very specific aspects of cholesterol transport will interest those in other disciplines following developments in the field, as well as those directly involved in lipoprotein research.

This book records the proceedings of the 5th International Symposium on cancer topics organised in collaboration with the Association for International Cancer Research, a cancer charity based in the United Kingdom. The Symposium was held at the Klinikum Steglitz, Free University of West Berlin, Germany, between 1 and 3 October 1987. The Organising and Scientific Committees are deeply grateful to the President of the Free University, Professor Heckelmann, for allowing us to meet in the Klinikum Steglitz and for the University's generous financial support. It was a special pleasure to have a positive and generous input from the West Berlin Senate. Their support was crucial in making the Symposium a scientific success. The Symposium received financial support from a number of sponsors, and we are indeed happy to acknowledge our gratitude to them: Behringwerke AG, Bert- hold AG, Boehringer Mannheim GmbH, the British Council, Deutsche Abbott GmbH, Deutsche Bank AG, Du Pont De Nemours GmbH, Knoll AG, Krewel- werke GmbH, Nunc GmbH, Schering AG, Schwarz GmbH and Varian GmbH. The Symposium was the most ambitious so far mounted by the Association for International Cancer Research. The organisation and planning were carried through by an Organising Committee including Professor J. Hammerstein, Profes- sor K. D. Asmus, Barbara Steiger and Renate Nigam. The Scientific Committee included Dr. D. C. H. McBrien, Professor T. Dormandy, Professor K. R. Rees, Pro- fessor M. U. Dianzani and Professor H. Esterbauer. We thank these colleagues very much for their dedication, hard work and expert input.

His scientific contributions are regarded as classics: the studies about the insulin effect on adipose tissue (together with George F. Cahill Jr. ), his work on the biosyn- thesis and secretion of insulin (together with Lelio Orci and Claes W ollheim) and his studies on various spontaneous and induced diabetes syndromes in rodents (together with Bernard Jeanrenaud and Eleazar Shafrir). Albert Renold will be remembered for a long time by all who knew him for his achievements, for his kindness and his humanity. We dedicate the Proceedings of this symposium to his memory. Werner Creutzfeldt Pierre Lefebvre G6ttingen Liege History and Philosophy of Bayer Pharmaceutical Research W. -D. Busse Fachbereich Forschung Pharma, Bayer AG, D-5600 Wuppertal, FRG Research has a long tradition at Bayer. This year, 1988, marks 100 years of our pharmaceutical activities. In 1888 the first Bayer drug - phenacetin, an antipyreti- was synthesized, starting from a by-product of dye manufacture. This finding led to the establishment of a Pharmaceutical Department within Friedrich Bayer and Co. in Elberfeld, with all its associated facilities (Fig. 1). The beginning of the company itself, however, dates back to 1863. In that year, Friedrich Bayer started the produc- tion of aniline dyestuffs in his private house in Barmen-Rittershausen. During the 125 years of the company's life and the 100 years of pharmaceuticals, many developments and products have been discovered by Bayer researchers and launched by Bayer.

"Endocrine and Metabolic Disease" is in two sections. The first is a systematic review of clinical and therapeutic aspects of endocrine diseases, whilst the second considers the clinical pharmacology of drugs used in endocrinology. All the major areas of endocrinology and metabolism are covered. Thyroid, adrenal and pancreatic disease are discussed in depth and there are separate chapters on the ovary and testes as well as on the pituitary gland and parathyroids. There is a useful pharmacopoeia of drugs used in endocrinology at the end of the volume.

Das Spektrum der in den westlichen Industrienationen filhren- den Krankheiten und der darauf basierenden Thdesursachen hat sich in den letzten J ahrzehnten gewandelt. Wahrend frliher die Infektionskrankheiten und speziell die Thberkulose den hochsten Todeszoll forderten, sind in den Jahrzehnten nach dem zweiten Weltkrieg mit steigendem Wohlstand die Herz- und GefaBkrankheiten an die erste Stelle gerlickt. Trotz gewis- ser Erfolge in der Pravention in einigen Uindern wie z. B. in den USA, Kanada, Australien; aber auch in einigen Gebieten West- europas, in denen die Zahl der tOdlichen Hirnschlage und Herzinfarkte inzwischen wieder rlicklaufig ist, wird die Spit- zenposition in der Todesursachenstatistik hier auch weiterhin von diesen Krankheiten eingenommen. In anderen Uindern wie z. B. in Osteuropanehmen die Erkrankungsraten weiter zu. Wenn man sich fragt, was getan werden kann, urn weitere Er- fqlge auf diesem Gebiet zu erzielen, dann ist ein Blick in die Lander des Fernen Ostens hilfreich. In der Volksrepublik Chi- na undin J apanliegt die Sterblichkeit an koronarer Herzkrank- heit bzw. an Herzinfarkten flinf- bis zehnmal niedriger als in der Bundesrepublik Deutschland. Arteriosklerotische Durch- blutungsstorungen der unteren Extremitaten, auch diabeti- sche GefaBerkrankungen kommen dort kaum vor. Vergleicht man die Lebensweise der Bevolkerung in diesen Uindern mit den Verhaltnissen in den westlichen Industriena- tionen, so fallenerhebliche Unterschiedeinder Ernahrungauf. Wahrend in China Fleisch und Molkereiprodukte in deutlich geringeren Mengen als bei uns verzehrt werden, besteht der Hauptanteil der Ernahrung aus einer an pflanzlichem EiweiB und Schlackenstoffen reichen Kost.

The sixth edition of this highly popular text retains its comprehensive coverage of endocrine basics from previous editions while featuring entirely new chapters on several topics, including the assessment of endocrine function, sexual differentiation, growth regulation, the thyroid, the adrenals, and calcium homeostasis. Chapters have been updated and reorganized to make information easily accessible in concise form, and new figures and tables have been added to enhance the presentation of complex concepts. Fundamental principles of endocrine physiology are reinforced with illustrative examples from clinical observation and the limitations of current knowledge are properly identified. The ideal resource for students entering the field, the Textbook of Endocrine Physiology aims to provide for all a solid basis in fundamentals of endocrinology and for some, inspiration for the pursuit of advanced medical or graduate studies in the field.

The authors have provided an overview of the relationships between hormones that are physiologic constituents of the body as well as their pharmacologic use in replacement therapies and related endocrine dys function. Principles of Endocrine Pharmacology concerns itself with the ther apeutic use of hormones, and hormone like substances, or drugs that can act either by suppressing or enhancing the metabolism of certain glands of internal secretion. Other drugs used for nonendocrine ther apies can likewise affect the endocrine system. Endocrine pharmacology emerged in the early 1900s with the use of crude pituitary extracts. By the mid-1900s several investigators had isolated and begun to synthesize hormones or hormonelike substances. Recognizing the limited supply of hormones that could be obtained both from animal sources and human autopsy material, the search for so called hormone substitutes also began early in the 1900s. Recently, re combinant DNA technologies have been used to provide alternative therapeutic sources of human insulin and human growth hormone. Aside from insulin, perhaps no other use of hormonally-active sub stance is better exemplified by those drugs which affect fertility. The synthesis of an orally-effective steroid represented one of the first major breakthroughs in the chemical suppression of ovulation. Since the orally active 19-norsteroids were introduced in the 1950s, several oral contra ceptive steroid preparations have been marketed. Indeed, the advent of oral contraceptives for birth control has led to a renewed interest in endocrine pharmacology."

In 1920, Hirose demonstrated the luteinising effect of placental tissue and one year later, Evans and Long described luteinised ovaries in rats treated with hypophysial extracts. In 1926, Zondek and Aschheim as well as Smith, independently of each other, showed that a gonad-stimulating hormone was secreted by the adenohypophysis. In 1927, Aschheim and Zondek found their "Prolan" in human pregnancy urine and the first reliable pregnancy test was available. In the following years it could be demonstrated that the gonadotropic hormones from pituitary and from pregnancy urin were not of identical structure. During the years 1931 - 1933 Fevold and coworkers prepared follicle stimulating hormone from sheep pituitaries which were free of other hormone activities. Already in 1934, Collip found "antihormones" in animals treated with proteinhormones from animals of another species. It could be shown that they were antibodies against these hormones and this was the future basis for the immunological era starting in 1960. The quantitative determination of gonadotropins has been performed over several decades by difficult bioassays and since 1960 immunological and later radioimmunological assays became available. Since that time a new field was opened for the studies of gonadotropins. During this time, highly purified preparations of gonadotropins were available for research and clinical treatment. I recall the first successful attempt of inducing follicle growth and ovulation by Gemzell and coworkers 1958 as well as by Lunenfeld and Bettendorf at about the same time.

Der innersekretorische EinfluB auf Stimmung, Befindlichkeit und Leistungsfahigkeit des Menschen ist ein faszinierendes Aufga- benfeld der forschenden und praktizierenden Medizin; er ist auch fOr die betroffenen Menschen von groBtem Interesse und groBer Bedeutung. Mit den damit zusammenhangenden Fragen befassen sich besonders die Arbeitsmedizin und in den letzten Jahren zuneh- mend auch die Sportmedizin. Dieses Engagement ergibt sich einmal aus der Bedeutung der Leistungsfahigkeit fOr diese Berei- che, zum anderen methodisch aus der Moglichkeit, innersekreto- rischen Parametern exakte Werte der Arbeit und des Leistens gegen 0 berzustellen. Gerade beim weltweiten Phanomen stark ansteigender Zahlen im Frauensport und der gleichzeitigen rasanten Entwicklung der Spitzenleistungen treten verstarkt Probleme innersekretorischer Regulationen aus frauenheilkundlicher Sicht in Erscheinung. Vielerorts wird von Arzten, Trainern und Sportlern mit Hormon- wirkungen argumentiert, ohne daB solchen Aussagen immer auch gesicherte Fakten zugrundeliegen. Der Deutsche Leichtathletikverband, darOber hinaus aber der Sport schlechthin haben allen AnlaB, der Universitatsfrauenklinik in TObingen fOr ihr Engagement auf diesem Sektor zu danken. Die im Rahmen dieses Symposiums ausgetauschten Kenntnisse, Erfahrungen und Anregungen werden dazu beitragen, die in Frage stehenden Zusammenhange aufzuklaren. Das aber wirQ nicht nur fOr den Sport von Nutzen sein, sondern Vorteile fOr Diagnostik und Therapie in Klinik-, Fach- und Aligemeinpraxis bringen konnen.

Klinefelter's syndrome occurs relatively frequently, being diagnosed for one in 600 male infants, yet it is probably very rare that it is recognized early enough to make effective treatment possible. Often the person afflicted does not go to a doctor until physical and emotional disturbances have developed on the ba sis of the syndrome. The appropriate therapy at the correct time can prevent many of these disturbances. In our andrology outpatient clinic we encountered Klinefelter's syndrome almost three decades ago in patients suffering from impotentia generandi. It was not until later that we dealt with it in our capacities as dematologists. It was observed at a rate too high to be coincidental among younger men suffer ing from ulcera crurum. On the other hand, we failed to see the condition during our work as con sultants in other specialities, especially internal medicine, although we re peatedly attempted to identify it. We should have encountered it at least occa sionally in our 10 years working in the Munich hospitals with their more than 4000 beds. It was this imbalance between the allegedly relative frequency of this condition and its rare detection which led us to plan a Klinefelter sympo sium. We soon determined, during a first search of the literature, that there was information in many more subject areas that we had expected or even guessed."

Thoroughly updated to reflect today's recent advances in adult and pediatric endocrinology, DeGroot's Endocrinology, 8th Edition, remains the comprehensive, international reference of choice for today's endocrinologists and fellows. A full peer review of the previous edition, conducted by a largely new group of renowned editors, was used to update this trusted, two-volume resource. In-depth coverage of both basic and clinical aspects of endocrinology and up-to-date information on the treatment and management of endocrine disorders are provided by a diverse group of expert contributors from six continents. A full-color format and helpful algorithms summarize clinical decision-making and practical approaches to patient management. Organizes content by all the glands that regulate the endocrine system while integrating basic science and clinical presentations of disease. Includes new chapters: Anatomy and Physiology of the Hypothalmus and Pituitary, Differentiated Thyroid Cancer, Medullary Thyroid Cancer, Drugs that Affect Thyroid Function, Genetic Disorders of the Adrenal Cortex, Adrenal Pathology, Primary Aldosteronism, Transgender Healthcare, Erectile Dysfunction, Prevalence and Causes of Male Infertility, Sexual Dysfunction in the Female, Glucose Toxicity and Oxidative Stress. Emphasizes basic science and evidence-based practice throughout. Features extensive updates to content on thyroid and adrenal disfunction, endocrine-disrupting chemicals and human disease, clinical management of diabetes, and advances in genetics. Includes algorithms to outline effective treatment protocols. Contains new emphasis boxes that highlight key points in each chapter. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Table 19. Local structural effects of endocrine diseases Endocrine symptoms and signs are rarely specific. This fact renders the art of recognizing an endocrine Structure affected Feature disorder in a patient more often one of suspecting rather than 'diagnosing' it. Unlike most other body Hypothalamus Headaches Pituitary Headaches, visual defect 'systems' the very nature of the endocrine system Thyroid Pressure symptoms, dysphagia, ensures that the effects of disordered function in a goitre gland affect the body as a whole and cause diffuse Gonads Testicular lumps, ovarian masses symptoms and signs. Most patients with a cardiac problem present with one or more specific symptoms such as chest pain, palpitations and oedema. The problem then becomes one of resolving whether a cardiac problem exists or not and, if so, what is the nature of the disease process. HISTORY Similarly, most patients with a gastro-enterological and neurological problem will present with a specific Present history symptom - diarrhoea, or tremor - which will direct attention to that organ system.

During the past 3 years, little has been added to our funda mental knowledge of hormonal disorders in gynecology. Diagnostically, however, there has been an almost com plete departure from traditional chemical methods in favor of radioimmunoassay techniques. As a result, diagnostic capabilities which previously were restricted to large cen ters have now been extended to the office and small clinic. Accordingly, the chapters dealing with these techniques have been revised and updated. There is also new material on advances in the hormonal treatment of endometriosis and hyperprolactinemic states. Finally, the bibliography has been extensively revised to include a number of recently published books and survey articles of general interest. Paul J. Keller v Preface to the First German Edition Menstrual disorders and sterility are among the most com mon complaints noted by both the specialist and general practitioner. For many patients they are far more distress ful than is generally assumed. Recent years have brought our knowledge. While this has led to great advances in major improvements in the results of treatment, it has made it difficult for the nonspecialist to keep abreast of developments in the field of gynecologic endocrinology.