Replacement therapy of disorders of endocrine function is a highly specialized area ofmedicine and is discussed in comprehensive textbooks of endocrinology. These textbookshave reviewed current physiology, pathophysiology, differential diagnosis, andtherapy. This book will focus on current replacement therapy of endocrine diseases andcan assist the endocrinologist, gynecologist, pediatrician, urologist, general surgeon,neurologist, neurosurgery, psychiatrist, generalist, and trainee in the management of theirpatients. Endocrine testing used to monitor replacement therapy will be reviewed, but thereader is referred to appropriate diagnostic testing as covered in other textbooks ofendocrinology. The authors have extensive knowledge and experience in management ofpatients with specific endocrine disorders requiring replacement treatment. It is recognizedthat none is considered an expert in all areas of endocrine therapy, but the expertcan share the knowledge and experience to facilitate use of the best approach available.

 

Differences of opinion exist in replacement therapy and each endocrinologist has afavorite regimen. Each review will attempt to be balanced without bias. If equivalentregimens exist, the authors will make this apparent to the reader who can choose whichis best for the patient. Considerations of cost of similar regimens are important and mustbe discussed with the patient; thus, various options will make selection of replacementtherapy an individual process.

 

The book is divided into six sections that cover hormone replacement therapy of thepituitary (I), parathyroid and vitamin D (II), thyroid (III), diabetes (IV), adrenal (V), andgonads of men and women (VI). In the pituitary section the management of diabetesinsipidus and polydipsia in children is presented by Donald Zimmerman and GregUramoto and in adults by Andjela T. Drincic and Gary L. Robertson. Catherine K. Lumand Darrell M. Wilson review growth hormone therapy with emphasis on growth disordersof children while David E. Cummings and George R. Merriam focus on growthhormone and growth hormone secretagogues in adults.

 

In Part II, issues related to treatment of disorders of calcium metabolism caused bydiseases affecting parathyroid hormone and vitamin D are presented by Robert F. Klein,Michael Bliziotes, and Eric S. Orwoll. In the thyroid section (III), current guidelines forthyroid hormone replacement therapy in patients with primary and secondary hypothyroidismare reviewed by David S. Cooper and special issues related to thyroid hormonereplacement therapy during pregnancy are discussed by Jorge H. Mestman.

 

Part IV has four chapters discussing hormone replacement therapy of diabetes. R.Philip Eaton and Martin Conway focus on insulin management of the insulin dependentdiabetic while David G. Johnson and Rubin Bressler provide guidelines for managementof the type 2 diabetic. The special issues of management of diabetes during pregnancy arehighlighted by Kay F. McFarland and Laura S. Irwin, and Susan S. Braithwaite, WalterG. Barr, Amer Rahman, and Shaista Quddusi have developed an algorithm for diabetictherapy during glucocorticoid treatment of nonendocrine disease. The unique problemsof treatment of the diabetic during exercise are summarized by Robert E. Jones.

 

There are three chapters in the adrenal section (V). One is by Lynnette K. Nieman andKristina I. Rother that covers glucocorticoid therapy for postnatal adrenal cortical insufficiencyand for congenital adrenal hyperplasia. Therapy of mineralocorticoid deficiencydisorders is summarized by W. Reid Litchfield and Robert G. Dluhy, and the pros andcons for dehydroandrosterone and pregnenolone therapy are carefully analyzed byRakhmawati Sih, Hosam Kamel, Mohamad Horani, and John E. Morley.

 

Part VI covers sex hormone replacement issues in both men and women. WayneMeikle details issues related to androgen replacement therapy in children and men withandrogen deficiency, and the influence of androgen replacement therapy on sexual behavior,affect and cognition is presented by Max Hirshkowitz, Claudia Orengo, andGlenn Cunningham. The merits and safety issues associated with testosterone therapy inolder men are summarized by J. Lisa Tenover. Shalender Bhasin and Marjan Javanbakhtpresent the rationale and recommendations for androgen therapy in men with musclewasting disorders and particularly as related to AIDS. Hormonal contraception, which isbecoming more commonly used in men and requires hormonal therapy to suppress spermatogenesiswhile maintaining normal testosterone concentrations, is discussed by ChristinaWang and Ronald S. Swerdloff.

 

C. Matthew Peterson and Lawrence C. Udoff make recommendations for hormonereplacement therapy in women with primary and secondary hypogonadism. Androgenreplacement therapy in women is still somewhat controversial, but is becoming moreaccepted. A rationale basis for androgen therapy in women is made by Susan R. Davisand Henry G. Burger.

 

 A. Wayne Meikle, MD