Guide to the Practice of Paediatric Endocrinology

192 Pages·1993·4.6 MB·English

by  C. G. D. Brook

This concise and practical book is designed for paediatricians
and endocrinologists trained or in training, who see children
with endocrine problems. All the endocrine glands are covered,
and the author has distilled his vast experience and expertise in
this area to provide hard-hitting, practical advice on the
diagnosis, management, and treatment of the main endocrine
disorders. It is not a heavily referenced tome but a monograph
in the true sense of the word - a book in which an expert
describes and discusses the area of his expertise for the benefit
and interest of others. The volume is illustrated throughout and
the text is also supplemented by many succinct and informative
tables. The volume concludes with a short chapter on practical
procedures, including endocrine tests, imaging, and drugs and
doses.

A GUIDE TO THE PRACTICE OF
PAEDIATRIC ENDOCRINOLOGY

A GUIDE TO THE
PRACTICE OF
PAEDIATRIC
ENDOCRINOLOGY
C. G. D. BROOK, MA, MD(CANTAB), FRCP, DCH
Professor of Paediatric Endocrinology
University College London
Consultant Paediatrician
The Middlesex Hospital, London WIN 8AA, UK
n
CAMBRIDGE
I* UNIVERSITY PRESS
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 2RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521431798
© Cambridge University Press 1993
This book is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.
First published 1993
A catalogue record for this publication is available from the British Library
Library of Congress Cataloguing in Publication data
Brook, C. G. D. (Charles Groves Darville)
A guide to the practice of paediatric endocrinology / C.G.D.
Brook
p. cm.
Includes index.
ISBN 0-521-43179-4 (hardback)
1. Pediatric endocrinology. I. Title.
[DNLM: 1. Endocrine Diseases - in infancy and childhood. WS330
B871g]
RJ418.B725 1993
618.92'4 - dc20
DNLM/DLC
for library of Congress 92-49015 CIP
ISBN-13 978-0-521-43179-8 hardback
ISBN-10 0-521-43179-4 hardback
Transferred to digital printing 2005
Every effort has been made in preparing this book to provide accurate and
up-to-date information which is in accord with accepted standards and
practice at the time of publication. Nevertheless, the authors, editors and
publishers can make no warranties that the information contained herein
is totally free from error, not least because clinical standards are constantly
changing through research and regulation. The authors, editors and
publishers therefore disclaim all liability for direct or consequential damages
resulting from the use of material contained in this book. Readers are
strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.
Contents
Preface page ix
1 Intersex 1
Sexual determination 1
Sexual differentiation 3
Abnormal sexual development 6
Disorders, management and treatment 12
2 Growth 18
Normal growth and its endocrine control 18
Growth assessment 25
The short child 33
The tall child 45
The fat child 51
The thin child 53
3 Puberty 55
Normal puberty and its endocrine control 55
Early puberty 66
Late puberty 76
4 The thyroid gland 83
Clinical physiology 83
Hypothyroidism 86
Hyperthyroidism 92
Thyroid swellings 95
5 The adrenal gland 97
Clinical physiology 97
Adrenal steroid deficiency 100
Adrenal steroid excess 105
Congenital adrenal hyperplasia 109
Adrenomedullary dysfunction 118
vii
viii Contents
6 Salt and water balance 119
Hyponatremia 119
Endocrine hypertension 121
Water balance 123
7 Calcium balance 128
Clinical physiology 128
Hypocalcemia 130
Hypercalcemia 134
8 Glucose homeostasis 136
Diabetes mellitus 137
Hypoglycemia 147
9 The endocrine consequences of neoplasia 151
Primary disorders 151
Secondary effects 152
10 Practical matters 158
Endocrine tests and their normal values 158
Imaging 165
Commonly used drugs and their doses 168
Appendix I: SI Conversion table 173
Bibliography 174
Index 175
Preface
In 1978 I published a small book about paediatric endocrinology. Since
that time, there has been an amazing advance in many aspects of the
practice of the discipline and some of my more loyal friends, Dr Stephen
Herman in particular, have been kind enough to say that it is time for
the subject to be brought up to date in a completely new book. This is it -
and I thank Peter Silver and the Cambridge University Press for the
opportunity to prepare it. Mary Sanders was extremely efficient in getting
the book into print.
The Press told me that in a monograph 'an expert describes and
discusses the area of his own expertise for the benefit and interest of others'
which is what I have done. I hope that it will be useful to general
paediatricians and endocrinologists. It encapsulates my view of the subject,
which may be iconoclastic in places, and it is a practical book not a major
work of critical analysis heavily referenced for the specialist in the field -
I edit a much bigger volume for that purpose.
I would probably never have summoned the strength to set pen to paper
in this venture were it not for the opportunity afforded to me to undertake
a sabbatical exchange visit to the Royal Children's Hospital in Melbourne
where I wrote the book. Dr John Court was generous enough to swap jobs,
houses and cars for 5 months to enable this to happen and I am very
grateful to him, to Cathy, my wife, for giving up her job and to our hospital
and university colleagues in England and Australia for allowing us to
exchange, and for their welcomes. I had a marvellous time; I hope that Dr
Court enjoyed himself as much.
Over the years at The Middlesex I have been very happy, thanks to many
people. I would like particularly to acknowledge the stimulation and
support I have had from Peter Hindmarsh, Howard Jacobs, Antony
Kurtz, Steve Semple, Jimmy Steele, Jeffrey O'Riordan, Sandra Ramsden
ix
x Preface
and, most especially, Jane Pringle. I should also like to thank several
generations of house physicians, registrars, research fellows, technicians
and secretaries whose work has made possible what has been achieved. On
this occasion, Emily Whitehead has been my secretary and has put up
uncomplainingly with my importunities over the months: I am very
grateful to her for her patient help.
C. G. D. Brook
August, 1992