The Netter Collection of Medical Illustrations

256 Pages·2013·18.32 MB·English

VOLUME 2
The Netter Collection
OF MEDICAL ILLUSTRATIONS:
Endocrine System
S econd Edition
William F. Young, Jr., MD, MSc
Professor of Medicine, Mayo Clinic College of Medicine
Division of Endocrinology, Diabetes, Metabolism, and Nutrition
Mayo Clinic
Rochester, Minnesota
Illustrations by
Frank H. Netter, MD, and Carlos A. G. Machado, MD
CONTRIBUTING ILLUSTRATORS
James A. Perkins, MS, MFA
John A. Craig, MD
Kristen Wienandt Marzejon, MS, MFA
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS: ISBN: 978-1-4160-6388-9
ENDOCRINE SYSTEM, Volume 2, Second Edition
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
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ISBN: 978-1-4160-6388-9
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ABOUT THE SERIES
r. Frank H. Netter exemplifi ed the distinct CUSHING’S SYNDROME IN A PATIENT WITH THE CARNEY COMPLEX
Dvocations of doctor, artist, and teacher.
Even more important, he unifi ed them. Netter’s
illustrations always began with meticulous
research into the forms of the body, a philoso-
phy that steered his broad and deep medical
understanding. He often said, “Clarifi cation is
ctanh homeat lgelmeodnaiacglk.ae eNl— ciollal eumnasdrat rtagte trirmeo ahnetod ewhsicta abssl e ulapicutocttleiienfs ustv.—l”lay lwu Hitea i isssi f pcg hiartiea nardtoeedrs-st, n
lCbPicbnaoyioeabcgv nrimsldniujap ue cedoanryanistnc nt cydeotg io bd fv s tme kathclh eierepsneo,ne l etetpluhiyixngipmeg i isl onms.i,s dneccteshs lhnet ,eha artvanereat –difrcoa mbtncneiled.rluli– ieztohened
ing a middle course between artistic clarity and
instructional complexity. That success is cap- CAadrdnietiyo ncaolm fepaletuxr ecsa no fi nthcelu de:
t
thuree dfi risnt cthoims psreerhieesn, sbiveeg icnonlilnegct iionn 1o9f4 8N, ewttheern’s caMunytdax nomemaomaussm: (caear.yrgd.,i aecy ealtirdiu),m,
w
Phoarkrm, aa cseinugtilcea lvso. luImt em, weta s wpuitbhl ishsuecdh b ys uCcIcBesAs Tcaelscticfyuilnagr lSaerrgteo-lci eclelll tumors
that over the following 40 years the collection Gsercoewretthin-hgo prmituointaery adenomas
was expanded into an eight-volume series— Pmsealmanmootimc asctohuwsannomas
each devoted to a single body system.
In this second edition of the legendary series,
we are delighted to offer Netter’s timeless work,
now arranged and informed by modern text and
Dr. Frank Netter at work radiologic imaging contributed by fi eld-leading doctors
and teachers from world-renowned medical institutions
and supplemented with new illustrations created by
artists working in the Netter tradition. Inside the classic
hgruenednr edcos voefr so,r igsitnuadle wntosr kasn odf aprrt—actihtieo hnuerms anw bilol dfiy nind PsnatdoPujdNdaudcAleeDdns tawa adritertre holne pbashlslai cgtch lkca,on brd t4reso xmaw.rmne , u ionsru draeilaldym noeoft denuro laremnsd.a Mli nsoitzester s opafen trdhs em dpo isgntm taherented
pictures—paired with the latest in expert medical
knowledge and innovation, and anchored in the sublime AM Db,r afnodr Tnheew E inllduosctrainteed S pyslatetem p, aVionltuemd eb y2 ,C eadrl.o 2s Machado,
style of Frank Netter.
Dr. Carlos Machado was chosen by Novartis to be
Dr. Netter’s successor. He continues to be the primary
artist contributing to the Netter family of products. Dr.
Machado says, “For 16 years, in my updating of the
illustrations in the Netter Atlas of Human Anatomy, as
well as many other Netter publications, I have faced
The single-volume “blue book” that paved the way for the the challenging mission of continuing Dr. Netter’s
multivolume Netter Collection of Medical Illustrations legacy, of following and understanding his concepts,
series, aff ectionately known as the “green books.” and of reproducing his style by using his favorite
techniques.”
Although the science and teaching of medicine en-
dures changes in terminology, practice, and discovery,
some things remain the same. A patient is a patient. A
teacher is a teacher. And the pictures of Dr. Netter—he
called them pictures, never paintings—remain the same
blend of beautiful and instructional resources that have
guided physicians’ hands and nurtured their imagina-
tions for over half a century.
The original series could not exist without the dedi-
cation of all those who edited, authored, or in other
ways contributed, nor, of course, without the excellence
of Dr. Netter, who is fondly remembered by all who
knew him. For this exciting second edition, we also
owe our gratitude to the authors, editors, advisors, and
artists whose relentless efforts were instrumental in
adapting these timeless works into reliable references
for today’s clinicians in training and in practice. From
all of us at Elsevier, we thank you.
Dr. Carlos Machado at work
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS v
ABOUT THE EDITOR
illiam F. Young, Jr, MD, MSc, is Professor
Wof Medicine at Mayo Clinic College of
Medicine, Mayo Clinic, Rochester, Minnesota, USA.
He holds the Tyson Family Endocrinology Clinical
Professorship in Honor of Vahab Fatourechi, MD. He
received his bachelor degree and his medical degree
from Michigan State University and his master of
science degree from the University of Minnesota. Dr.
Young trained in internal medicine at William Beau-
mont Hospital in Royal Oak, Michigan, and completed
a fellowship in endocrinology and metabolism at Mayo
Clinic in Rochester, Minnesota. He has been a member
of the staff at Mayo Clinic since 1984. Dr. Young is
the recipient of multiple education awards including
the Mayo Fellows Association Teacher of the Year
Award in Internal Medicine, the Mayo Clinic Endocri-
nology Teacher of the Year Award, the Mayo School
of Continuing Medical Education Outstanding Faculty
Member Award, and the H. Jack Baskin, MD, Endo-
crine Teaching Award from the American Association
of Clinical Endocrinologists in recognition of his
profound impact in teaching fellows in training.
Professional honors include being a recipient of the
Distinguished Mayo Clinician Award, the Distinction
in Clinical Endocrinology Award from the American
College of Endocrinology, and the Distinguished
Physician Award from the Endocrine Society. Dr.
Young’s clinical research focuses on primary aldoste-
ronism and pheochromocytoma. He has published
more than 200 articles on endocrine hypertension and
adrenal and pituitary disorders. Dr. Young has pre-
sented at more than 300 national and international
meetings and has been an invited visiting professor at
more than 100 medical institutions.
vi THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS
PREFACE
he second edition of the Endocrine System volume and magnetic resonance imaging). The original Netter
Tof the Netter Collection is designed to provide edition and the new illustrations focus on embryology,
physicians at all stages of training and practice with a gross anatomy, histology, physiology, pathology, clini-
visual guide to the anatomy, physiology, and patho- cal manifestations of disease, diagnostic modalities, and
physiology of the endocrine glands. The fi rst edition surgical and therapeutic techniques.
was published in 1965. In the intervening 5 decades, Writing an “update” that spans 5 decades has been a
there have been remarkable developments in our daunting challenge. However, this new edition will
understanding of endocrine disorders. The text has serve to preserve and provide context for the original
been entirely rewritten, but most of the anatomic and Netter illustrations well into the twenty-fi rst century.
clinical artwork of Frank H. Netter, MD, has stood the This work is not a complete textbook of endocrinology,
test of time. Since new endocrine disorders and treat- but rather it is a visual tour of the highlights of this
ment approaches have been recognized over the past 50 medical discipline. I hope readers fi nd the artwork and
years, new artwork has been added in every section, accompanying text useful guides as they navigate the
including the following: current surgical approaches world of endocrinology.
to remove pituitary tumors, tests used in the diagnosis I gratefully acknowledge my colleagues and patients
of Cushing syndrome, adrenal venous sampling for at Mayo Clinic who have provided me with the clinical
primary aldosteronism, Cushing syndrome caused by experience, perspective, and insights to address the
primary pigmented nodular adrenocortical disease, broad fi eld of endocrinology. The editorial and produc-
treatment of type 1 and type 2 diabetes mellitus, tion staffs at Elsevier have been very supportive at every
multiple endocrine neoplasia types 1 and 2, and von step from initial general concepts to fi nal publication. I
Hippel–Lindau syndrome. Carlos Machado, MD, am indebted to the incredible second generation of
James A. Perkins, MS, MFA, Kristen Wienandt Netter artists. I also want to thank my daughter, Abbie
Marzejon, MS, MFA, and John Craig, MD, have L. Abboud, MS, CGC, ELS, for her invaluable help in
contributed outstanding new plates to this edition, medical editing and providing guidance on clarity of
as well as adapted and updated existing artwork. The thought and concept. Finally, I dedicate this book to my
accompanying text serves to illuminate and expand on family—their encouragement and support have been
the concepts demonstrated in the images. inspirational during the 2 years it took to produce the
The book is organized in 8 sections, which corre- second edition of the Endocrine System volume of the
spond to the glands and components of the endocrine Netter Collection.
system: pituitary and hypothalamus, thyroid, adrenal,
reproduction, pancreas, bone and calcium, lipids and William F. Young, Jr., MD, MSc
nutrition, and genetics and endocrine neoplasia. In Rochester, Minnesota
some cases, the Netter drawings are supplemented with November 2010
modern diagnostic images (e.g., computed tomography
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS vii
ABOUT THE ARTIST FROM THE FIRST EDITION
Among others, the pictures showed a medical
student sitting up the night before the osteo-
logy examination, studying away to the point
of exhaustion; an emergency ward; an ambu-
lance call; a class reunion; and a night call
made by a country doctor.
During World War II, Dr. Netter was
an offi cer in the Army, stationed fi rst at
the Army Institute of Pathology, later at
the Surgeon General’s Offi ce, in charge of
graphic training aids for the Medical Depart-
ment. Numerous manuals were produced
under his direction, among them fi rst aid
for combat troops, roentgenology for tech-
nicians, sanitation in the fi eld, and survival in
the tropics.
After the war, Dr. Netter began work on
several major projects for CIBA Pharmaceu-
tical Company, culminating in THE CIBA
COLLECTION OF MEDICAL ILLUS-
TRATIONS. To date, fi ve volumes have been
published and work is in progress on the
sixth, dealing with the urinary tract.
Dr. Netter goes about planning and exe-
cuting his illustrations in a very exacting way.
First comes the study, unquestionably the
most important and most diffi cult part of
the entire undertaking. No drawing is ever
any readers of the CIBA COLLECTION have started until Dr. Netter has acquired a complete under-
Mexpressed a desire to know more about Dr. standing of the subject matter, either through reading
Netter. In response to these requests this summary of or by consultation with leading authorities in the fi eld.
Dr. Netter’s career has been prepared. Often he visits hospitals to observe clinical cases, patho-
Frank Henry Netter, born in 1906 in Brooklyn, New logic or surgical specimens, or operative procedures.
York, received his M.D. degree from New York Uni- Sometimes an original dissection is necessary.
versity in 1931. To help pay his way through medical When all his questions have been answered and the
school and internship at Bellevue, he worked as a com- problem is thoroughly understood, Dr. Netter makes a
mercial artist and as an illustrator of medical books and pencil sketch on a tissue or tracing pad. Always, the
articles for his professors and other physicians, perfect- subject must be visualized from the standpoint of the
ing his natural talent by studying at the National physician; is it to be viewed from above or below, from
Academy of Design and attending courses at the Art the side, the rear, or the front? What area is to be
Students’ League. covered, the entire body or just certain segments? What
In 1933 Dr. Netter entered the private practice of plane provides the clearest understanding? In some pic-
surgery in New York City. But it was the depth of the tures two, three, or four planes of dissection may be
Depression, and the recently married physician contin- necessary.
ued to accept art assignments to supplement his income. When the sketch is at last satisfactory, Dr. Netter
Soon he was spending more and more time at the transfers it to a piece of illustration board for the fi n-
drawing board and fi nally, realizing that his career lay ished drawing. This is done by blocking the back of the
in medical illustration, he decided to give up practicing picture with a soft pencil, taping the tissue down on the
and become a full-time artist. board with Scotch tape, then going over the lines with
Soon, Dr. Netter was receiving requests to develop a hard pencil. Over the years, our physician-artist has
many unusual projects. One of the most arduous of used many media to fi nish his illustrations, but now he
these was building the “transparent woman” for the San works almost exclusively in transparent water colors
Francisco Golden Gate Exposition. This 7-foot-high mixed with white paint.
transparent fi gure depicted the menstrual process, the In spite of the tremendously productive life Dr.
development and birth of a baby, and the physical and Netter has led, he has been able to enjoy his family, fi rst
sexual development of a woman, while a synchronized in a handsome country home in East Norwich, Long
voice told the story of the female endocrine system. Dr. Island, and, after the fi ve children had grown up, in a
Netter labored on this project night and day for 7 penthouse overlooking the East River in Manhattan.
months. Another interesting assignment involved a
series of paintings of incidents in the life of a physician. ALFRED W. CUSTER
viii THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS
INTRODUCTION TO THE FIRST EDITION
n the early days the endocrine glands were looked patient, and unrelenting work of the men and women
Iupon as an isolated group of structures, secreting who have, bit by bit, unraveled and correlated the mys-
substances which, in some strange way, infl uenced the teries of these various fi elds. It has been my great pleas-
human organism. The thyroid gland was known to ure, in creating this volume, to have worked with some
be an organ of considerable signifi cance. The clinical of these pioneers or with their disciples. No words of
syndromes of hyper- and hypothyroidism and the appreciation for the help and encouragement I received
therapeutic effects of thyroid administration and thy- from all my collaborators can completely convey the
roidectomy were recognized. Insulin had become avail- satisfaction I obtained from getting to know each of
able, and its use in controlling diabetes was being them and becoming their friend.
explored. It was known generally that the pituitary In fi nding my way through the uncharted space of
gland exerted some infl uence over the growth and sex the endocrine universe, I sorely needed a guide—one
life of mankind. Nonetheless, the endocrine glands who could plot a course among the biochemical con-
were still considered as a system apart, secreting mys- stellations, yet at all times would know his way back to
terious and potent substances. In the light of modern earthly clinical considerations. Such a one I found in
knowledge, however, this is not an isolated system at all Dr. Peter H. Forsham, who took over the editorship of
but, rather, an essential and controlling mechanism of this volume upon the death of Dr. Ernst Oppenheimer,
all the other systems; indeed, together with the nervous about whom I have written in the preceding pages. I
system, the integrator of biochemistry and physiology shall always cherish the stimulating hours Dr. Forsham
in the living organism. and I spent together in work and, occasionally, in play.
Thus, although this volume was originally planned as A creative effort such as that which this volume has
an atlas on the endocrine glands, it was impossible to demanded absorbs a great deal of one’s time, effort, and
execute it intelligently without becoming involved in dreams. In short, it tends to detach the artist from his
such basic and related subjects as carbohydrate, protein, surroundings and personal relationships and to make
and fat metabolism; the major vitamins; enzyme chem- him diffi cult to live with! For these reasons I must
istry; genetics; and inborn metabolic errors. As a matter express special appreciation to my wife, Vera, for
of fact, as I now survey the entire subject, it seems to patiently bearing with me through these tribulations.
me that the growth of our understanding of the func- She always managed to return me to reality when I
tion of the endocrine glands has come about as much became too detached, bring a smile to my face when I
or more from the study of the basic physiology of the was distressed, and help me in so many other ways during
glandular secretions as from study of the morphological this challenging but rather awesome assignment.
effects of the endocrine system itself. I have also been
tremendously impressed and awed by the painstaking, FRANK H. NETTER, M.D.
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS ix