Description

Diabetes mellitus, described by Arataeus in the first century A.D. as “a melting down of the flesh and limbs into urine”, has been recognised for thousands of years. Its cause, however, remained unknown until the latenineteenth century when Oskar Minkowski made the serendipitous discovery that pancreatectomy in the dog resulted in diabetes. With the discovery of insulin in 1921 it soon became apparent that a subset of diabetics typified by the obese, middle-aged, non-ketotic adult was much less sensitive to insulin in terms of its blood glucose lowering effect compared to ketosis-prone younger patients. Thus, the concept of “insulin resistance” gained ground, and soon other hormone-resistant states such as pseudohypoparathyroidism became widely recognised. The recent exponential growth in our understanding of the subtle pathophysiology of cellular and subcellular processes has led to recognition of several other disease states caused by a spectrum of resistance to various hormones. Hormone resistance could result from defects in pre-receptor, receptor or post-receptor mechanisms and the degree of resistance could vary according to target tissue. These concepts are thoroughly discussed in this comprehensive but not unmanageably oversized monograph, one of a three-part series, Modern Endocrinology (series editor: Luciano Martini), each dedicated to a major pathophysiological mechanism underlying the majority of endocrine diseases: alterations in hormone sensitivity, gene mutations, and autoimmunity. The phenomenon of hormone hypersensitivity is far more nebulous and the book would have benefited from a focussed chapter introducing current concepts for the uninitiated. As such only the chapter on glucocorticoid resistance and hypersensitivity states, one of 38 invited chapters contributed by authors who are eminent leaders in their field, does justice to this subject. The book makes no pretence of being a clinical text in the conventional sense and the physician faced with a patient suspected of one of the disorders described is unlikely to feel comforted by its presence on the bookshelf. Nevertheless, there is adequate description of clinical features and variations in phenotype, and brief but satisfactory discussion of treatment. The chapters, as is often the case in multi-author textbooks, differ in style, approach and overlap, but the reading experience does not suffer, perhaps because of judicious editing. The text is liberally illustrated with 152 figures of a very high quality across its 542 numbered pages but there is a decided lack of illustrations in some of the chapters. However, each chapter is well referenced and the index is faultless. Thus this volume is excellent material for “further reading” for trainees as well as senior clinicians and researchers in the rapidly expanding fields of adult and paediatric endocrinology, and, to a lesser extent, human genetics. The price is a bit on the steep side for purchasing personal copies but departmental and medical school libraries would benefit from having it on their shelves. The book also targets family physicians but the relevance to general practice is limited.