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2020_ME
The Endocrine System
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SYSTEMS OF THE BODY
The Endocrine System
BASIC SCIENCE AND CLINICAL CONDITIONS
THIRD EDITION
Joy Hinson BSc, PhD, DSc, PFHEA, FRSB
Professor Emerita of Endocrine Science
Formerly Dean for Postgraduate Studies
Barts and the London School of Medicine and Dentistry;
Queen Mary University of London
London, UK
Peter Raven
BSc, PhD, MBBS, MRCP, MRCPsych, FHEA
Now retired, formerly Faculty Tutor (Biomedical Sciences),
UCL
Deputy Director of Medical Education, UCL Medical School;
and Honorary Consultant Psychiatrist
Camden and Islington Mental Health Trust
London, UK
Series Editor
Shern Chew
BSc, MD, FRCP
Professor of Endocrine Medicine/Consultant Physician
Barts and the London School of Medicine and Dentistry;
Queen Mary University of London
London, UK
Stephen Hughes
BSc, MSc, MBBS, FRCSEd, FRCEM, FHEA
Consultant in Emergency Medicine, Broomfield Hospital;
Senior Lecturer in Medicine, School of Medicine, Anglia
Ruskin University
Chelmsford, UK
For additional online content visit ExpertConsult.com
© 2023, Elsevier Limited. All rights reserved.
First edition 2003
Second edition 2010
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verication of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
ISBN: 978-0-7020-8327-3
Publisher: Jeremy Bowes
Content Project Manager: Fariha Nadeem
Design: Margaret Reid
Illustration Manager: Anitha Rajarathnam
Marketing Manager: Deborah Watkins
Copyedited by Editage, a unit of Cactus Communications Services Pte. Ltd.
Typeset by TNQ Technologies Pvt. Ltd.
Printed in Poland
Last digit is the print number: 9 8 7 6 5 4 3 2 1
This book is dedicated to the memory of Dr Saad Al- Damluji, endocrinologist and teacher.
SERIES EDITOR FOREWORD
Many students study medicine through an integrated
curriculum. These courses blend basic science with
exposure to clinical medicine from an early stage. These
students have the good fortune to be left in no doubt,
from the outset, why they are studying medicine. I teach
in a medical school that delivers a fully integrated curriculum and I can compare it with the traditional model
according to which I received my early medical education. That com parison is very favourable.
Unlike many other texts, the Systems of the Body series
has been designed very specifically to sup port an integrated approach to learning medicine. Our carefully
selected panel of authors drawn from across the Englishspeaking world have combined basic sci ence with
clinical application. Links to clinical skills, clinical investigation and therapeutics are made clear throughout.
The aim is to offer highly accessible guidance for all
student types and stages. It will be invaluable to those
who are approaching the subject for the first time or
who may have found a topic challenging when using
other more traditionally configured resources – as well as
greatly assist all students wishing to excel as their course
progresses. The clear layout and writing style, together
with detail that informs without overwhelming, go a
long way to supporting students. It may also provide
welcome reminders to postgraduates facing their own
examinations.
Whatever curriculum you follow, wherever you
are in the world, and whichever stage you are at, we
know that the Systems of the Body volumes will serve as
great places to start when learning something new and
enable you to effectively piece together the essential
components of each major body system, in a modern
clinical context.
Good luck!
Stephen Hughes, MSc MBBS FRCSEd FRCEM FHEA
Senior Lecturer in Medicine
Anglia Ruskin University
Chelmsford, UK
and
Consultant, Emergency Medicine
Broomfield Hospital
Chelmsford, UK
PREFACE
Endocrinology is really very simple. You can either have
too much of a hormone … or too little.
(Professor John Landon’s traditional
and reassuring introduction to his
endocrinology teaching.)
The first edition of this book was aimed primarily at
medical students, particularly those taking a modern,
integrated course. The second edition was enlarged and
expanded to include more detail of physiological and
biochemical mechanisms. This third edition has been
revised and fully updated. We hope that this edition will
be used by students of the biomedical sciences as well as
medical students.
The book is intended as a broad general introduction
to the Endocrine System, although we hope that you will
be sufficiently enthused after reading it to wish to take
your studies further in this exciting and fast- moving
area.
Each chapter is structured around clinical cases.
Endocrinology is at its most interesting when considered
in the context of what happens when things go wrong.
These cases have been chosen to illustrate important
points about either the biochemistry of hormone synthesis or the physiology of endocrine regulation. This will
allow medical students early in their studies to understand the clinical relevance of the basic science. However,
we hope that the book will also allow clinical students
to understand the basic science underlying endocrine
disease.
In the clinical cases featured in this book we have tried
to show common presentations of the different disorders,
but endocrine problems present in such a wide variety
of ways that students should not be misled into thinking
that these are the only presentations!
The ‘Interesting facts’ we included in the first edition
have been added to. These are snippets of information
that particularly interested us and that we wanted to
share with you. We hope that you will find them interesting too.
The first two chapters are not case- based; these contain details of the basic concepts needed to understand
hormones and their actions. The final chapter describes
a mixture of hormones and other signalling molecules
with varying degrees of clinical importance. This chapter
illustrates perfectly the idea that endocrinology is rather
more than a stand- alone speciality, but, rather, it is a subject which impinges on the cardiovascular system, the
immune system, and all other systems of the body.
We do hope that we have managed to convey to you
our enthusiasm for this most fascinating subject.
ACKNOWLEDGEMENTS
We are most grateful to all our colleagues for their help
and advice in the preparation of this book. In particular, we would like to thank: Dr Dan Berney for providing the histology, Dr Norbert Avril for the whole- body
glucose image, and Dr Alistair Chesser for the EPO case.
Although many colleagues have helped and advised us,
all errors remain our own. Thanks are due also to the
team at Elsevier.