Pediatric Endocrinology (5th Edition)

Forewords:
Robert Blizzard, MD: The previous four editions of Pediatric Endocrinology progressively have been a dominating educational tool for sub specialists in Pediatric Endocrinology, genetics, nutrition, etc., and for pediatric generalists. The fifth edition exceeds my expectations and will exceed yours. The expansion of the text into two volumes could be discouraging to the prospective owner. It should not be. The educational leadership and organizational talent of Dr. Lifshitz have provided us with a text that mow has necessarily expanded into two volumes as the scope of the specialty expanded. The new organization enhances the use of this textbook, permitting the reader initially to be very focused in obtaining the information he/she seeks, but it subsequently supplement that information as time permits by going to other chapters each written by different well known authors. Examination of Dr. Lifshitz’s preface of this text and the indexed outline of chapters and subchapters permits confirmation of my conclusion. The multiple contributing authors also deserve strong commendations for the excellent content of this two volume text. The collaboration of multiple authors for each subsection permits the presentation of broader perspectives than if a single author had been responsible.

I have considered the presence of each of the previous four editions of pediatric endocrinology a necessity on my shelf because of their high quality as a diagnostic and therapeutic tool in the practice of pediatrics and pediatric endocrinology. The firth edition similarly will be a necessary and welcomed addition on the self reserved for my favorite textbooks. I personally extend my thanks and congratulations to Dr. Lifshitz and to each of his contributors in producing this excellent and timely textbook.

Robert M. Blizzard, MD
Professor and Chairman Emeritus
Department of Pediatrics and Children’s Medical Center
University of Virginia
Charlottesville, VA

Maria I New, MD: In this age of molecular science, our knowledge of the genetic basis of endocrine disorders is rapidly expanding. As we come to understand the etiology of disease with pinpoint accuracy, our treatments become more effective and tailored to our patients’ needs. Current molecular research impacts treatment when clinicians can use such findings to guide their therapies. This textbook serves as a crucial bridge between the molecular laboratory and the clinical practice, encouraging translational research.

Dr. Fima Lifshitz has again collected an authoritative, current and important text to serve the burgeoning field of pediatric endocrinology. I know that it will continue to be an invaluable tool for both clinicians and researchers.

Maria I New
Professor of Pediatrics
Director, Adrenal Steroid Disorders Program
Mount Sinai School of Medicine
New York, New York, U.S.A.

Janet Silverstein, MD: As Osler once said, “Read with two objects: first, to acquaint yourself with the current knowledge on a subject and the steps by which it has been reached; and secondly, and more important, read to understand and analyze your cases”. The fifth edition of the textbook of Pediatric Endocrinology provides the reader with an opportunity to meet both objectives, combining both an update on the latest developments in the field of pediatric endocrinology while also providing practical information on how this knowledge can be applied to patient care.

Books are a reflection of their times. It is not surprising, therefore, that the evolution of pediatric endocrinology over the past 2 decades is reflected by the changes that have occurred in this textbook since its initial printing in 1985. The first edition of Pediatric Endocrinology consisted of 27 chapters with 668 pages; the current edition has 53 chapters with more than 1300 pages. The expansion in the size of the book reflects the rapid expansion of knowledge that has occurred in the field over the last 22 years. In 1985, only 3 chapters with 60 pages were devoted to the diagnosis and treatment of type 1 diabetes mellitus and Ketoacidosis, while type 2 diabetes and obesity were not addressed. The current edition has been split into 2 separate but complementary volumes, the 1st  volume covering disorders of carbohydrate metabolism (Obesity, T1DM, T2DM, Insulin resistance and hypoglycemia) in 20 chapters with  over 500 pages; and the 2nd volume dealing with “traditional” endocrinology (Growth, Adrenal Sexual, Thyroid, Calcium & Fluid balance) in 33 chapters with 768 pages. The increase in the number of chapters and pages devoted to obesity and diabetes reflects the increased prevalence of these disorders in the pediatric population and is concordant with the patient distribution in many pediatric endocrine practices.

This book, therefore, provides in-depth coverage of the disease states seen in the early 21 st century. It provides the readership with an opportunity to explore the wonders of the science and the clinical breadth of pediatric endocrinology by just turning the pages. Osler wisely said, “To study the phenomena of disease without books, is to sail an uncharted sea while to study books without patients is not to go to sea at all”. This book provides the sail, the boat, and the rudder; the clinicians must determine how to apply it to their patients.

Janet Silverstein MD
Professor of Pediatrics
University of Florida College of Medicine

Joseph Wolsdorf, MD: Dr. Fima Lifshitz' expansive view of the scope of pediatric endocrinology is reflected in the fifth edition of his classic textbook Pediatric Endocrinology, first published in 1985. Each edition has improved upon its predecessor by adding new chapters on topics relevant to the rapidly developing science and changing practice of pediatric endocrinology. Unlike other textbooks of pediatric endocrinology, which tend to be largely devoted to classical pediatric endocrinology, Lifshitz' Pediatric Endocrinology is equally devoted to what might be referred to as metabolic endocrinology. The latter includes the various forms of diabetes mellitus, hypoglycemia, obesity and its related disorders, insulin resistance, lipid disorders, and various genetic disorders of metabolism. With 53 chapters, the fifth edition of Pediatric Endocrinology has expanded to two volumes. A substantial portion of volume one is devoted to metabolic endocrinology, whereas volume two contains chapters on all the classical topics in pediatric endocrinology as well as miscellaneous other endocrine disorders. This textbook also provides valuable information on a variety of topics relevant to pediatricians, pediatric endocrinologists, and academic clinicians throughout the world. The two volumes complement each other and together provide comprehensive coverage of the contemporary practice of pediatric endocrinology and metabolism.

Dr. Lifshitz has carefully selected pertinent topics and superb authors, all experts in their respective fields, who are both investigators and clinicians. As a result, Pediatric Endocrinology is characterized by an exceptional blend of rigorous scholarship and pragmatism, which undoubtedly contributes to its broad appeal and will ensure its continued success. I congratulate Dr. Lifshitz on admirably accomplishing the monumental task of editing, unassisted, a textbook of this magnitude and complexity and ensuring that each chapter meets his exacting standards of scholarship, clinical relevance, and clarity of exposition. It has been an honor and a privilege to serve as a contributor to Pediatric Endocrinology and to write this foreword.

Joseph I. Wolfsdorf, M.B.,B.Ch.
Children's Hospital Boston
Harvard Medical School
Boston, MA
U.S.A

Preface:
Pediatric Endocrinology. Fifth Edition.
Editor Fima Lifshitz MD
”The good life is one inspired by love and guided by knowledge” Bertrand Russell
The fifth edition of Pediatric Endocrinology marks the 22nd anniversary of this textbook. This edition has built upon the accumulated experience of the previous versions and every one of the chapters has been thoroughly updated; thereby its content enhances the reputation that Pediatric Endocrinology has enjoyed as “the classic book in the field”. Each of the topics of the chapters of the fifth edition of this book addresses one of the many potential alterations of patients referred to the pediatric endocrinologist for evaluation and treatment. Together they provide the most updated information needed by the physician caring for these children, yet written with the detail required by the sub specialist in academic settings. The chapters are written in a didactic manner containing practical information, with comprehensive discussions, that address all clinical situations. Thereby the book serves to increase the knowledge of both the practitioner and the sub specialist. The fifth edition of Pediatric Endocrinology constitutes a state-of-the art textbook, written by mature, well established contributors, who transmit their knowledge in an erudite manner, covering the theoretical and the clinical considerations of each entity.

Since the first edition of Pediatric Endocrinology published in 1985 the field has grown and has evolved. The state of knowledge and scientific basis of the practice of the specialty is markedly different from that of two decades ago. This edition encompasses the current status of the specialty and the care of patients with pediatric endocrine diseases. The ever increasing scope of the science of endocrinology and the rapid acquisition of new knowledge is captured and synthesized in each chapter by experts in all aspects of the specialty. The clinical care and practical aspects of pediatric endocrinology is written by those who are committed to the practice of the specialty.

The fifth edition of Pediatric Endocrinology comprises two volumes, each one dealing with major areas in the filed. The expanded version of the textbook allows a comprehensive review of the multiple advances and provides the reader the factual information to address all the concerns that arise when caring for children with endocrine related alterations. Each one of these two books contains comprehensive chapters of specific entities that contain sufficient detailed information to cover the topic in its entirety. Thereby each volume constitutes a book in its own right, yet both complement each other and together they form the resource in the field in an integrated easy to read and clearly written manner.

Volume 1 of Pediatric Endocrinology is devoted to Obesity, Diabetes Mellitus, Insulin Resistance and Hypoglycemia with a special section on Private Practice & Clinical Research. Currently caring for patients with these diseases constitutes a major part of the pediatric endocrinologist’s time and effort. Thus the expanded review of these topics reflects the true state of the specialty. Whereas previous editions of this book already contained chapters dealing with obesity and diabetes in children, long before these entities attracted the full attention of pediatric endocrinologists; other texts in the field have barely addressed these topics. However in this 5 th edition of Pediatric Endocrinology, these entities are fully expanded to provide the reader with a substantive appraisal of the subjects and of the current issues. The major public health problem of obesity is most blatantly visible, yet it is often a neglected disease. In this book obesity is discussed from a pediatric endocrinologist’s perspective, with attention given to all aspects of the disease; including the epidemic and the mechanisms of the illness. The genetics and the single gene disorders that are manifested with obesity are reviewed as are the prevention and treatment of this disorder and the co-morbidities. Included are also the chapters that address the current state of knowledge of the insulin resistance/metabolic syndrome and the diseases that often result from insulin resistance, such as hypertension and hyperlipidemia. The long term endocrine alterations that follow the birth of a small for gestational age infant are reviewed, with particular detail to the development of the insulin resistance syndrome, appearing later on in the life of such children.

There was a time when pediatric endocrinologists were not involved with the care of children with diabetes or with the teaching and research of this disorder; that was the past. Currently the care for such patients demands the attention of the specialist; pediatric endocrinologists are now intimately involved providing care and advancing the knowledge of the disease through clinical and basic science research. This is evident in each of the chapters of this book that pertain to all aspects of diabetes mellitus. Included in the book is an update of the new clinical multicenter research programs designed to address the causes of type 1diabetes and chapters dealing with the theoretical and practical aspects of the care of such patients. Also there is an expanded chapter dealing with type 2 diabetes mellitus since this disease has become a more prominent area for the pediatric endocrinology specialty. In the section of hypoglycemia, the disorders that produce this alteration are reviewed with attention paid to the pathophysiology, its causes and the treatment, both in children and in neonates. The emergencies that pediatric endocrinologists deal when consulted for patients with inborn errors of metabolism are thoroughly addressed and the norms for the assessment of newborn screening alterations are provided. Finally there are new chapters dealing with the current realities in the field, namely the private practice of the sub specialty and the performance of clinical trials by both the academic pediatric endocrinologist as well as the physician committed to patient care. There is also a comprehensive reference resource containing frequently used charts and tables needed for the assessment of endocrine patients.

Volume 2 of Pediatric Endocrinology is devoted to Growth, Adrenal, Sexual, Thyroid, Calcium and Fluid Balance Disorders with a special section on Radiation Terrorism. The Web Resources available to the pediatric endocrinologist and the Dynamic & Genetic tests utilized in the care of patients with endocrine diseases are also contained therein. The diseases reviewed in this volume have been traditionally included within the realm of the pediatric endocrinology specialty and were included in previous editions of the book. However in the fifth edition of Pediatric Endocrinology the specific chapters dealing with each of these entities are thoroughly reviewed and completely updated with attention given to the clinical and pathophysiological aspects of the disease. The book contains sections devoted to: a) growth and growth disorders, b) adrenal disorders, c) sexual development abnormalities, d) thyroid disorders, e) calcium & mineral metabolism disorders, as well as to f) miscellaneous endocrine entities, and g) endocrine testing protocols. In these sections the diseases that afflict children cared for in a pediatric endocrine service are discussed. In the fifth edition of Pediatric Endocrinology there are new chapters dealing with specific advances in the field of growth hormone insufficiency, the molecular basis of growth disorders and the integrity of the IGF system for appropriate growth. Also there is a chapter on the transition from adolescence to adulthood of the growth hormone deficient patient and the deficiency of this hormone in adults. The skeletal dysplasias leading to short stature and the syndromes leading to overgrowth and tall short stature are thoroughly reviewed.

The neonatal screening program is now widely used for the diagnosis of multiple inborn errors of metabolism, hypothyroidism and congenital adrenal hyperplasia. Thus, a readily available resource of the standards and guidelines for the care of newborns with abnormal newborn screens is found in the book. The traditional diseases of the adrenal cortex and medulla as well as the sexual differentiation disorders and thyroid and parathyroid alterations chapters provide great detail in comprehensive reviews of all the alterations of patients with diseases of these endocrine glands. Also there are new chapters dealing with rickets and osteoporosis and brittle bone syndromes, as the scope of the specialty has demanded that pediatric endocrinologists deal with patients with these entities. A major source of concern to pediatricians in practice is also addressed in this book, namely the patient with non endocrine diseases associated with abnormal endocrine tests, often causing referrals to the pediatric endocrinologist. In this era a chapter of radiation terrorism was necessary to bring to the pediatric endocrinologist the necessary information “to be aware and prepared”. Additionally the chapter dealing with the use of the Web provides an important practical update to the practicing physician for the recognition of genetic syndromes in pediatric endocrinology. Finally all the chapters address the diagnostics of endocrine function and disease with algorithms and updated tables, special growth charts, dynamic endocrine testing protocols and interpretation of the data. Altogether the book provides the necessary information to facilitate the care of the pediatric endocrine patient and the understanding of the diseases that they present.

Sophocles said it long ago:
  “ Look and you will find it - what is unsought will go undetected. ”