Preface

Harrison’s Principles of Internal Medicine has been a respected source of medical information for students, residents, internists, family physicians, and other health care providers for many decades. This book, Harrison’s Endocrinology, now in its fourth edition, is a compilation of chapters related to the specialty of endocrinology, a field that includes some of the most commonly encountered diseases such as diabetes mellitus, obesity, thyroid disorders, and metabolic bone disease.

Our readers consistently note the practical value of the specialty sections of Harrison’s. Specifically, these sections include a rigorous explanation of pathophysiology as a background for differential diagnosis and patient management. Our goal was to bring this information to readers in a more compact and usable form. Because the topic is more focused, it is possible to improve the presentation of the material by enlarging the text and the tables and providing clearly illustrated figures that elucidate challenging concepts. We have also included a Review and Self-Assessment section that includes questions and answers to provoke reflection and to provide additional teaching points.

The clinical manifestations of endocrine disorders can usually be explained by considering the physiologic role of hormones, which are either deficient or excessive. Thus, a thorough understanding of hormone action and principles of hormone feedback arms the clinician with a logical diagnostic approach and a conceptual framework for treating patients. The first chapter of the book, Approach to the Patient with Endocrine Disorders, provides this type of “systems” overview. Using numerous examples of translational research, this introduction links genetics, cell biology, and physiology with pathophysiology and treatment. The integration of pathophysiology with clinical management is a hallmark of Harrison’s, and can be found throughout each of the subsequent disease-oriented chapters. The book is divided into six main sections that reflect the physiologic roots of endocrinology: (I) Introduction to Endocrinology; (II) Pituitary, Thyroid, and Adrenal Disorders; (III) Reproductive Endocrinology; (IV) Diabetes Mellitus, Obesity, Lipoprotein Metabolism; (V) Disorders Affecting Multiple Endocrine Systems; and (VI) Disorders of Bone and Calcium Metabolism.

While Harrison’s Endocrinology is classic in its organization, readers will sense the impact of scientific advances as they explore the individual chapters in each section. In addition to the dramatic discoveries emanating from genetics and molecular biology, the introduction of an unprecedented number of new drugs, particularly for the management of diabetes, hypogonadism, and osteoporosis, is transforming the field of endocrinology. Numerous recent clinical studies involving common diseases like diabetes, obesity, hypothyroidism, hypogonadism, and osteoporosis provide powerful evidence for medical decision making and treatment. These rapid changes in endocrinology are exciting for new students of medicine and underscore the need for practicing physicians to continuously update their knowledge base and clinical skills.

Our access to information through web-based journals and databases is remarkably efficient, but also daunting, creating a need for books that synthesize concepts and highlight important facts. The preparation of these chapters is therefore a special craft that requires distillation of core information from the ever-expanding knowledge base. The editors are indebted to our authors, a group of internationally recognized authorities who are masters at providing a comprehensive overview while being able to distill a topic into a concise and interesting chapter. We are also indebted to our colleagues at McGraw-Hill. Jim Shanahan is a tireless champion for Harrison’s, and these books were impeccably produced by Kim Davis.

We hope you find this book useful in your effort to achieve continuous learning on behalf of your patients.