bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and staging of cancer
Authors: Cutter David , Scott-Brown Martin
Published: August 2018

The accurate diagnosis of the precise type and stage of a malignancy is a vital part of cancer management. Treatment options and decisions vary significantly between various stages of the same malignancy (e.g. treatment with radical vs palliative intent) and also between specific histological subtypes of a cancer arising from the same organ (e.g. small-cell lung cancer vs non-small-cell lung cancer). It is therefore of critical importance that as much accurate information about each individual case is obtained. This is achieved with a variety of diagnostic procedures which allow the multidisciplinary team to reach correct decisions about management. The types of investigations performed typically include radiology and pathology, but clinically important information may also be obtained by other methods, for example surgical staging, clinical examination, endoscopy, and blood tests. As well as directing therapy, accurate staging also allows a more precise estimation of prognosis or the probability of treatment success, knowledge which is of obvious importance to the patient.
Treatment of cancer
Authors: Cutter David , Scott-Brown Martin
Published: August 2018

The variety of conditions that are considered to be ‘cancer’ is extremely wide, with marked variation in the management approach from disease to disease. A common feature in the management of malignant conditions, however, is the involvement of a wide range of medical professionals at different stages of the patient pathway. This commonly includes physicians, surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, and specialist nurses, as well as a plethora of other allied disciplines. As such, a practice that has been widely adopted is to work as a multidisciplinary team (MDT), with regular meetings to decide the appropriate treatment for each patient with a cancer diagnosis, on an individual and case-by-case basis. The main treatment modalities for the treatment of cancer are surgery, radiotherapy, and chemotherapy. While these are often combined to form a multimodality therapy, they are all, in isolation, potentially radical (curative) therapies for certain conditions. For example, surgery (in the case of a Stage I colon adenocarcinoma), radiotherapy (in the case of early laryngeal squamous cell carcinoma), and chemotherapy (in the case of acute lymphoblastic leukaemia) are all curative as single-modality treatments. It is commonly the case, however, for a patient to require more than one mode of therapy to achieve the best outcome, for example a combination of surgery, chemotherapy, and radiotherapy for early breast cancer. It can also be the case that two or more different management strategies are thought to give equivalent oncological results, for example surgery or radiotherapy for early prostate cancer. In this situation, the MDT and the patient need to decide on the ‘best’ management plan for the individual, based on their personal and professional opinions and on the differing toxicity profiles of the alternate treatments.
Prostate cancer
Authors: Ajzensztejn Daniel
Published: August 2018

Prostate cancer is the commonest male malignancy, with approximately 35 000 new cases in the UK annually, equating to a lifetime risk of 1 in 10. When diagnosed early, it has a high chance of cure with surgery, external beam radiotherapy, or brachytherapy. Even for metastatic disease, the prognosis is usually several years.
Breast cancer
Authors: Ajzensztejn Daniel
Published: August 2018

Breast cancer is the commonest female cancer, with a lifetime risk of approximately 1 in 9. There are approximately 40 000 new cases and 11 000 deaths from the disease in England and Wales each year. Breast cancer is an adenocarcinoma which arises from the glandular tissue of the breast. Its etiology is complex, with hormonal, genetic, and modifiable lifestyle factors all involved in developing the disease. Prognosis is related to the anatomical extent of the cancer, and other factors. This chapter discusses the definition and etiology of breast cancer, as well as its typical symptoms, less common symptoms, demographics, natural history, complications, diagnosis, treatment, and prognosis.
Ovarian and testicular cancer
Authors: Chapman Hannah , Elwell Christine
Published: August 2018

Ovarian cancer is the fifth most common cancer in females in the UK. In contrast, testicular cancer is a rare disease: there were 2138 new cases of testicular cancer diagnosed in 2008 in the UK, and only 70 deaths. Ninety per cent of all ovarian cancers are of epithelial origin, although germ cell and sex cord–stromal cell tumours also occur. In contrast, 95% of testicular cancers are germ cell tumours, with stromal cell tumours and lymphomas making up the remaining 5%. This chapter discusses ovarian cancer and testicular cancer, including definitions of the diseases and their etiologies, typical symptoms, uncommon symptoms, demographics, natural history, complications, diagnostic approach, other diagnoses that should be considered, prognosis, and treatment.
Symptom control in cancer
Authors: Scott-Brown Martin
Published: August 2018

Treatment in cancer is aimed at improving survival (curing where possible) and/or improving symptoms. Symptoms may be caused by the cancer itself (primary tumour, metastases, or paraneoplastic phenomenon) or by the treatments patients undergo to treat the cancer (surgery, radiotherapy, chemotherapy, hormone therapy, and biological therapy). Therefore, symptom control is one of the key roles of oncologists as they treat cancer patients. The most important part of symptom control in cancer patients is to elucidate the underlying cause of the symptom. Symptom control is most effective when the underlying cause is targeted; for example, shoulder pain may be treated most effectively by local radiotherapy if it is due to a bone metastasis in the humeral head, by dexamethasone if it is referred pain due to diaphragmatic irritation from hepatomegaly, and by amitriptyline or gabapentin if it is neuropathic pain due to cervical nerve root irritation. Covering all symptom control in cancer patients is beyond the remit of this chapter; however, it will cover the control of pain and nausea and vomiting, as these are very common symptoms in cancer patients.
Dying from cancer
Authors: Scott-Brown Martin
Published: August 2018

For many patients, dying from cancer has been an ever-present reality from the time they were diagnosed with incurable recurrent or metastatic cancer. Treatment may have delayed the inevitable, but there does come a point where aggressive management no longer improves the prognosis or can only prolong life that is of such a poor quality that it is not valued by the patient. It sometimes is easier to continue with treatment than to take the time with the patient to discuss the reasons why further treatment is not appropriate. For patients with advanced cancer and whose condition is deteriorating, a number of questions should be considered before initiating treatment aimed at prolonging life. Is this the final stage of a progressive deterioration or an acute event? Are the causes of this deterioration reversible? Are there any further oncological treatments that may improve the prognosis? What is the patient’s perception of their quality of life? Is there a realistic chance of return to a quality of life that will be of value to the patient? Is the patient dying? The ICU is usually not appropriate for patients with advanced cancer. Treatment of correctable causes (e.g. obstructive uropathy, chest infection) may still not be in the patient’s best interest if they recover only to face a period of further deterioration and distressing symptoms before they die. However, patients and their families must be included in discussions as to the level of further intervention and the reasons for stopping active treatment.
Normal nutritional function
Authors: Ellinson Michelle , Rampling Tommy
Published: August 2018

Normal nutritional function requires a healthy diet. Healthy eating incorporates a variety of nutrients that are essential for energy expenditure, prevention of disease, and maintenance of normal physiological function. An unhealthy diet can result in malnutrition, and this contributes to illness and death throughout the world. The core principle of healthy eating is obtaining an adequate balance, and the diseases resulting from overnourishment differ greatly from those resulting from undernourishment. In the third world, diets tend to rely heavily on staple crops, and can be very seasonal. Energy sources are predominantly cereals, whereas meat and fish are limited. Malnutrition tends to occur from a lack of essential nutrients, leading to conditions such as vitamin deficiencies, kwashiorkor, and iodine deficiency syndromes. In first-world countries, people have more freedom to choose what they eat. Thus, diets tend to be high in fat and dense in energy. Obesity, diabetes, coronary heart disease, cancer, and hypertension are major contributors to morbidity and mortality. A healthy diet should contain adequate proportions of carbohydrates, fats, proteins, vitamins, and trace elements. The intake of these constituents is sporadic, with meals constituting major boluses of potential energy. Energy expenditure, conversely, is continuous. The human body has, therefore, developed complex mechanisms directing nutrients into storage when in excess, and mobilizing these stores as they are needed, and it is essential that sufficient energy is always available to maintain the basal metabolic rate, which is the amount of energy expended while at rest in a neutrally temperate environment. This energy is sufficient only for the functioning of the vital organs, such as the heart, the lungs, the liver, the kidneys, and the CNS.
Starvation and malnutrition
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

Starvation is a state of severe malnutrition due to a reduction in macro- and micronutrient intake. The basis underlying starvation is an imbalance between energy intake and energy expenditure. The commonest cause of starvation is lack of available food, usually due to environmental, social, and economic reasons, although other causes include anorexia nervosa; depression and other psychiatric disorders; coma and disturbance of consciousness; intestinal failure; and mechanical failure of digestion, including poor dentition and intestinal obstruction. Protein energy malnutrition is usually seen in developing countries. This chapter discusses starvation and malnutrition, focusing on their etiology, symptoms, demographics, natural history, complications, diagnosis, treatment, and prognosis.
Nutritional support in the critically ill
Authors: Wise Matt , Frost Paul
Published: August 2018

Major injury evokes a constellation of reproducible hormonal, metabolic, and haemodynamic responses which are collectively termed ‘the adaptive stress response’. The purpose of the adaptive stress response is to facilitate tissue repair and restore normal homeostasis. If critical illness is prolonged, the adaptive stress response may become maladaptive, in essence exerting a parasitic effect leaching away structural proteins and impairing host immunity. Primarily therapy should be directed towards the underlying illness, as nutritional support per se will not reverse the stress response and its sequelae. Nonetheless, adequate nutritional support in the early stages of critical illness may attenuate protein catabolism and its adverse effects. This chapter covers nutritional assessment; detection of malnutrition; energy and protein requirements; monitoring the effectiveness of nutritional replacements; nutritional delivery; complications; and refeeding syndrome.
Poor diets
Authors: Andrews Rob , England Clare
Published: August 2018

Apart from breast milk, no single food contains all the essential nutrients the body needs to be healthy and function efficiently. The nutritional value of a person’s diet depends on the overall balance of foods eaten over a period of time, as well as on the needs of the individual. Over the last 60 years, there has been increasing agreement about the balance of nutrients and foods that make up a ‘good’ diet. This consists primarily of wholegrains (i.e. cereal grains, or foods made from them, containing bran, germ, and endosperm, e.g. wholemeal breads, oatmeal, and dark rye); vegetables and fruit, including nuts and pulses; moderate amounts of fish and low-fat dairy foods; and limited amounts of meat. The consumption of saturated fat should be low, with saturated fat being replaced by mono- and polyunsaturated vegetable fats and fish oils. Trans-fatty acids should be minimized, and added sugar should provide no more than 10% of energy intake. However, as omnivores, humans can survive on a wide range of different foods, and many people worldwide eat diets that fall far short of this ideal.
Obesity: epidemiology, prevention and management
Authors: Chen Mimi , Andrews Rob
Published: August 2018

Obesity has been around for more than 20 000 years, as evidenced by statuettes produced in the Stone Age. Body mass index (BMI), calculated as weight divided by the square of the height, is one of the simplest and most common ways of defining obesity. A BMI between 18.5 and 24.9 is classed as normal. BMI values of 25.0–29.9 suggest overweight, and any values over 30 are deemed obese. Across populations, BMI is closely associated with whole body adiposity, and the cut-off levels for overweight and obesity reflect the increasing risk of metabolic, cardiovascular, and other complications of obesity as BMI increases above the normal range. Obesity is widely agreed to be caused by a prolonged period of energy imbalance. In 95% of cases, it is due to the impact of an obesogenic lifestyle (overconsumption of energy and/or insufficient energy expenditure) on a variable background of genetic susceptibility. The remaining cases are caused by certain drugs, specific endocrine diseases, and monogenic syndromes.
Physical activity and its role in disease prevention
Authors: Hillsdon Melvyn , Anstiss Tim
Published: August 2018

Regular physical activity is one of the most powerful protective and therapeutic factors known to medicine—protecting people from a wide range of health problems and benefitting over 20 conditions and diseases, including coronary heart disease, stroke, diabetes, and cancer. It is also associated with mental well-being and a healthy body weight. Insufficient physical activity, therefore, is a powerful risk factor for a wide range of diseases and health conditions. It is widely prevalent and contributes significantly to burdens of disease and cost. It is detectable and reducible in individuals and groups.
Smoking
Authors: Lewis Keir
Published: August 2018

The UK government, in its White Paper in 1998, declared that ‘smoking is the greatest single cause of preventable illness and premature death in the UK’. Cigarette smoke is inhaled because it contains nicotine, which is highly addictive. Nicotine itself has some adverse physiological effects but it is mainly the 4000+ chemicals (including acetone, arsenic, paint stripper, pesticides, and over 60 known carcinogens), added to make the cigarette such an extremely potent nicotine delivery device, that cause so much damage.

A smoker dies on average 8–10 years before a non-smoker does. The commonest causes of premature death in smokers are cardiovascular disease, lung cancer, and COPD. However, smoking also leads to much morbidity, causing or worsening many illnesses and affecting every system of the body. In addition, it is associated with a number of cancers, including lung cancer, nasopharyngeal cancer, laryngeal cancer, oesophageal cancer, stomach cancer, pancreatic cancer, colonic cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukaemia. Stopping smoking at any age has been shown to improve health and increase life expectancy. Even with advanced smoking-related diseases, observational studies show clinically meaningful benefits in stopping smoking.
Environmental radiation
Authors: Little Mark P.
Published: August 2018

Risks associated with ionizing radiation have been known for almost as long as ionizing radiation itself. Within a year of the discovery of X-rays by Röntgen, skin burns had been reported and, within 7 years, a case of skin cancer was observed, all associated with high-dose X-ray exposure. In general, the risks associated with ionizing radiation can be divided into what have been termed (by the International Commission on Radiological Protection) stochastic effects (e.g. genetic risks in offspring, and somatic effects (cancer) in the directly exposed population), and deterministic, or tissue-reaction, effects. Deterministic effects are typically associated with high-dose exposures, and will not be considered further here.
Prevention of cardiovascular disease
Authors: Banerjee Amitava , Asrress Kaleab
Published: August 2018

The global scale of the cardiovascular disease epidemic is unquestionable, with cardiovascular disease causing a greater burden of mortality and morbidity than any other disease, regardless of country or population. With demographic change and ageing populations, the prevalence of cardiovascular disease and its risk factors is set to increase. The commonest cardiovascular diseases are atherosclerotic, affecting all arterial territories. The ‘burden of disease’ approach has highlighted the fact that cardiovascular disease and non-communicable diseases are not simply diseases of affluence but affect people of all countries, with enormous costs in terms of public health, healthcare, and overall economies. Coronary artery disease is the leading cause of mortality in all regions of the world apart from sub-Saharan Africa, followed by cerebrovascular disease. It should be noted, however, that there has been a major decline in cardiovascular disease mortality in Western Europe, the US, and Japan over the past 40 years. There are multiple factors underlying these favourable trends but understanding the epidemiology and characterizing individual risk factors for cardiovascular disease has been central in formulating preventive and treatment strategies. The INTERHEART study showed that 90% of cardiovascular risk can be explained by nine easily identifiable risk factors; an awareness of these, and the discovery of novel factors, will continue to serve in the fight to reduce the burden of cardiovascular disease. Geoffrey Rose first championed population-wide approaches versus strategies which target only high-risk individuals. Prevention aims to ‘catch the disease’ upstream, therefore delaying, reducing, or eliminating the risk of coronary artery disease. Surrogate markers for coronary artery disease have emerged in efforts to detect disease at earlier stages, and in order to better understand the pathophysiology. For example, coronary artery calcium scoring is emerging as a marker of future risk of coronary artery disease. Risk stratification scores are increasingly used as tools to individualize a person’s future risk of coronary artery disease in order to better target treatment and prevention strategies.
Prevention of respiratory disease
Authors: Bafadhel Mona
Published: August 2018

The prevention of disease at a population health level rather than an individual health level is aimed at reducing causes of ‘preventable’ death and, under the auspices of public health and epidemiology, is an integral part of primary, secondary, and tertiary care. Classification of death is usually according to the type of primary disease or injury. However, there are a number of recognized risk factors for death, and modifications in behaviour or risk factors can substantially reduce preventable causes of death and the associated healthcare and economic burden of chronic disease management. According to the WHO, hundreds of millions of people from infancy to old age suffer from preventable chronic respiratory diseases, there are over four million deaths annually from preventable respiratory diseases, and common respiratory disorders (e.g. lower respiratory tract infections, chronic obstructive pulmonary disease, lung cancer, and tuberculosis) account for approximately 20% of all deaths worldwide. This chapter discusses the prevention of respiratory disease, covering diseases associated with smoking (one of the biggest risk factors associated with preventable deaths), air pollution, and other lifestyle factors associated with respiratory disease; changes in legislation concerning smoking and work-related respiratory disease; and, finally, the prevention of respiratory diseases through the use of immunization and screening tools.
Prevention of kidney disease
Authors: Chakera Aron , Herrington William G. , O’Callaghan Christopher A.
Published: August 2018

A number of factors are known to predispose to renal disease, such as diabetes mellitus, hypertension, and exposure to certain drugs or substances (e.g. mercury and other heavy metals). In people who are at risk for these reasons, renal function should be regularly monitored as part of routine care. Kidney diseases are identified by elevations in the serum creatinine; the presence in the urine of blood, protein, or elevated levels of certain electrolytes; or evidence of anatomical abnormalities. Due to the large functional reserve of the kidneys, symptoms of impaired renal function usually occur late in the course of disease, highlighting the importance of early detection and, where available, the use of ameliorating therapies.
Prevention of gastrointestinal disease
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

Disease prevention is usually directed where there is considerable morbidity or mortality, and etiological factors that can be controlled, treated, or reduced. The greatest morbidity and mortality from gastrointestinal disease is related to infectious diarrhoea and gastrointestinal cancer, both of which can be prevented. Smoking has been closely associated with oesophageal, gastric, and liver cancer and also has a significant effect in inflammatory bowel disease. In addition, alcohol consumption and viral hepatitis are preventable causes of liver disease, liver failure, and hepatic cancer. This chapter addresses the prevention of gastrointestinal disease, focusing on alcohol, smoking, peptic ulcer disease, colorectal cancer, oesophageal adenocarcinoma, hepatitis B, hepatitis C, non-alcoholic fatty liver disease, and gastrointestinal infection.
Prevention of neurological disease
Authors: Morrison Karen
Published: August 2018

Neurological disease is very common. It is estimated that one-third of consultations with general practitioners involve neurological complaints, and neurological disorders are present in one-third of patients admitted to hospital. In considering how to reduce the incidence of neurological disease, one must take into account the feasibility of prevention, and the overall morbidity caused by the disease. In stroke, which is very common, interventions which reduce incidence by a small percentage have the potential to have a large impact on a population basis. A disorder such as migraine, while not life-limiting, accounts for significant morbidity and time off work (one study suggests that there are the equivalent of 112 million bedridden days per year due to migraine alone), so, again, interventions that reduce the frequency of episodes even by a small percentage can have great overall impact. This chapter discusses the major categories of neurological disease based on pathogenesis, and current and future approaches to prevention.
Prevention of cerebrovascular disease
Authors: Morrison Karen
Published: August 2018

Stroke is the main cause of neurological morbidity in adults and the third most common cause of death worldwide after ischaemic heart disease and cancer (all forms combined). It is more common in older people, with three-quarters of strokes occurring in people over 65 years of age, and estimates are that overall stroke morbidity will double by the early 2020s. The worldwide figure of increasing incidence of stroke detection masks the fact that mortality from stroke has actually been falling in developed countries since the latter half of the twentieth century while the mortality has continued to rise in China, Asia, and eastern Europe. This chapter discusses prevention of cerebrovascular disease, and includes strategies to reduce the risk of thromboembolic stroke and cerebral haemorrhage.
Prevention of infection
Authors: Bentley Tony
Published: August 2018

Medicine is the science of diagnosing, treating, and preventing disease; its focus is the needs of an individual patient. Public health is the science and practice of protecting and improving the health of a community—medicine on a larger scale. The aim of government should be to create the health and happiness of its people. Politics is, therefore, public health medicine on a grand scale. Likewise, prevention of infection can be seen as an individual issue, a population issue, or a global issue. The principles of prevention of infection, whether at the level of the individual patient or at the level of a population, are the avoidance of infectious agents, the maintenance of innate immunity, and the stimulation of acquired immunity. In this chapter, these principles are reviewed in relation to the prevention of cholera, polio, blood-borne viral infections, and healthcare-associated infections.
Screening for respiratory disease
Authors: Nasimudeen Abdul
Published: August 2018

Routine screening for respiratory diseases is currently not available to the general healthy population, with the exception of screening for cystic fibrosis. This chapter discusses the screening strategies in place for cystic fibrosis, TB, and other conditions, such as COPD, lung cancer, alpha-1 antitrypsin deficiency, pulmonary hypertension, pulmonary arteriovenous malformation, and obstructive sleep apnoea, for which screening can be applied. While screening has the potential to improve quality of life through early diagnosis and management, it is not an easy process and cannot offer a guarantee of protection.
Screening for kidney disease
Authors: Chakera Aron , Herrington William G. , O’Callaghan Christopher A.
Published: August 2018

Renal disease is common and, with routine reporting of estimated glomerular filtration rates, impairment of renal function is increasingly being recognized. As renal impairment is usually asymptomatic until very advanced, chronic kidney disease (CKD) guidelines have been developed to improve the identification and screening of at-risk populations. Target groups include patients with vascular risk factors (e.g. diabetes mellitus and hypertension); patients with certain multisystem diseases which can cause renal impairment; patients with urological conditions; patients on nephrotoxic medication; and immediate relatives of patients with established renal disease. Kidney function should also be checked during intercurrent illness and perioperatively in all patients with CKD or suspected CKD. The frequency of screening is dictated by the CKD stage.
Screening for gastrointestinal disease
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

This chapter discusses screening for gastrointestinal disease, including Barrett’s oesophagus (BO), colorectal cancer, and hepatocellular cancer (HCC). In patients with BO, approximately 5% will develop dysplasia, and 10%–50% of the low-grade dysplasias will progress to high-grade dysplasia or adenocarcinoma within 2–5 years. Thus, screening for BO has been developed to reduce the development of adenocarcinoma via the early detection of high-grade dysplasia or cancer in situ. The main aim of colorectal cancer screening is the early detection of polyps and cancers, at a time when treatment is likely to be more effective. Similarly, early detection of HCC is advantageous, as the prognosis in advanced disease is very poor. This chapter describes the current processes of screening for these diseases, and the impact of this screening, as well as screening for gastrointestinal cancer in specific groups.
Screening for neurological disease
Authors: Cader Sarah
Published: August 2018

Given the nature of some neurological diseases to become progressively disabling, early detection and treatment would be very welcome. However, screening for neurological illnesses in the general population has a number of problems. There are only a few neurological conditions that exist in a detectable asymptomatic state prior to development of clinical disease, and a small number of other conditions have early symptomatic stages before the full impact of the disease manifests. In addition, in many neurological conditions, there are no definitive treatments available. There are, of course, many genetic conditions that have neurological manifestations and could be screened, and early access to neurological assessment for some progressive conditions may enable early intervention. Potential target groups include patients with neurogenetic disorders, patients with neurodegenerative disorders, patients with inflammatory disorders, and patients with metabolic disorders.
Principles of endocrinology
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses the principles of endocrinology, starting with a description of the anatomy of endocrine glands, hormone structures, and hormone receptors. It similarly provides information on hormone measurements, such as immunoassays, mass spectrometry, hormonal-binding proteins, and biological matrices from serum, urine, and saliva. It relates autoimmunity to the endocrine system, and provides examples of studies of genetic endocrine disorders, such as linkage studies, complex endocrine disease-related case control studies, and genome-wide association studies. Providing information on the endocrine epidemiology, this chapter describes ethnic and geographic variation in disorders such as iodine deficiency, thyroid cancer, vitamin D deficiency, pituitary disease, diabetes, and multiple endocrine neoplasia.
Thyroid hormone metabolism
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter describes the thyroid gland, its associated hormones, and metabolism. Thyroid function is regulated most importantly by thyroid-stimulating hormone (TSH), also called thyrotropin. In turn, TSH secretion from the anterior pituitary is stimulated by the hypothalamic factor thyrotropin-releasing hormone (commonly abbreviated as TRH). It investigates genetic thyroid disorders, thyroid hormone resistance, autoimmune hypothyroidism, and Graves’ disease. The chapter lists the modalities of thyroid imaging, including ultrasound and radionuclide imaging (RNI), and describes indications of endocrine disease, like goitre, nodules, and malignancy. It describes thyroid hormone homeostasis and conditions affecting homeostasis. It also describes clinical features, causes, and management for disorders including hypothyroidism, hyperthyroidism, thyroiditis, thyroid nodules, and cancer.
Pituitary gland
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter describes the pituitary gland, associated disorders, and clinical practice. The pituitary gland or hypophysis is a bean shaped, bilaterally symmetrical reddish-brown organ, located in the sella turcica at the base of the brain under the hypothalamus. The chapter discusses genetic testing for pituitary adenomas, as well as imaging methods, indications for treatment and management. It presents disorders such as prolactinoma, acromegaly, Cushing’s disease, pituitary tumours, pituitary carcinoma, and parasellar pituitary conditions, describing their causes, common symptoms, and clinical treatments. It also describes the general, anatomical pathway for pituitary-related disorders from growth hormone (commonly abbreviated as GH), to gonadotrophins, to adrenocorticotropic hormone (commonly abbreviated as ACTH), and finally to thyroid-stimulating hormone (commonly abbreviated as TSH).
Posterior pituitary gland
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses disorders specific to the posterior pituitary gland. It includes diabetes insipidus, describing its epidemiology, pathophysiology, including vasopressin and renal water loss, aetiology, and common investigations such as water deprivation test, pituitary function tests, and MRI. The chapter continues with sections on hyponatraemia and syndrome of inappropriate anti-diuretic hormone secretion (often abbreviated as SIADH), describing the disorders clinical assessment, causes, and management. It also enumerates disorders of hypothalamic dysfunction, including craniopharyngiomas, ependymomas, sarcoidosis, and basilar meningitis. It lists neurological manifestations of these hypothalamic dysfunction including food intake-related, fluid intake-related, sleep-related, temperature-regulation-related, and periodicity-related syndromes and disorders.
Adrenal gland
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter describes the adrenal gland’s structure and disorders. The adrenal gland is a vital mediator of an organism’s response to stress, and is a critical regulator of immune function, blood pressure, and energy homeostasis. It describes the adrenal gland’s principal hormones, such as glucocorticoids, adrenal androgens, mineralocorticoids, and catecholamines. The chapter describes imaging methods like MRI and CT for clinical assessment and explores the common problem of incidentally detected adrenal abnormalities. Furthering discussion of disorders, the chapter describes the definition, epidemiology, pathophysiology, and treatment of primary aldosteronism, mineralocorticoid hypertension, Liddle syndrome, Bartter syndrome, Gitelman syndrome, adrenal carcinoma, Addison’s disease, autoimmune polyglandular syndrome, phaeochromocytomas, and Cushing’s syndrome. It considers both medical and surgical treatment for adrenal-related disorders.
Female hormone metabolism
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses the female-specific endocrine system anatomy and function. It discusses reproductive physiology in terms of follicles and associated hormones, such as oestradiol and progesterone. The chapter investigates biochemical processes related to female endocrinology as well as singular genetic features, such as a karyotype for premature ovarian insufficiency and fragile X syndrome. It also describes female-specific endocrine disorders, such as polycystic ovary syndrome, androgen secreting tumours, primary ovarian failure, and Turner syndrome, defining the disorders as well as outlining disorder prevalence, symptoms, biochemistry, and management. It relates endocrinology to menstrual function, documenting clinical features of menstrual disorders as one approaches menopause and suggesting treatments such as hormone replacement therapy (commonly abbreviated as HRT) and alternative methods.
Male hormone metabolism
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses the male-specific endocrine system anatomy and function. It details the physiology of the hypothalamo-pituitary–testicular axis, testosterone, luteinizing hormone, and gonadotropin-releasing hormone. Considering male metabolic, sexual, bone, muscle, and neurological health, this chapter frames male hormones in their relation to well-being. It describes disorders evidenced by genetic analysis, such as Klinefelter’s syndrome, XYY syndrome, Noonan’s syndrome, mixed gonadal dysgenesis, and androgen-receptor defects. It discusses total testosterone and sex hormone-binding globulin in diagnosing or predicting male endocrine-related disorders, such as primary hypogonadism, secondary hypogonadism, erectile dysfunction, and gynaecomastia. It also lists the epidemiology, symptoms, and management of these disorders.
Disorders of gender and fertility
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses disorders of sex development, listing terminology, proper communication, family history, hormonal assessment, genetic assessment, and management strategies like surgery and psychosocial therapy. Disorders of sex development are a wide range of conditions with diverse pathophysiology that most often present in the newborn or the adolescent. Affected newborns usually present with atypical genitalia, whereas adolescents present with atypical sexual development during the pubertal years. The chapter also describes gender dysmorphia, its physical symptoms, hormonal causes, and drug-related or surgical treatment options. It finally discusses the epidemiology, clinical features, and management of infertility in both sexes, and the causes behind infertility, like hypogonadism, endometriosis, intrauterine factors, autoimmunity, primary testicular disease, varicocele, and ejaculatory disorders.
Endocrine disorders in pregnancy
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses thyroid, adrenal, and pituitary diseases that occur during pregnancy. A series of changes in thyroid hormone economy take place in normal pregnancy. As a result of these changes, thyroid hormone levels in pregnancy differ from those in the non-pregnant state. This chapter includes a description of normal thyroid physiology and thyroid pathophysiology, including hyperemesis gravidarum, post-partum thyroiditis, hypothyroidism, and hyperthyroidism. Changes in the hypothalamo-pituitary–adrenal axis during normal and abnormal pregnancies are also described, with syndromes such as Cushing’s syndrome and Addison’s disease listed. Finally, pituitary adenomas in pregnancy, and their respective features and management strategies, are listed, including acromegaly, hypopituitarism, TSH-secreting adenomas, and prolactinoma.
Mineral metabolism
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses skeletal functions and interactions between the endocrine system and the body’s mineral store. It describes minerals like calcium, phosphate, and magnesium’s regulation by hormones like parathyroid hormone (PTH), vitamin D, and calcitonin. It also investigates mineral-related disorders, such as hypercalcaemia, hypocalcaemia, pseudohypoparathyroidism, and hypophosphataemic rickets, describing their relations with serum PTH, symptoms, genetic causes, and treatment options. Separating disorders of phosphate homeostasis into hypophosphataemia, hyperphosphataemia, and chronic kidney disease, this chapter offers clinical advice on treating mineral–hormonal disorders and describes the symptoms and causes of disruptions in mineral homeostasis.
Bone
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses the anatomy and physiology of the bone, including mineralization, and outlines techniques in bone remodelling. It describes formation and resorption hormonal markers that are part of the bone remodelling cycle, such as procollagens and serums. It describes how diagnostic measures in these formation markers are increased for focal bone disorders like Paget’s disease, fibrous dysplasia, osteomalacia, bone metastases, myeloma, primary hyperparathyroidism, thyrotoxicosis, and acromegaly. The chapter also discusses osteoporosis, including causes, symptoms, and treatment options. Clinical suggestions for bone diagnoses and diseases are provided, based on dual-energy X-ray absorptiometry (commonly abbreviated as DXA), plain radiography, and bone biopsy. The chapter also defines osteogenesis imperfecta and describes its epidemiology and management. In addition, it outlines sclerosing bone disorders such as osteopetrosis, pycnodysostosis, and hyperostosis type Worth, as well as fibrodysplasia ossificans progressive.
Inherited endocrine syndromes and multiple endocrine neoplasia
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses the characteristic features, epidemiology, pathophysiology, clinical features, complications, and management of endocrine-related genetic disorders and diseases such as McCune–Albright syndrome, endocrine tumours in neurofibromatosis type 1, Von Hippel–Lindau disease (VHL), Carney complex, Cowden syndrome, and multiple endocrine neoplasia type 1 and type 2 (MEN1 and MEN2, respectively). It also provides some remarks on multiple endocrine neoplasia type 4 (MEN4). Given the genetic basis of disorder manifestation, the chapter discusses the relation of disease severity to the genome and genetic variations of the causes for endocrine system disorders.
Endocrinology of metabolism
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter describes the relationship between hormonal activity and metabolism, as well as the disorders that are associated with endocrine metabolism dysfunction. It discusses hormonal causes, epidemiology, physiology, diagnosis, and management for hypoglycaemia. It describes obesity and eating disorders, such as anorexia nervosa, in terms of hypothalamo-pituitary pathway dysfunction, associated hormones, nutritional status, imaging, and management. The chapter describes hormones’ role in sport performance, and methods of doping detection for hormones such as anabolic steroids, growth hormone, and erythropoietin. It also relates the symptoms of endocrine-related disorders, such as excessive flushing, sweating, and excessive tiredness, with possible causes in endocrine dysfunction.
Hormone resistance syndromes
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses clinical features, epidemiology, and management/treatment strategies for resistance to hormones such as thyroid receptor alpha and beta resistance to thyroid hormone (TR-alpha RTH and TR-beta RTH, respectively). It also discusses androgen insensitivity, as in resistance to testosterone and dihydrotestosterone, which can result in complete, partial, and mild forms of androgen insensitivity. It describes Chrousos syndrome, which is a type of glucocorticoid resistance, and its clinical manifestations, molecular mechanisms, and clinical evaluation. The chapter also describes resistance to adrenocorticotrophin hormone, and the potentially resulting familial glucocorticoid deficiency (FGD) and triple A syndrome. It also discusses aldosterone resistance, describing potential manifestations such as generalized pseudohypoaldosteronism type 1 (PHA1) and renal PHA1.
Endocrinology of different age groups
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter discusses endocrine care for adolescents and the ageing. It discusses timing of transitional periods and associated changes in hormones, such as those that take place during puberty. It describes disorders in hormones during puberty, such as hyper-/hypogonadotrophic hypogonadism, craniopharyngiomas, microphallus, scoliosis, midline defects, anosmia, gonadotropin-releasing hormone deficiency, abnormal uterine bleeding, gynaecomastia, growth-hormone deficiency, and polycystic ovary syndrome (commonly abbreviated as PCOS). It also describes disorders accompanied with ageing, such as declines in growth hormone and insulin-like growth factor, or ‘somatopause’, as well as andropause and menopause. Differentiating what is normal physiology from pathology is important to prevent over-investigation.
Patient advice and reference
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter provides simplified figures and diagrams to help explain common hormonal conditions to patients in clinic, as well as resources on bone and mineral metabolism, such as the National Osteoporosis Society (commonly abbreviated as NOS) in the UK. It discusses clinical genetics services, including genetic testing and genetic counselling, which is defined as ‘a communications process which deals with human problems associated with the occurrence, or the risk of occurrence, of a genetic disorder in a family’. The chapter also provides information on resources for travel advice and other forms of patient support. In addition, it enumerates services offered to better understand endocrine-related disorders, testing options, education materials, and treatments.
Opioid Medications
Authors: Atkinson Timothy , Coleman John J. , Fudin Jeffrey
Published: August 2018

This chapter describes the dilemma of today’s chronic pain patient in the face of well-intentioned regulatory efforts to reduce opioid-related mortality. From the beginning of recorded history, there has been interest in substances derived from opium poppy. As modern governments evolved, efforts were made to ensure the availability of opiates for medicinal use while restricting their nonmedical use. This chapter discusses US efforts to control opiates and the severe problem of opiate abuse in the United States that gave rise to these efforts. The United States was the first nation to establish specialized drug treatment centers, serving also as prison-hospitals, devoted solely to treating opiate addiction. Today’s liberal policies on the use of opioids to treat chronic pain appear to have unintentionally produced an epidemic of prescription opioid abuse. Meanwhile, legitimate concerns remain for treating chronic pain, despite the growing morbidity and mortality associated with such treatment.
Legal Regulation of Prescription Opioids and Prescribers
Authors: Dineen Kelly K. , Ruggles Adam J.
Published: August 2018

Prescribing opioids and other controlled substances is challenging on myriad levels. Beyond the complexities and uncertainties of evaluating and treating patients in pain, the legal landscape is increasingly complicated. Even within the already highly regulated health care environment, opioid prescribing involves additional legal and regulatory constraints. This chapter provides an overview of the legal frameworks for opioid prescribing, including a brief history of opioid regulation in general and for addiction treatment. The federal Controlled Substances Act, Food Drug and Cosmetic Act, and the federal agencies charged with enforcement are reviewed. The chapter also outlines the function, scope, and authority of state professional licensure boards. Clarified definitions of misprescribing are offered and a framework for classifying misprescribers is suggested. Finally, the penalties providers may face for misprescribing in civil court, licensure and discipline actions, and federal and state criminal legal actions are explained.
Monitoring Prescriptions, Third-Party Healthcare Payers, Prescription Benefit Managers, and Private-Sector Policy Options
Authors: Coleman John J.
Published: August 2018

This chapter discusses how opioids are diverted from legitimate to illegitimate channels and examines the systems that have been developed to keep track of these drugs by monitoring their prescribing and dispensing. Also covered are the regulations that enable authorities to scrutinize manufacturers and distributors for anomalous transactions that might signal diversion. The chapter also discusses potential strategies involving the private sector, which has a corresponding interest in curtailing waste, fraud, and abuse in the third-party healthcare payer systems that each year process billions of prescriptions for drugs, including controlled substances. The chapter looks at the role of pharmacy benefit managers in the dispensing of controlled substances. The potential benefits of adding pharmacy benefit managers to the present classes of business activities regulated by the Drug Enforcement Administration are explored.