Big hairy deal

View Large Image | Download PowerPoint SlideThat this is the second edition of Androgen Disorders in Women represents the importance of polycystic ovary syndrome (PCOS) as the predominant endocrinopathy of women and its associated hyperandrogenism and fills an important role in updating the literature. Although during the past decade several volumes have been published about PCOS and hyperandrogenism, the publication rate of this active research area is so great that frequent reviews are required to keep physicians and researchers abreast of new developments. This volume fills that capacity. Despite the list of authors being a veritable ‘who's who’ of researchers in this area, the androgen excess pie has been divided into too many small pieces. There are 39 chapters from 69 authors and many chapters provide small slices of information. In some cases, combining several related brief chapters into a longer chapter with a more thorough discussion of related areas might have been more desirable. Notwithstanding the large number of chapters, the information presented is both thorough and useful and each chapter is well referenced to serve as a resource for investigators and clinicians alike, who need the latest information and wish to find key references in this rapidly growing area.The volume begins with a brief history of androgen excess. This reviewer appreciates the clinical history of this disorder and some of the vignettes provided give a realization of how severe the consequences of androgen excess were, prior to the development of diagnostic and treatment modalities for these conditions. The next section discusses the physiology of androgens and presents, within a few chapters, a nice physiological and endocrinological background for much of the material to be presented in the rest of the volume. This background is given in chapters on ovarian and adrenal androgen biosynthesis, the role of androgens throughout the life of women and the physiological effects of androgens in women. There is an important chapter on androgen measurements, which highlights the controversy surrounding the immunological assay of androgens currently in use, especially regarding low-end sensitivity required for concentrations found in womenThe next section has seven chapters that cover the broad area of uncommon causes of androgen excess and discusses a variety of topics, including adrenal and ovarian neoplasms, Cushing's syndrome, pregnancy-related androgen excess and idiopathic hirsutism The next section contains 20 chapters that are devoted to PCOS, beginning with a definition and epidemiology, and going on to describe clinical and biochemical features of the syndrome. Other chapters in this section include ovarian histology and ultrasonography, steroidogenic abnormalities, genetics, pediatric origins of PCOS, relationship to obesity, B-cell dysfunction, insulin resistance and diabetes and generally everything you ever wanted to know about PCOS. This section, in particular, could have benefited by combining several chapters together for a more thorough presentation. In the final section, there are seven chapters that cover the evaluation and treatment of androgen excess. These chapters include clinical and hormonal evaluation of androgen excess, ovarian suppression and treatment of hirsutism, ovulation induction and in vitro fertilization for the PCOS patient, surgical management and the increasingly important question of insulin sensitizers in the management of PCOS.In summary, Androgen Excess Disorders in Women is a timely update of a rapidly mushrooming area of the reproductive literature. Polycystic ovarian disease is certainly one of the most active areas of research and androgen in the female represents another exciting area of both research and clinical interest. The distinguished editors and their selection of generally preeminent researchers in this area present a thorough and up-to-date review of this important topic. Androgen Excess Disorders in Women should be of interest not only to endocrinologists, but also to gynecologists, infertility specialists, pediatricians and generalists, particularly those who serve as the first clinical contact with potential PCOS patients. Although the book is predominately clinical, basic scientists would appreciate those aspects of physiology that help to delineate ovarian function and the role of androgens in the females, as well as the clinical importance of steroidogenic disorders.