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Pediatric endocrinology: the requisites in pediatrics
  1. M P Tighe

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    Thomas Moshang, Missouri: Elsevier Mosby, 2004, £34.99 (hardback), pp 282. ISBN 0323018254

    Studying paediatric endocrinology is like staring into the waters of Loch Ness. In the cold light of a Scottish day it is possible to see a few inches into the murky depths, and while most visitors are comfortable seeing the loch’s surface, to consider plumbing the dark waters gives one an eerie feeling about what could lie beneath (encouraged by the locals). Like the mythical monster, the rarer syndromes are often the subject of fragmented fables, discussed using apocryphal stories (in darkened rooms using faded slides), yet to catch them in the wild needs both an inquisitive mind, an awareness of what one could be hunting for, and the investigative equivalent of a big submarine with echo-location sonar.

    This book aims to support paediatricians, paediatric trainees, and paediatric endocrinologists alike and aims to update the clinician on current management and current research developments in paediatric endocrinology (that is, to act as a lifebelt if you’re adrift on the loch and screaming for help).

    “Requisites” is defined here as the “basic knowledge that is necessary for practise or board review” and aims to provide knowledge up to the level of a tutorial rather than aspiring to be a reference text or source book. The authors also designed their chapters to maintain a clinical focus. There are seven sections: Carbohydrate Disorders; Sexual Development; Growth; Thyroid; Adrenal Gland; Calcium, Phosphorus, and Bone; and Vasopressin and Disorders of Electrolytes.

    Have the authors succeeded with this lifebelt? I believe they have gone a long way to helping the clinician manage common clinical scenarios (such as the hypoglycaemic neonate and type I diabetes). Tables and “major points” boxes highlight the key features to be drawn from each chapter. Colour photographs are all grouped at the front of the book, but could be better placed, either incorporated with the relevant text, or have references in the text linking the pictures appropriately.

    There is also a useful integration of current research to refresh oft-said information that is readily available in older texts. This provides clinicians with a gauge of current academic thinking, for example important genes in pubertal delay (e.g. leptin), and there is certainly enough detail for consultants wanting to keep one step ahead of enthusiastic registrars, fresh from their membership exams.

    The recent proliferation of cases of type II diabetes is also discussed, drawing on extrapolated experience from current paediatric diabetic practice, and adult type II diabetes, while the evidence base develops for management of paediatric type II diabetes. There is a good explanation of the diagnostic features, and their differences from type I diabetes, and management includes good practical advice to parents regarding weight loss, exercise, and reducing TV watching.

    All the chapters brought new depths to my understanding of paediatric endocrinology. However, as with other American textbooks, the glucose is measured in mg/dl not mmol/l, and providing a conversion would have helped those clinicians using mmol/l (N.B. mmol/l×18 = mg/dl). Also there is no mention of aspects of paediatric endocrinology specific to the UK, for example NICE (National Institute of Clinical Excellence) guidelines on the use of growth hormone.

    There are some paediatric tomes on paediatric endocrinology that are as likely to help you sink faster, with their weight of information, as they are to bring succour to the distressed, and some that are too light and miss out essential information. This however is an excellent resource to access for the clinician in difficulty, is well worth the money, and would be a good lifebelt to choose.

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