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Preface

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 subspecialist 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 subspecialist. 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 the scientific basis of the practice of the specialty are 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 are captured and synthesized in each chapter by experts in all aspects of the specialty. The clinical care and practical aspects of pediatric endocrinology are 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 field. 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 endocrinerelated 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 and 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 fifth 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 comorbidities. 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 in 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, which 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 1 diabetes 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 because this disease has become a more prominent area for the pediatric endocrinology specialty. In the section on 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 subspecialty and the performance of clinical trials by both the academic pediatric endocrinologist and 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 and 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 (i) growth and growth disorders, (ii) adrenal disorders, (iii) sexual development abnormalities, (iv) thyroid disorders, (v) calcium and mineral metabolism disorders, (vi) miscellaneous endocrine entities and (vii) 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 chapters on traditional diseases of the adrenal cortex and medulla, as well as the sexual differentiation disorders and thyroid and parathyroid alterations, 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 nonendocrine 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.''