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The author perceives that there has been a shift away from academics and toward private practice in reproductive endocrinology and infertility over the last 25 years. It has been difficult to integrate assisted reproductive technology into academic medicine in the United States.
We describe a medical information system tailored to the operational needs of the Gynecologic and Infertility Clinic at The Johns Hopkins Hospital. It is used for patient registration and scheduling, medical and surgical record keeping, and research investigation. Data entered include a complete medical history, diagnoses, procedures performed and their outcomes, surgical pathologic study, follow-up notes, phone consultations, and laboratory findings. Data are coded individually and can be retrieved and presented in a standard or user-specific report format. The Reproductive Endocrinology Medical Information System (REMIS) was implemented over 6 months from January to June 1984. To date, 8000 new patient registrations and 3600 outpatient visits have been entered. There are approximately 100 new patient entries and 240 return visit entries per month. Preliminary evaluation of the system based on the effect on quality care, use by each user group, and research applicability demonstrates that the REMIS provides clinicians with more complete, organized, and accessible patient records to serve as an effective adjunct to clinical operations.
The Cochrane Collaboration is an international nonprofit organization that aims to make up-to-date accurate information about the effects of health care readily available worldwide by preparing, maintaining, and disseminating systematic reviews of the effects of health care. The Cochrane Metabolism, Endocrinology, and Diabetes Review Group's primary concern is the evaluation of randomized controlled trials and other controlled comparisons of health care interventions relevant to the prevention, treatment or management, and rehabilitation of metabolic, nutritional, and endocrine disorders. This article discusses the role of systematic reviews and metaanalyses and invites interested parties to get involved and contribute.
The steps for undertaking the case-control approach to studying potential causal factors (i.e., host or environmental factors) related to diseases or conditions of interest are outlined, together with warnings of the potential pitfalls and biases to be avoided. Guidelines are provided for appropriate selection of cases and controls and for ascertaining and valid exposure or host information. In addition, the elements needed to determine the sample size needed for a case-control study, the approach to the analysis of case-control data, and criteria for assessing whether associations observed in epidemiologic studies are actually causal also are provided. Finally, the strengths and limitations of the case-control approach, compared with the cohort approach, are described. Published studies are cited to provide endocrinologic examples of the methodologies and issues raised by the case-control study approach.
It is likely that more studies that use meta-analysis will be published in the endocrinologic literature. Major strengths of meta-analysis are the systematic ascertainment of research on a given topic and the explicit delineation of reasons for accepting or rejecting studies as a basis for drawing conclusions. The tendency of meta-analysis to focus on a single estimate of effect and to ignore heterogeneity are problems both with the conduct of meta-analysis and the way in which it is interpreted. Meta-analysis cannot overcome bias in the original studies. It is difficult to perform a good meta-analysis and easy to perform a bad one. The critical reader should not be overawed by the results of a meta-analysis. Reading a meta-analysis should not substitute for careful reading of the primary studies on which the meta-analysis is based. Meta-analysis should not be used to stifle the conduct of original research.
The introduction of fusion of functional and anatomical imaging modalities into the field of endocrinology led to a major breakthrough in diagnosis, staging, and follow-up of patients with endocrine tumors. The management of endocrine tumors is based on a wide variety of conventional techniques, including computed tomography, ultrasound, or magnetic resonance imaging, and on scintigraphic functional techniques, associated with unique uptake and transport mechanisms and with the presence of high density of membrane receptors on some of these tumors. Anatomical modalities provide accurate detection and localization of morphological abnormalities, whereas nuclear medicine studies reflect the pathophysiological status of the disease process. Lack of structural delineation and relatively low contrast hamper the precise anatomical localization of the abnormal functional findings in the presence of potential concurrent foci related to the physiological biodistribution of the radiotracer or to processes unrelated to the evaluated disease entity. The notion that anatomical high-resolution and functional imaging data act as complementary methods led to various combination techniques of these modalities. However, coregistration of the functional and anatomical data after the acquisition of the 2 imaging modalities on separate machines, in different sessions, fails to provide accurate alignment of data, and the mathematical modeling is too cumbersome to be used on a routine basis. In contrast, hybrid imaging devices of single-photon emission computed tomography/computed tomography in a single gantry enable the sequential acquisition of the two modalities, with subsequent merging of data into a composite image display. These hybrid studies have led to a revolution in the field of imaging, providing clinically relevant information that is not apparent on separate images. The present review evaluates the contribution of the integrated single-photon emission computed tomography/computed tomography technology to image analysis and management of patients with endocrine tumors.
Sexual endocrinology has contributed decisively to the development of sexology. Effects of most recent findings in neuroendocrine research on the development of terminology in sexology, sex therapy and sex legislation are discussed.
Hypoparathyroidism is a rare disease with hypocalcemia as the leading symptom. In adults, hypocalcemia is mainly due to postoperative hypoparathyroidism. Hypoparathyroidism requires lifelong therapy with vitamin D or metabolites. Genuine vitamin D3 (Vigantol) is the most economic treatment of hypoparathyroidism; however, vitamin D3 has a very long biologic half life with the subsequent danger of chronic vitamin D intoxication. Dihydrotachysterol (A.T.10), an analogue of vitamin D, acts similarly and can be used alternatively. 1,25-dihydroxyvitamin D3 (Rocaltrol), the biologically active metabolite of vitamin D3, is very potent, but bears the danger of causing acute intoxication; it has a short half life and is more expensive than vitamin D3. A further metabolite, 1-hydroxy-vitamin D3 (alfacalcidol, Doss, EinsAlpha) is available for therapeutic use. Clinical intervention trials concerning the best therapy and management of hypoparathyroidism are lacking. We therefore surveyed German physicians treating hypoparathyroidism. Furthermore, we carried out a retrospective study of 45 patients treated in our endocrinology department during the last 8 years and examined whether measurement of 25(OH)-vitamin D3 is helpful in managing hypoparathyroidism. The data from 59 children and 270 adults could be completed in the survey. 1,25-dihydroxyvitamin D3 was the only vitamin D agent that was administered in the treatment of children, whereas in adults 52% were treated with dihydrotachysterol, 28% with genuine vitamin D3, and 20% with 1,25-dihydroxyvitamin D3. There was a positive correlation between serum 25(OH)-vitamin D3 levels and administered vitamin D3 doses. In patients treated with vitamin D3, serum calcium levels correlated significantly with serum 25(OH)-vitamin D3 levels whereas they did not correlate with administered calcium doses. Thus: (1) in Germany dihydrotachysterol is preferred for therapy of hypoparathyroidism in adults and (2) measurement of serum 25(OH)-vitamin D3 may be helpful in assessing efficacy of therapy and compliance in patients treated with vitamin D3.
The aim of this article is firstly to elucidate the historical roots which preceded the foundation of the first Institute of Experimental Endocrinology in Germany and secondly to illustrate the special development of this Institute with its ups and downs within the context of German history.
Gastrointestinal hormones are peptides released to circulation from endocrine cells as well as neurons in the gastrointestinal tract. More than 30 hormone genes are currently known to be expressed in the stomach and intestines, which makes the gut the largest endocrine organ in the body. Moreover, cell and molecular biology now makes it feasible to conceive gastrointestinal endocrinology under five general headings: 1) The structural homology groups the hormones into eight families, each of which is assumed to originate from a common ancestral gene; 2) the individual hormone gene often have multiple phenotypes due to alternative splicing of the primary transcript, tandem organization of the translational product or differentiated maturation of the prohormone. By a combination of these mechanisms, more than 100 different hormonally active peptides are released from the gastrointestinal tract; 3) in addition, gut hormone genes are also widely expressed outside the gut, some only in neurons and/or in endocrine cells, but others also in other extraintestinal cell-types; 4) the different cell types may express different hormonally active fragments of the same prohormone by variation in the cell-specific posttranslational processing. Finally, 5) endocrine cells, neurons, and spermatozoa display different cell-specific release of gut peptides, so the same peptide may act as a metabolic blood-borne hormone, as a neurotransmitter, as a long-acting growth factor, and as an acute fertility factor.
Nodular thyroid disease is highly prevalent in iodine deficient areas. In Germany it affects approximately 30 % of the adult population. Differential diagnosis of thyroid nodules is directed at exclusion of rare thyroid malignancy and assessment of the nodules' functional characteristics in order to determine the best treatment approach. In 2003 the annual meeting of the Sektion Schilddrüse, a thyroid specialist group of the German Society of Endocrinology addressed the topic of "management of benign nodular thyroid disease". To assess the current diagnostic and therapeutic approach to nodular thyroid disease by German thyroid experts we designed a questionnaire, which was sent to all members of the Thyroid Section before the meeting and was answered by 70 % of the participants. We here report the results of the questionnaire, which show a considerable national heterogeneity in the management of thyroid nodules as well as diagnostic and treatment preferences for different thyroid specialist subgroups, e.g. endocrinologists and nuclear medicine specialist. This is in agreement with results of previous questionnaires assessing state-of-the-art practise among members of the European and American Thyroid Associations and underlines the definite need for a consensus process and for carefully planned randomized trials to answer the many unresolved questions in diagnosis and therapy of nodular thyroid disease.
OBJECTIVE: To explore areas of consensus in the use of imaging techniques in the investigation of endocrine disorders. DESIGN: A postal questionnaire sent to members of the Endocrine Section of the Royal Society of Medicine following a meeting of the Section in January 1993 on Imaging in Endocrinology. SUBJECTS: Fifty-two specialists completed the questionnaire which was sent in the first mailing after the meeting. MEASUREMENTS: Consensus statements were defined as those in which greater than 75% of respondents either agreed or opposed the statement. Majority support or rejection was defined as greater than 50% in favour with less than 25% opposed or vice versa. RESULTS: Many areas of consensus were defined particularly in the field of the use of imaging in the investigation of pituitary disease. The questionnaire highlighted difficulties in obtaining a consensus view on the imaging techniques which should be employed in the investigation of thyroid, parathyroid and pancreatic disorders. CONCLUSION: The results are a useful guide to areas in which further discussion and/or research is required. This methodology could, and we believe should, be applied to other areas of endocrine practice. Such results provide an initial data base to develop national audit guide-lines on the use of imaging techniques in endocrine disorders.
OBJECTIVE: To assess current provision of specialist and transitional paediatric endocrine services in the UK and Ireland. DESIGN: A questionnaire was sent to paediatric endocrinologists requesting details of patients receiving GH and also details of specialist and transitional services. RESULTS: Of 72 questionnaires received, 56 [21 from historical growth centres (group 1), 10 from other teaching hospitals (group 2) and 25 from district general hospitals (DGHs) (group 3)] were analysed. A total of 4758 children [3709 (78%) in group 1] currently receive GH in the UK. Fifty-six per cent of units (90% in groups 1 and 2) provide transfer clinics: transition (N = 27), adolescent (10), young adult (11) and adult (3). In 90% of the paediatric units, the paediatric and adult endocrinologist sit together, and 58% of clinics are held in the paediatric unit. Clinic entry is based on final height (33%), age (51%), both (14%), and other (2%). Fifty-five per cent of units transfer all GH-treated patients, the remainder transfer only those non-GH-deficient on retesting. Eighty per cent retest prior to transfer using the insulin tolerance test (ITT) [N = 27 (including three DGHs)], glucagon (22), arginine (4), clonidine (2) and other (5). Apart from intersex clinics (13), there are few specialist clinics for other paediatric endocrine patients, including only three for Turner syndrome (TS). Adult TS transfer is to multidisciplinary clinics (N = 11), adult endocrinology (27), gynaecology (14), cardiology (5) and general practitioner (GP) (1). CONCLUSIONS: We have confirmed more GH-treated patients than before; many remain within historic growth centres. Although in the UK and Ireland transition services are established in many larger units, current guidelines are not always adhered to. Provision of specialist paediatric endocrine clinics for all groups remains variable.
A genomic approach to human biology involves examination of the entire complement of human genes and their protein products in contradistinction to the conventional phenomena-driven examination of individual components, one at a time. This approach may have limitations, but it also has the potential to increase our knowledge by an order of magnitude or more. It is expected that it will leave no field of biology and medicine unaffected, and this includes endocrinology. The structural and functional aspects of the human genome are reviewed, and the nature of the novel knowledge from the genome effort (acquired or expected) is described. More importantly, an overview is given of new ways of thinking and new approaches to endocrine research using genomic concepts and tools. Although these research breakthroughs have relatively few applications in clinical practice at the present moment, the clinician must expect drastic changes in diagnostics and therapeutics in the next decade or two, and endocrine- specific examples of such applications are given. Finally, the question is raised of social and ethical issues that these developments are generating.
This microhistory analyzes the transformation of French medical practice after World War II. Before the 1940s, coordinated clinical and experimental studies on a patient with thyroid disease were nonexistent. Starting in 1945, thyroid endocrinology was pushed forward by the use of radioiodine, which led pediatricians to rethink the hereditary transmission of thyroid diseases, stimulated by the school of biochemistry headed by Jean Roche, who participated in the elucidation of thyroid-hormone metabolism. Roche knew how to listen to hospital clinicians, who, in return, gave him free access to patients to conduct investigations on thyroid metabolism. Radioiodine proved to be sufficiently flexible to respond to the respective information needs of clinicians and biochemists, and was also responsible for the profound transformation of scientific reasoning: the chemical framework that had dominated thyroid studies since the discovery of thyroid iodine (1896) was replaced by the hormone paradigm.
The technical possibility of surgical sex change has opened up a debate concerning the legitimacy and utility of carrying out such an intervention at the request of the transsexual. Diagnostic, psychological, medical and ethical arguments have been brought forth, both for and against. Nonetheless, anatomical transformation by surgical means has currently become a practice as the frequency of serious gender identity disorders is constantly progressing. After a brief introduction, the present paper will consider typological, aetiological and epidemiological aspects of transsexualism. Treatment of the sex change applicant is then defined and discussed in terms of psychological, psychiatric, endocrinological and surgical aspects. Finally, the question of post-operation follow-up will be examined.
The World Wide Web, also known as the Internet, is an important agent of spreading human knowledge. Medical education through the web without formal presence at the classroom is a modern use of this valuable resource, characterizing the online continuous medical education (eCME). The search of videoconferences, monographs, guidelines and update courses in endocrinology and metabolism at the Internet through search mechanisms is an extremely slow and hard task due to the huge amount of sites resulting from this process. This revision aims to make this quest easier, by presenting in a rational order, according to the subspecialty, glandular organ and language, the most important web pages that deal with this subject, obtained in a previous research promoted by the author.
In the last several decades, the concept of "endocrinology" has been greatly changed. One major change was due to the discovery of peptide hormones secreted by the organs that were not "classical" endocrine organs. For example, corticotropin-releasing hormone and many neuropeptides are secreted by the neurons, atrial natriuretic peptide by the heart, endothelin-1 by the vascular endothelial cells, and leptin by the adipose tissues. Now, the brain, heart, vascular tissue and adipose tissue can be considered to be endocrine organs. Cardiovascular diseases and obesity are therefore important targets of the endocrine research. Adrenomedullin is a potent vasodilator peptide consisting of 52 amino acids. It was originally discovered from a human pheochromocytoma, and belongs to the calcitonin gene-related peptide (CGRP) family. Adrenomedullin is produced and secreted by various types of cells, for example, vascular endothelial and smooth muscle cells, cardiomyocytes, fibroblasts, macrophages, neurons, glial cells, and retinal pigment epithelial cells. Such ubiquitous expression has not been observed in other neuropeptides, including neuropeptide Y and CGRP. Expression of adrenomedullin is induced by hypoxia and proinflammatory cytokines. In addition to vasodilator actions, this peptide has central inhibitory actions on water drinking and salt appetite, effects on the secretion of some hormones and cytokines, inotropic actions and effects on cell growth and apoptosis. Adrenomedullin is produced by various non-endocrine tumors, as well as endocrine tumors, and acts as a growth stimulatory factor for the tumor cells. Adrenomedullin seems to be involved in the pathophysiology of many diseases, including ischemic heart diseases, inflammatory diseases, tumors, and even eye diseases. The adrenomedullin research implies that "the neuroendocrine system" exists in much broader types of cells than previously thought, and that the endocrine research is able to contribute to the understanding of the pathophysiology of many diseases.