“以器官系统为中心”的医学教学模式是国际医学教育的趋势。本系列书是世界著名医药卫生出版集团爱思唯尔公司出版的一套“以器官系统为中心”的医学基础课程教材。该套教材第1版出版后受到世界各地许多医学院校的欢迎，并被多家进行“以器官系统为中心”教学的医学院校选定为教材。第2版根据第1版出版后教师和学生的反馈意见，结合医学知识的更新进行了全新修订。在编写内容上，该系列教材强调基础与临床的整合。每一章节都是围绕着一个临床病例展开，通过对病人问题的呈现以及解决过程引出对相关知识的探究，从而使与器官系统结构、功能以及疾病相关的重要的基础医学知识得到了完善的整合。在版式安排上，图框中的病例资料与正文中的医学知识完美匹配，一步一步地激起读者的求知欲望。本册为《内分泌系统》。

1 INTRODUCTION 1

 What is endocrinology? 2

 What do hormones do? 2

 Types of hormone: their synthesis and secretion 4

 The transport and metabolism of hormones 7

 Important concepts in endocrine regulation 8

 Endocrine disorders 10

 Endocrine investigations: general principles 12

2 RECEPTORS AND HORMONE ACTION 15

 Introduction 16

 General characteristics of receptors 16

 Types of hormone receptors 17

 Cell-membrane receptors 17

 Hormonal regulation of transcription 23

 Intracellular receptors 24

 Disorders of receptor function 26

3 THE HYPOTHALAMUS AND PITUITARY PART I: THE HYPOTHALAMUS AND POSTERIOR PITUITARY 27

 Introduction 28

 Where can I find the hypothalamus and pituitary? 28

 Connection between the hypothalamus and pituitary 31

 Development of the hypothalamus and pituitary 31

 The hormones of the hypothalamus 31

 The hormones of the posterior pituitary 32

 Release of posterior pituitary hormones is part of a neuroendocrine reflex: oxytocin secretion and actions 32

 Regulation of vasopressin secretion 33

 Actions of arginine vasopressin 34

 Disorders of vasopressin secretion and action 35

 Thirst 36

 Other hypothalamic hormones 37

4 THE HYPOTHALAMUS AND PITUITARY PART II: THE ANTERIOR PITUITARY 39

 Introduction 40

 Structure of the anterior pituitary 40

 The hormones of the anterior pituitary 41

 Regulation of hormone secretion in the anterior pituitary 43

 Growth hormone and prolactin in blood 46

 Actions of the anterior pituitary hormones growth:

 hormone and prolactin 46

 Disorders of anterior pituitary function:

 over-secretion 48

 Disorders of under-secretion of anterior pituitary

 hormones 49

 Tests for hypopituitarism 50

 Insufficient growth hormone secretion 50

5 THE ADRENAL GLANDS PART I: THE ADRENAL MEDULLA 53

 Introduction 54

 Where to find the adrenal glands 54

 Blood supply 54

 Nerve supply 55

 Embryology of the adrenal gland 55

 The adrenal medulla 55

 Disorders of the adrenal medulla: phaeochromocytorna 59

 Familial phaeochromocytoma 59

 Pharmacological uses of hormones of the adrenal medulla 60

6 THE ADRENAL GLANDS PART II: THE ADRENAL CORTEX 61

 Introduction 62

 Structure of the adrenal cortex 62

 Hormones produced by the adrenal

 cortex 62

 Regulation of steroid production 66

 Transport of steroid hormones in blood 68

 Disorders of adrenal steroids 71

 Pharmacological use of glucocorticoids 73

7 THE THYROID GLAND 75

 Introduction 76

 Thyroid anatomy 77

 What is a goitre? 77

 Blood supply 77

 Structure of the thyroid 78

 Synthesis of thyroid hormones 78

 Iodine 79

 Thyroxine and T3: the thyroid hormones in blood 79

 Control of thyroid function 81

 Cellular action of thyroid hormones 82

 Effects of thyroid hormones 82

 Disorders of thyroid hormone secretion 83

 Causes of thyroid hyposecretion 85

 Effects of thyroid hormone insufficiency: myxoedema 85

8 HORMONAL CONTROL OF REPRODUCTION PART I: MALE REPRODUCTIVE SYSTEM 87

 Introduction 88

 Where are the testes? 88

 What are the testes? 89

 Testicular blood and nerve supply 90

 Spermatogenesis 91

 Androgen production 91

 Hormonal control of testicular function 91

 Transport of testosterone in blood 93

 Actions of testosterone 93

 Hormone-dependent cancer in men 95

 Disorders of male reproduction 96

 Therapeutic uses of androgens 97

 Abuse of anabolic androgenic steroids 97

 Declining sperm counts 98

9 HORMONAL CONTROL OF REPRODUCTION PART II: FEMALE REPRODUCTIVE SYSTEM 99

 Introduction 100

 Structure of the ovary 100

 Ovarian hormones 100

 Transport and metabolism of oestrogen and

 progesterone 102

 Oestrogens 102

 Androgen secretion by,the ovaries 104

 Hormonal regulation of ovarian function 105

 Hormone-dependent cancer in women 105

 The menstrual cycle 105

 Disorders of the menstrual cycle 108

 The endocrinology of pregnancy 110

10 HORMONAL CONTROL OF REPRODUCTION PART III: DEVELOPMENT AND FERTILITY 115

 Introduction 116

 Gender determination and differentiation 116

 Hormonal control of sexual differentiation 116

 Abnormalities of sexual differentiation 117

 Hormones during development: puberty and menarche 118

 Disorders of puberty 119

 Menopause and the climacteric 121

 Premature ovarian failure 122

 Symptoms of the menopause 122

 Hormone replacement therapy 123

 Alternative therapies 125

 Hormonal control of fertility: contraception 125

 Hormonal control of fertility: assisted conception 126

11 INSULIN AND THE REGULATION OF PLASMA GLUCOSE 129

 Introduction 130

 Glucose in urine 130

 Insulin and the response to high blood glucose

 levels 131

 Disorders of blood glucose regulation: diabetes

 mellitus 135

 Gestational diabetes 143

 The metabolic syndrome--a growing problem? 143

12 HORMONAL REGULATION OF PLASMA CALCIUM AND CALCIUM METABOLISM 147

 Introduction 148

 Serum calcium 148

 The structure, functions and endocrinology of bone 149

 Hormones involved in the regulation of serum

 calcium 151

 Parathyroid hormone 151

 Calcitriol: source and activation of vitamin D 153

 Effects of other hormones on plasma calcium 156

 Disorders of hypercalcaemia 156

 Disorders of hypocalcaemia 157

 Diseases of bone 158

 A brief mention of calcitonin 159

 Regulation of serum phosphate 159

13 MISCELLANEOUS HORMONES 161

 Erythropoietin 162

 Immune-endocrine interactions: cytokines and eicosanoids 163

 Age-related changes in hormone secretion 164

 Melatonin 164

 Gut hormones 166

 The hormonal control of appetite: fat is an endocrine tissue 167

 Multiple organ disorders in endocrinology 168

 Regulation of blood pressure and volume 169

 The next 100 years of endocrinology 169

Glossary 171

Index 173