Diagnostic Endocrinology

This book provides a terse summary of the laboratory and imaging methods used in diagnosing endocrine diseases. It starts with an outstanding introductory chapter by Herberts and Noel on "Diagnostic Tests and Clinical Decisions." This essay summarizes statistical and Bayesian methods for selecting diagnostic techniques and deciding which tests are likely to be useful. The second chapter, on "Competitive Binding Assays," is a good summary of the pertinent methodology, but it is no different from what is available in many complete textbooks of endocrinology. Thereafter, as individual endocrine organs and diseases are discussed, the book begins to fall apart. The problem is not that the individual chapters are incompetent; indeed, some of them are excellent. It is disappointing, however, that they don't fulfill the promise of the first chapter by presenting a rational and statistically valid method of approaching endocrine diagnosis. The chapter on ectopic hormone syndromes is one of the few to offer a decision tree about approaching diagnosis (in this case, of hyperadrenocorti-cism). There is very little discussion of the specificity or sensitivity of the tests. Many of the chapters merely describe and list various pertinent tests without clarifying when each should be used, or outlining a logical, efficient sequence to use in making a diagnosis. One wonders what readers the editors hoped to reach with this volume. Specialists in endocrinology will undoubtedly have in their libraries much more comprehensive treatments of the subject in standard texts such as those of De Groot, Wilson and Foster, or Felig et al. Generalists will probably find the discussions of laboratory details distracting, especially since the methods are often described without clear recommendations about the sequence in which they should be applied, and when further tests are unnecessary. Moreover, for most physicians in practice, the method available through local or national labs is the one which must be used, so presentations of the merits of various techniques will not affect practical decisions. The book enshrines laboratory technology as the "gold standard," but any experienced physician knows that the history and physical examination are of paramount importance in making a diagnosis. Most chapters compress the data from these clinical approaches into a few lines or a table. A physician seeking help in making a diagnosis will therefore have to turn to a standard textbook for a fundamental discussion of the vital clinical details. There are a few curious omissions: (1) Inappropriate lactation …