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Anesthesia and the patient with endocrine disease.

This 13-chapter, 203-page book written by four internists, two surgeons, and 12 anesthetists attempts to describe the successful management of the perioperative course of the patient with endocrine disease. Appropriately, more space is devoted to common endocrinopathies, e.g., diabetes (three chapters), than to the rare endocrinopathies, e.g., parathyroid disease (one chapter) and pheochromocytoma (one chapter). No space is allotted to the management of patients with inappropriate secretion of antidiuretic hormone, acromegaly or autonomic deficiency states, the amenorrhea-galactorrhea syndrome (prolactin disturbances), or the common diseases with endocrinology implications (e.g., breast cancer). This book has something for everyone, but before you mistake this review for one that is solely laudatory, some caveats are in order. The book suffers from the problems of a multiauthored volume; the authors do not have a common goal in writing the book, and to say the writing is uneven is a gross understatement. Chapter 1, “Anesthetic Considerations for Adrenalectomy” contains many statements that need elaboration so that the reader can understand the pathophysiology of the disease covered. Chapter 2, on insulinoma resection, presents two points of view succinctly in a way that virtually guarantees understanding of the pathophysiology of insulinoma. Although the chapter has current references, it fails to mention the mechanical pancreas, how it works, and why it is or is not the wave of the future for insulinoma resection. Chapters 3 and 4 present outstanding reviews of the effect of anesthetic and surgery on the renin-angiotensin system and on antidiuretic hormone; these chapters represent concise summations of all that is known. Chapter 7, however, reviews all that is known about the effect of anesthesia on thyroid function in a rambling, disjointed way; conclusions are hard to find in this 35-page chapter, but it does have current references. Chapters 5 and 8 deal with perioperative management of the diabetic; these two chapters are laden with “pearls” and practical tips. Chapters 7 and 10 deal with perioperative management of the patient with thyroid disease; they contain an occasional pearl but are generally weak. Chapter 10, especially, contains many so-called pearls, several of which are wrong, thus casting doubt on other unsubstantiated ones. Chapter 9 saves the day for the patient with thyroid disease, yielding a concise review of pathophysiology while granting the careful reader a plethora of pearls for anesthetic management. Chapter 11 on parathyroid surgery has an occasional sentence benefitting the anesthetist. The author of chapter 12 has done much work in studying the influence of anesthesia and surgery on endocrine function, but only his own work is reviewed in this chapter. It would have been helpful if other work had been synthesized, resulting in a more meaningful and current review of the literature. Chapter 13 gives Dr. Brown’s views on care of the patient with a pheochromocytoma. Despite not referring to any of the literature published after 1970, Dr. Brown has written an excellent chapter, laden with clinical management wisdom. A third caveat to an all-out recommendation concerns this book’s organization and copy editing. If the book is read cover to cover (which most readers will not do) one wonders why chapters 2,5, and 8 are separated (all concern insulin excess of deficiency); why chapters 7, 9, and 10 are separated (all concern thyroid function); and why chapters 1 and 13 are separated (both concern adrenal surgery). In addition, one wonders whether the publisher employed a copy editor-misspellings and incomplete references (missing dates or volume or page numbers) punctuate the book. Despite these three caveats, however, the anesthetist who occasionally or commonly deals with patients with endocrinologic disease (and who doesn’t deal with diabetic patients) cannot help but improve his/her patient care and enjoyment of patient care by reading this book. Michael F. Roizen, MD Assistant Professor Anesthesia/Medicine/Pharmacology Department of Anesthesia University of California San Francisco, CA