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Androgen Excess Disorders in Women, edited by R. A. Azziz, J. E. Nestler, and D. Dewailly, Lippincott-Raven Publishers, (Philadelphia; 1997, 831 pages)

Northwestern University Medical School Chicago, Illinois 60611

Address correspondence to: Ralph R. Kazer, M.D., Department of Obstetrics and Gynecology, Northwestern University Medical School, Section of Reproductive Endocrinology & Infertility, 333 East Superior Street, Chicago, Illinois 60611.

	Introduction

Top Introduction

 
The direct and indirect consequences of disorders associated with androgen excess in women include hirsutism, acne, infertility, glucose intolerance, and increased risk for cardiovascular disease. Such endocrinopathies are quite common, and in recent years significant advances have been made to elucidate the underlying pathophysiology of these disorders and the mechanisms by which their clinical sequelae develop. The publication of this monograph Androgen Excess Disorders in Women, is therefore timely and welcome.

The title of this remarkable book does not do justice to its scope and the sheer volume of information contained within it. The 3 editors, all of whom are recognized as leading experts in the field of hyperandrogenic disorders in women, have successfully sheparded most of their remaining senior colleagues (96 in all) into providing contributions to this enormous volume. The 77 chapters are grouped into 12 larger sections, each edited by Azziz, Nestler, or Dewailly. To their credit, 14 of the chapters were authored or coauthored by the editors themselves.

The book begins with comprehensive reviews of normal androgen physiology and the clinical manifestations of androgen excess in women. Subsequent sections deal with polycystic ovary syndrome (PCOS), the adrenal hyperplasias, and other uncommon causes of androgen excess. Separate sections explore in further detail the well known, but poorly understood, association of adrenal androgen excess with PCOS, as well as the role of insulin resistance in the development of PCOS. Shorter sections on idiopathic hirsutism and the long-term impact of androgen excess are included. The book closes with a review of treatment options for women suffering from androgen excess. The figures are of good quality and are generally helpful. The book contains several color plates, which are duplicated in black and white within the text for enhanced readability.

The chapters are all about 10–12 pages in length and have identical formats: a background section, which comprises the bulk of the chapter, a synopsis/conclusions section, which provides a summary of the key points made, and a brief section describing future avenues of investigation. The latter are particularly appropriate given the current rapid pace of advance in this area of inquiry.

The book suffers from the inevitable consequences of having so many contributors. Significant amounts of the material overlap, although multiple viewpoints bearing on controversial or poorly understood issues will be of value to the diligent reader. Because the individual chapters are short and cover such tightly circumscribed areas, the book lacks broader discussions of some of its key underlying themes: the etiology of PCOS, the differential control of adrenal androgen and glucocorticoid secretion, and the relationship of these two long-standing puzzles to the physiologic events which constitute adrenarche.

Readers looking for simple algorithmic approaches to the evaluation and treatment of women with clinical manifestations of androgen excess may not find this monograph particularly satisfying. The fact remains that the treatment of such disorders is often difficult and frustrating for both patient and clinician, and the contributing authors, as well as the editors, wisely avoid offering simplistic approaches to what are often complex issues. What this book does contain is nothing less than a state-of-the-art compilation of what is currently known about androgen excess in the female patient. While it is primarily suited for the practicing endocrinologist, it also constitutes a valuable resource for a wider audience of practitioners who have the discipline and motivation to digest its contents and modify their clinical styles accordingly. Clinical investigators and even basic scientists will also find this book to be a valuable resource.

Received June 29, 1998.

Accepted July 1, 1998.

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