Clinical Gynecologic Endocrinology & Infertility, 8th Edition

1451 Pages·2010·40.13 MB·English

by  Marc A. Fritz

Clinical
Gynecologic
Endocrinology
and Infertility
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Clinical
Gynecologic
Endocrinology
and Infertility
Eighth Edition
Marc A. Fritz, MD
The University of North Carolina at Chapel Hill
Leon Speroff, MD
Oregon Health & Science University
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Library of Congress Cataloging-in-Publication Data
Fritz, Marc A.
Clinical gynecologic endocrinology and infertility / Marc A. Fritz, Leon Speroff. -- 8th ed.
p. ; cm.
Speroff’s name appears fi rst in previous editions.
Includes bibliographical references and index.
ISBN 978-0-7817-7968-5
1. Endocrine gynecology. 2. Infertility--Endocrine aspects. 3. Contraception. I. Speroff,
Leon, 1935- II. Title.
[DNLM: 1. Endocrine System Diseases. 2. Genital Diseases, Female. 3. Contraception.
4. Infertility, Female. 5. Reproductive Techniques, Assisted. WP 505]
RG159.S62 2011
618.1--dc22
2010031879
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Preface
Thirty-eight years ago, I was walking along a corridor at Yale and encountered Bob Glass
coming toward me. He stopped and said, “Nate (Nathan Kase) and I are writing a book.
Are you interested in joining us?” “You bet!” I said, and a year later, the fi rst edition of our
book appeared, typed by me on a Royal portable typewriter, 273 pages long, $17 in price.
Not too long ago, I was talking with one of my colleagues and mentioned that I had just
looked at the fi rst edition of our book, and it looked to me like a grade school primer. My
colleague looked me in the eye and said, “That’s why I liked it!”
Many years and several editions later, I was standing on a New York City corner, waiting
to cross the street. Without warning, a thought struck me like a thunderbolt. It froze me on
that corner, and when the light changed, everyone crossed without me. The thought was:
What an enormous obligation it is to not let anything written in our book lead to improper
care of a patient. I had to get it right!
How did I get here? My grandparents, father, and my uncle were Macedonian mountain
peasants in the northern limit of Greece. One day in 1911, my grandfather just walked away
and disappeared. For the next 10 years, the village helped my grandmother take care of her
two boys. Then one day in 1921, a hand-delivered telegram from my grandfather came for
my grandmother, saying: “I’m in Sofi a, Bulgaria. Come and join me.” He had been in the
U.S. for those 10 years, working on railroad construction.
He neglected to send any money. My grandmother and her two sons walked 200 miles to
Bulgaria. It wasn’t as diffi cult as it sounds because they walked for 2 months from village
to village, and the villagers gave them food and a place to sleep. They found my grandfa-
ther in a hotel, with thousands of dollars saved from his work in America. The plan was to
purchase a farm, but somehow they were cheated out of half their money, with nothing to
show for it. My father, now age 18, said, “If you can make that much money in America,
let’s go.”
They came through Ellis Island to Ohio, where a close family friend had arranged a job
for my grandfather in the steel factory in Lorain. With the last of their money, they bought
a 24-acre farm. My early years were spent on that farm, speaking Macedonian, and little
English.
By now, you are wondering, “What is the point of this story?” The point is that if you would
have told me when I was a boy how my life would turn out, I never would have believed
you. If you had told me that someday I would be writing a Preface in the Eighth Edition
of a large, medical book, I would have been incredulous. Because of my early life, I never
take anything for granted. I am deeply appreciative for all that has happened throughout
my career, especially this book.
For many years and through multiple editions in eleven languages, this book has opened
doors and made friends for me and my family in numerous countries. I am thankful for an
experience that has always been heart-warming and uplifting.
Now it is time to pass the torch. Marc Fritz came to Oregon in 1981 for his fellowship in
reproductive endocrinology. Early on, I asked Marc to write a review on the regulation of
the menstrual cycle. Finished with the task, he carefully put the manuscript in my offi ce
mailbox on a Friday afternoon when I wasn’t around, anticipating a critical destruction
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PREFACE
of his work. He didn’t have long to wait. I called him that Sunday afternoon, but with a
m essage he was not expecting. I congratulated him on his work, telling him how impressed
I was with his ability to articulate the science in a clear and conceptual fashion. Some of
those sentences are still in Chapter 6.
This book may be the only remaining medical book of its size to be single-authored, a rea-
son why the writing style is consistent from beginning to end. The writing style of this book
has always been a major factor in its success, a style that avoided medical jargon and never
feared to make relevant clinical conclusions and recommendations based on up-to-date
medical knowledge. Marc Fritz and I have been good friends since 1981, and his writings
taught me that he matched me in a compulsion to get it right and his efforts to be clinically
relevant. For these reasons, Marc was an obvious and natural choice to become the senior
author of this book.
Now I am a professor emeritus, riding my tractor, playing softball, fl y-fi shing, and still
writing. My best wishes to all for good health and a happy, rewarding life.
Leon Speroff
Portland, Oregon
Twenty-nine years ago, my fellowship training in Reproductive Endocrinology with Leon
Speroff began. I was Leon’s fi rst fellow, arriving in Portland, Oregon in 1981, eager, excited,
and determined. The next 2 years, in many ways, shaped all of those that have followed.
Leon’s story about the fi rst manuscript I wrote as a fellow is quite true. When fi rst assigned
the task, I was again eager, excited, and determined, but also uncertain. I spent countless
hours searching the stacks and copying articles at the medical library, organizing and syn-
opsizing the literature on 4 x 6 index cards, and typing the paper on an Underwood portable
typewriter at the kitchen table. I had done my best with the assignment, but was not at all
sure it would be good enough. As it turned out, that review on the menstrual cycle, pub-
lished as a Modern Trends article in Fertility and Sterility in 1982, became the foundation
for a lifelong friendship.
During my residency, this book (then in its second edition, with 433 total pages) was a
constant companion. I read and re-read it from cover to cover, and found in its pages my
passion, career path, and my teacher. Had I been told then that someday I would be writing
a preface for the Eighth Edition of this book, I would have been incredulous. In the years
that followed my training in Oregon, I became just as familiar with each subsequent edi-
tion. To me, reading the book was very much like having a conversation with Leon, or like
listening to him lecture; always clear, logical, and practical, with a personal touch.
When Leon invited me to co-author the Seventh Edition of this book, I experienced many
of the same emotions I had when preparing that fi rst manuscript as a fellow; it was only
natural. It was a joy to work closely together again in preparing the previous edition, and
this one. I am truly honored to become the senior author of this book, and to be entrusted
with its future. I understand the responsibility and am truly grateful for the opportunity.
Understandably, Leon views it as passing the torch. Understandably, I view it as closing a
perfect circle.
Marc A. Fritz
Chapel Hill, North Carolina
P.S. The cover colors of the Eighth Edition are those of Tulane University. The symbol on
the cover is the Macedonian Star, from the days of Philip of Macedon and Alexander the
Great.
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Contents
Preface v
Section I Chapter 1: 3
Reproductive Physiology Molecular Biology for Clinicians
A basic guide to the language of molecular medicine.
Chapter 2: 29
Hormone Biosynthesis, Metabolism, and Mechanism of Action
How hormones are formed and metabolized, and how hormones work.
Chapter 3: 105
The Ovary—Embryology and Development
The ovary from conception to adult function; correlation of morphology with
reproductive and steroidogenic function.
Chapter 4: 121
The Uterus
Embryology, histology, and endocrinology of the uterus and menstruation.
Anatomical abnormalities and leiomyomas.
Chapter 5: 157
Neuroendocrinology
How reproductive events are perceived, integrated, and acted upon by the central
nervous system.
Chapter 6: 199
Regulation of the Menstrual Cycle
The cyclic changes of ovarian and pituitary hormones and growth factors, and
what governs those changes.
Chapter 7: 243
Sperm and Egg Transport, Fertilization, and Implantation
Mechanisms of the days just before and after conception.
Chapter 8: 269
The Endocrinology of Pregnancy
The steroid and protein hormones of pregnancy.
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CONTENTS
Section II Chapter 9: 331
Clinical Endocrinology Normal and Abnormal Sexual Development
Normal and abnormal sexual differentiation, and the differential diagnosis
of ambiguous genitalia.
Chapter 10: 391
Normal and Abnormal Growth and Pubertal Development
The physiology of puberty, and abnormalities that produce accelerated or
retarded sexual maturation and growth problems in adolescents.
Chapter 11: 435
Amenorrhea
Differential diagnosis of amenorrhea of all types utilizing procedures
available to all clinicians. The problems of galactorrhea and pituitary
adenomas, exercise and amenorrhea.
Chapter 12: 495
Chronic Anovulation and the Polycystic Ovary Syndrome
How loss of ovulation can occur and the clinical expressions
of anovulation. The polycystic ovary and hyperinsulinemia.
Chapter 13: 533
Hirsutism
The biology of hair growth; the evaluation and management of hirsutism.
Chapter 14: 567
Menstrual Disorders
Medical problems linked to menstruation: the premenstrual syndrome,
dysmennorhea, menstrual headache, catamenial seizures, premenstrual
asthma, and catamenial pneumothorax.
Chapter 15: 591
Abnormal Uterine Bleeding
A physiologic basis for medical management without primary
surgical intervention.
Chapter 16: 621
The Breast
The factors involved in physiologic lactation, and the differential
diagnosis of galactorrhea. The endocrinology of breast cancer.
Chapter 17: 673
Menopause and the Perimenopausal Transition
Physiology of the menopause; long-term effects of estrogen on cognition,
the cardiovascular system, and bone.
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