ENDOCRINOLOGY

medical discipline dealing with the role of hormones and other biochemical mediators in regulating bodily functions and with the treatment of imbalances of these hormones. Although some endocrine diseases, such as diabetes mellitus, have been known since antiquity, endocrinology itself is a fairly recent medical field, depending as it does on the recognition that body tissues and organs secrete chemical mediators directly into the bloodstream to produce distant effects. Friedrich Henle in 1841 was the first to recognize ductless glands, glands that secrete their products into the bloodstream and not into specialized ducts. In 1855 Claude Bernard distinguished the products of these ductless glands from other glandular products by the term internal secretions, the first suggestion of what was to become the modern hormone concept. The first endocrine therapy was attempted in 1889 by Charles Brown-Squard, who used extracts from animal testes to treat male aging; this prompted a vogue in organotherapies that soon faded but that led to adrenal and thyroid extracts that were the forerunners of modern cortisone and thyroid hormones. The first hormone to be purified was secretin, which is produced by the small intestine to trigger the release of pancreatic juices; it was discovered in 1902 by Ernest Starling and William Bayliss. Starling applied the term hormone to such chemicals in 1905, proposing a chemical regulation of physiological processes operating in conjunction with nervous regulation; this essentially was the beginning of the field of endocrinology. The early years of this century saw the purification of a number of other hormones, often leading to new therapies for patients affected by hormonal disorders. In 1914 Edward Kendall isolated thyroxine from thyroid extracts; in 1921 Frederick Banting and Charles Best discovered insulin in pancreatic extracts, immediately transforming the treatment of diabetes; and in 1929 Edward Doisy isolated an estrus-producing hormone in the urine of pregnant females. The availability of nuclear technology after World War II also led to new treatments for endocrine disorders, notably the use of radioactive iodine to treat hyperthyroidism, greatly reducing the need for thyroid surgery. Combining radioactive isotopes with antibodies against hormones, Rosalyn Yalow and S.A. Berson in 1960 discovered the basis for radioimmunoassays, which enable endocrinologists to determine with great sensitivity minute amounts of hormone, permitting the early diagnosis and treatment of endocrine disorders. These assays have become increasingly important in the late 20th century.