Arpan K Banerjee
Solihull, United Kingdom

In Signals, the endocrinologist Saira Hameed writes about a range of interesting patients seen in her clinic. Clinical stories are interwoven with snippets from the history of endocrinology, including pioneers and early experimenters.

Diseases caused by an imbalance of hormones were difficult to diagnose before the twentieth century. Claude Bernard, a nineteenth-century French physiologist, discovered that the pancreas released an enzyme involved in digestion. He coined the term “milieu interior,” which later became known as homeostasis.

The chemicals that control the body’s internal communications were only understood after experiments by Ernest Starling, a physiologist at University College, London and his brother-in-law, William Bayliss. These chemical messengers are now called hormones. Secretin was the first hormone to be identified in 1902, and Bayliss acknowledged Claude Bernard’s earlier work .

The first chapter of Signals tells the story of a patient with Addison’s disease, named after the physician from Guy’s Hospital who first described this condition. Patients with Addison’s disease have a cortisol deficiency, a hormone normally produced by the adrenal glands. ACTH, produced by the pituitary gland in the brain, affects the function of the adrenal glands. The book describes the discovery of hypothalamic control of the anterior pituitary gland through the experiments of neuroendocrinology pioneer Geoff Harris, a professor of anatomy at Oxford.

Another patient, with a benign tumor of the pituitary gland, leads to a discussion in the book of the contributions of American neurosurgeon Harvey Cushing, who removed these tumors in over one hundred patients. Today Cushing is best remembered for his eponymous disease, but he was also a brilliant and meticulous surgeon, considered the father of neurosurgery.

A patient presenting with fertility issues introduces a discussion of ethical dilemmas. Ever since 1979, when American philosophers Tom Beauchamp and James Childress described the four pillars of medical ethics- justice, beneficence, non-maleficence, and respect for autonomy- doctors have strived to use these concepts as an ethical basis in their daily practice.. Endocrine problems requiring treatments such as in vitro fertilization often involve ethical considerations.

One of the most common endocrine problems worldwide, diabetes is not given short shrift. A discussion of a patient presenting for the first time with diabetic symptoms introduces the story of the extraction and clinical use of insulin by Banting, Best, Macleod, and Cullip in Toronto. The story reminds us that serendipity, determination, collaboration, and interpersonal conflicts all play a part in great discoveries.

Throughout the book, the author emphasizes the importance of a thorough history and careful examination to establish a diagnosis. This holds true even with the armamentarium of blood tests and imaging scans at a physician’s disposal today.

Dr. Saira Hameed has produced a highly readable account of interesting patient stories interspersed with informative historical aspects of the scientific discoveries and advances that underscore modern endocrinology. The notes and references at the end provide further material for those who wish to delve into the subject in more detail.

Signals: The Inside Story of Our Hormones 
Dr. Saira Hameed, 2026
ISBN 9780571389773, Faber and Faber Ltd, London