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Classically, endocrinology has consisted of the study of hormone-secreting organs and the evaluation of hormonal activity. Hormones were considered chemical substances that, when secreted into the circulation, would affect the metabolic pathways of cells with appropriate receptors. In recent years it has been appreciated that many hormones can also act as neurotransmitters, and in addition to being secreted in the systemic circulation, hormones may also have a local effect where they are secreted. Compounds such as vitamin D are now called hormones, even though they are not produced by any one gland. Hormone action is dependent on the functional status of specific hormone receptors as well as the absolute blood level.

Monitoring of the diabetic patients' own blood sugar is now an important component in the management of diabetes of all degrees of severity. Education in proper monitoring techniques, attention to the continued quality of testing, and utilization of the information achieved by testing are important responsibilities of primary care physicians and their health care teams.

Every three or four years the conscientious physician must again answer the recurrent question of whether to buy the newest edition of Harrison's textbook of medicine. The physician may ask, Are there substantial changes in the text? Are there important additions? Although the changes in the newest edition are mostly not substantive, they are indeed numerous and of some importance. For example, infectious mononucleosis is now discussed with diseases of viral origin rather than being included in the section "Diseases of Uncertain Etiology," a section that has now shrunk from four to just three listings. As another example, in the eighth edition, the discontinuation of cold baths in treatment of heat stroke is recommended when the rectal temperature falls below 101 F (38.3 C), while in the seventh edition, the recommendation is made to do so when the temperature falls below 103 F (39.5 C). I personally care more what