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glands. Almost 300 years later (1855), Thomas Addison, one of the forefathers of clinical endocrinology, described the consequences of their inadequacy. Catecholamines (epinephrine/adrenaline and norepinephrine/noradrenaline) were identified at the turn of the 19th century, in parallel with Oliver and Schaffer’s discovery that these adrenomedullary substances raised blood pressure. This followed shortly after the clinical features of myxoedema were linked to the thyroid gland, when, in 1891, physicians in Newcastle‐upon‐Tyne treated hypothyroidism with sheep thyroid extract. This was an important landmark, but long after the ancient Chinese recognized that seaweed, as a source of iodine, held valuable properties in treating swelling of the thyroid gland (‘goitre’).
These early aspects of clinical endocrinology and diabetes tended to rely on recognition and description. Since then our understanding has advanced through:
Successful quantification of circulating hormones
Molecular unravelling of complex hormone action
Mechanistic identification of pathophysiology underlying endocrine dysfunction
Molecular genetic diagnoses
Some of the landmarks from the last 100 years are shown in Box 1.2. Endocrinology and diabetes is notable for researchers who have been awarded the Nobel Prize for Medicine, Physiology or Chemistry for their landmark discoveries (Table 1.1).
Box 1.2 Some landmarks in endocrinology over the last century or so
| 1905 | First use of the term ‘hormone’ by Starling in the Croonian Lecture at the Royal College of Physicians |
| 1909 | Cushing removed part of the pituitary and saw improvement in acromegaly |
| 1914 | Kendall isolated an iodine‐containing substance from the thyroid |
| 1921 | Banting and Best extracted insulin from islet cells of dog pancreas and used it to lower blood glucose |
| Early 1930s | Pitt‐Rivers and Harrington determined the structure of the thyroid hormone, thyroxine |
| 1935–1940 | Crystallization of testosterone |
| 1935–1940 | Identification of oestrogen and progesterone |
| 1940s | Harris recognized the relationship between the hypothalamus and anterior pituitary in the ‘portal‐vessel chemotransmitter hypothesis’ |
| 1952 | Gross and Pitt‐Rivers identified tri‐iodothyronine in human serum |
| 1955 | The Schally and Guillemin laboratories showed that extracts of hypothalamus stimulated adrenocorticotrophic hormone (ACTH) release |
| 1950s | Adams and Purves identified thyroid stimulatory auto‐antibodies |
| Gonadectomy and transplantation experiments by Jost led to the discovery of the role for testosterone in rabbit sexual development | |
| 1955 | Marcel Janbon and colleagues first recognized the hypoglycaemic effects of sulphonamide antibiotics during a typhoid epidemic in Marseilles in 1942. This led to the introduction of sulphonylureas into clinical practice |
| 1955 | Sanger reported the primary structure of insulin |
| 1956 | Doniach, Roitt and Campbell associated antithyroid antibodies with some forms of hypothyroidism – the first description of an autoimmune phenomenon |
| 1957 | Growth hormone was used to treat children with short stature |
| 1966 | First transplant of human pancreas to treat type 1 diabetes by Kelly, Lillehei, Goetz and Merkel at the University of Minnesota |
| 1969 | Hodgkin reported the three‐dimensional crystallographic structure of insulin |
| 1969–1971 | Discovery of thyrotrophin‐releasing hormone (TRH) and gonadotrophin‐releasing hormone (GnRH) by Schally’s and Guillemin’s groups |
| 1973 | Discovery of somatostatin by the group of Guillemin |
| 1981–1982 | Discovery of corticotrophin‐releasing hormone (CRH) and growth hormone‐releasing hormone (GHRH) by Vale |
| 1983 | Cloning of gene encoding glucagon and two glucagon‐like peptides, including GLP‐1, by Bell and colleagues |
| 1994 | Identification of leptin by Friedman and colleagues |
| 1994 | First transplantation of pancreatic islets to treat type 1 diabetes by Pipeleers and colleagues in Belgium |
| 1999 | Discovery of ghrelin by Kangawa and colleagues |
| 1999 | Sequencing of the human genome – publication of the DNA code for chromosome 22 |
| 2000 | Advanced islet transplantation using modified immunosuppression by Shapiro and colleagues to treat type 1 diabetes |
| 2005 | GLP‐1 receptor agonists introduced into clinical practice |
| 2010 | SGLT‐2 inhibitors entered clinical practice |
Table 1.1 Nobel prizewinners in endocrinology and diabetes or those whose discoveries have profoundly affected the specialty
| Year | Prizewinner(s) | For work on … |
|---|---|---|
| 1909 | Emil Theodor Kocher | Physiology, pathology and surgery of the thyroid gland |
| 1923 | Frederick Grant Banting and John James Richard Macleod | Discovery of insulin |
| 1928 | Adolf Otto Reinhold Windaus | Constitution of the sterols and their connection with the vitamins |
| 1939 | Adolf Friedrich and Johann Butenandt |
Sex hormones
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