Abstract

In the four decades that encompass this observer’s identification with the field of pediatric endocrinology, undreamed of advances have accompanied the development of radioimmunoassay and the molecular biology revolution. The virtual abolition in the US of cretinism from congenital hypothyroidism, the availability of unlimited supplies of recombinant growth hormone (GH), and other revolutionary advancements in pediatric endocrine knowledge, diagnostic capability, and treatment resulting from scientific and technological progress are not the only dramatic differences from midcentury practice. The inaugural ‘Hot Topic’ Fetal and childhood nutrition in type 2 diabetes in children and adults is one that would likely be considered outside the interests of pediatric endocrinologists by a founder of our subspecialty, Lawson Wilkins, and many of his early disciples. The third, 1965 edition of what was then the only textbook of pediatric endocrinology, Wilkin’s 600 page The diagnosis and treatment of endocrine disorders in childhood and adolescence, devotes a short paragraph to diabetes mellitus as one of half a dozen causes of hyperglycemia. For many years, beginning in the mid-1970s, diabetes sessions at the Lawson Wilkins Pediatric Endocrine Society annual meetings were held in the evening, adjunctive to the Society, rather than integral, as diabetes sessions are now. The movement of diabetology into mainstream pediatric endocrinology has multiple causes beyond the clinical importance and challenge of the problem, including the scientific excitement about diabetes research (and its funding!), the extensive endocrine physiology that diabetes affects, and the inclusion of diabetes in the accreditation requirements of training programs and board certification for pediatric endocrinology. This history comes to mind because we are presently engaged in a comparable revolution in what is considered to be within the purview of pediatric endocrinology. One need not go back to the 1960s, as with diabetes, to recall when obesity was unequivocally outside the clinical interest of this specialty. In just the past few years, ever increasing numbers of pediatric endocrinologists, as they earlier did for diabetes, are becoming involved in developing teams to deal with this difficult and growing clinical challenge. For most, if not all, this interest and assumption of responsibility is a direct result of seeing an increasing proportion of new diabetes patients, especially those over 10 yr of age, who have type 2 diabetes, and whose treatment entails major behavioral

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