Pediatric Endocrinology Centers Research Articles

LGBTQ+ Supportive and Inclusive Care Practices: Survey Data From the T1D Exchange Quality Improvement Collaborative

OBJECTIVE Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites. RESEARCH DESIGN AND METHODS Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher’s exact tests were used to evaluate response frequencies. RESULTS All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (P = 0.04) and pronouns (P = 0.02). CONCLUSION Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.

Factors beyond Body Mass Index Associated with Cardiometabolic Risk among Children with Severe Obesity.

Background: The increasing prevalence of severe obesity among children and adolescents poses a significant challenge for pediatricians and general practitioners. This study aimed to investigate the relationships between biochemical results, anthropometry, blood pressure measurements, and bioimpedance analysis (BIA)-derived parameters to identify potential cardiometabolic complications associated with severe obesity. Methods: This study included 347 children (162 boys, 185 girls) aged 0-19 years, meeting the criteria for severe obesity based on BMI thresholds for different age groups. The patients were recruited in four pediatric endocrinology centers in Poland (Zabrze, Cracow, Rzeszow, Szczecin). Each participant underwent anthropometric measurements, pubertal stage assessment, blood pressure measurement, biochemical and hormonal tests, and BIA. Results: BMI showed significant associations with fat mass percentage (FM%) and waist-to-height ratio (WHtR) but not waist-to-hip ratio (WHR). The relationship between BMI and FM% was stronger in girls and prepubertal children. The metabolic syndrome (MetS) Z-score showed a strong positive correlation with BMI in the pubertal children. A negative correlation between HDL and triglycerides was observed only in the boys. The prepubertal children exhibited more significant correlations, despite a smaller sample size and shorter duration of obesity. Conclusions: Considering multiple parameters beyond BMI alone provides a better understanding of cardiometabolic risks associated with severe obesity in children. MetS Z-score was not a reliable indicator of increased cardiometabolic risk in younger children. Early-onset severe obesity was associated with a higher risk of metabolic complications. Early intervention is crucial to mitigate metabolic complications in this population.

Precocious puberty, pandemic and beyond.

WHO declared SARS-COVID19 a pandemic in March 2020. Most governments declared health emergency states and implemented various measures. Since then, changes in the reasons for medical consultations were observed in healthcare institutions. Pediatric endocrinologists perceived an increase in the number of consultations related to early or accelerated CPP during the months following the lockdown that different governments had established. Several papers reported the increment in incidence in Central Precocious Puberty, especially in girls. Reports from different parts of the world highlighted a two to threefold rise in the number of cases of precocious puberty treated in Pediatric Endocrinology Centers. This trend of CPP incidence strongly suggests that changes in habits and the environment in which boys and girls were immersed during the lockdown, have played a significant role in triggering the early onset of the gonadotrophic axis.

Growth hormone therapy does not impact the development of intracranial hypertension in children with Chiari malformation.

Patients with Chiari malformation (CM) are prone to a variety of neurological sequelae, including benign intracranial hypertension (BIH). In these patients, BIH is attributed to impaired cerebrospinal fluid (CSF) flow due to anatomical abnormalities of the posterior fossa. Occasionally, patients with CM may require growth hormone therapy (GHT), which can increase the production of CSF. It is thought that patients with CM who undergo GHT are at high risk of BIH-associated symptoms (BIHAS). We describe the incidence of neurological symptoms in 34 patients with CM before and during GHT. The database of a pediatric endocrinology center was queried for patients with CM who received GHT from2010-22. Records were reviewed for adverse events. Demographic and radiological data were collected and analyzed. Patients with neoplastic disease, active inflammation, or acute trauma were excluded. CM diagnoses were independently assigned by a neuroradiology department. Patients were grouped based on the presence and nature ofsymptoms before and during GHT. Relationships between starting dose/BMI and occurrence of BIHAS/all GHT-associated symptoms were evaluated. GHT was not associated with new-onset or worsening of preexisting BIHAS in 33 out of 34 patients with CM. Five complex patients continued to have preexisting BIHAS, which did not worsen. Of the four patients who developed new-onset BIHAS during GHT, three patients' symptoms were attributed to other medical conditions. No patient permanently discontinued GHT due to BIHAS. Growth hormone therapy is likely a safe treatment in patients with Chiari malformation and is unlikely to cause BIHAS.

Comparison of the clinical picture and hormonal test results in children with growth hormone deficiency and idiopathic short stature – diagnostic difficulties and brief overview

Introduction and objective: Short stature is a common paediatric problem. Some children with short stature present growth hormone (GH) deficiency (GHD), whereas others have no hormonal disturbances (idiopathic short stature, ISS). Distinguishing between these two conditions is the task of the paediatric endocrinology centres. The aim of this study was to compare the clinical picture and hormonal tests results in patients with short stature caused by GHD and ISS. Materials and methods: The study included 100 short stature children. In all the children, medical history was obtained and a physical examination was performed. Next, bone age, insulin-like growth factor type 1 (IGF-1) levels, and GH secretion in two stimulation tests were assessed. With respect to the GH results, the children were divided into two groups: GHD (n = 38) and ISS (n = 62). Results: There were no significant differences between the groups with respect to age, sex, puberty stage, bone age, birth length and birth weight. Growth retardation was observed in both groups with a similar frequency, but in the ISS group it occurred significantly earlier. The mother’s height was lower in the ISS group. Body mass was significantly higher, but IGF-1 significantly lower in the GHD group. In both groups, the maximum GH secretion in the stimulation tests was higher after clonidine than after glucagon, which indicates that this test is more reliable. Conclusions: A similar degree of growth deficiency, growth rate deceleration and bone age delay are observed in ISS and GHD children, though ISS children are thinner and have higher IGF-1 levels. Despite some differences in clinical presentation, all short stature patients with growth rate deceleration should undergo thorough diagnostic testing along with GH stimulation tests.

High frequency of transient congenital hypothyroidism among infants referred for suspected congenital hypothyroidism from the Turkish National screening program: thyroxine dose may guide the prediction of transients

PurposeWe aimed to determine the frequency of transient congenital hypothyroidism (TCH) in 17 participating centers in Türkiye, evaluate the etiological distribution in permanent congenital hypothyroidism (PCH) cases, and investigate the role of laboratory and clinical findings in predicting TCH.MethodsThis retrospective observational multicenter study included patients from 17 pediatric endocrinology centers identified by “National Newborn Screening Program” (NNSP) who were born in 2015 and followed for 6 years. Demographic, clinical, and laboratory information of the cases were compiled through the database http://cedd.saglik-network.org (CEDD-NET).ResultsOf the 239 cases initially treated for CH, 128 (53.6%) were determined as transient in whom a trial of levothyroxine (LT4) withdrawal was performed at a median age of 36 (34–38) months. Among the patients with PCH (n = 111), thyroid dysgenesis was diagnosed in 39.6% (n = 44). The predictive factors for TCH were: LT4 dose at the withdrawal of treatment, and initial newborn blood screening (NBS)-TSH level. Based on the receiver operating characteristic (ROC) curve analysis to predict optimal cut-offs for TCH predictors, LT4 dose < 2.0 µg/kg/day at treatment discontinuation was predictive for TCH and was associated with 94.5% specificity and 55.7% sensitivity, with an area under the curve (AUC) of 0.802. The initial NBS-TSH level value < 45 µIU/mL was predictive for TCH with 93.1% specificity and 45.5% sensitivity, with an AUC of 0.641. In patients with eutopic thyroid gland only LT4 dose < 1.1 µg/kg/day at withdrawal time was predictive for TCH with 84.7% sensitivity and 40.4% specificity, with an AUC of 0.750.ConclusionAccording to our national follow-up data, the frequency of TCH was 53.6%. We determined the LT4 dose < 2.0 µg/kg/day at discontinuation of treatment and the initial NBS-TSH level < 45 µIU/mL as the best cut-off limits to predict TCH.

THU203 Self-puberty Staging In Endocrine Encounters During The COVID Pandemic

Abstract Disclosure: C. Ebo: None. J. McCray: None. K. Bowers: None. S.R. Rose: None. N. Yayah Jones: None. Background and Objective: Telemedicine became increasingly necessary during the COVID 19 pandemic. It presents challenges for evaluating pubertal staging, essential for endocrine care. Studies testing validity of pubertal self-staging compared with clinical examination have had conflicting results and have not focused on telemedicine encounters. The aim of this study was to determine validity and reliability of patients’ self-staging pubertal assessments for potential use at home during telemedicine visits. Methods: Study included patients [referred to Cincinnati Children Hospital Medical Center pediatric endocrinology center for specialty care], age 7-22y, who required pubertal staging as part of their comprehensive evaluation. Upon clinic check-in, patients received a packet with description of study procedure and rationale; an option to “opt in” or “opt out” of the study; written sex-specific instructions on how to do self-pubertal staging; and gender-appropriate illustration sheet(s) depicting Tanner (T) stages. Boys’ packets included drawings and descriptions for pubic hair (PH) stages T1-T5; girls’ packets included drawings and descriptions for PH and also for breast development (BR) stages T1-T5. Patients who “opted in” were given &amp;lt;10 minutes alone in their clinic room to choose the image(s) that most resembled their bodies. Their selection went in a sealed envelope. Patients then underwent their clinic visit with physical examination by a board-certified pediatric endocrinologist including BR staging for girls, assessment of testicular size in boys, and PH staging in both sexes. Results: We received 243 self-assessments (51.4% girls), of which 80% were complete with self- and endocrinologist staging (48.0% girls). Mean age of participants was 12.8y. Mean BMI was 22.2 kg/m2 (boys), 23.7 (girls). Hypothyroidism was the most common endocrine diagnosis among participants. We calculated a Tanner stage kappa statistic for agreement with the endocrinologist with 95%CI for BR/PH by sex. Kappa &amp;gt;0.60 was considered strong agreement; 0.40-0.60 moderate agreement; 0.20-0.40 fair agreement. Agreement for girls was highest in T1 (BR 0.65, 95%CI 0.44-0.86; PH 0.57, 95%CI 0.35-0.79) and T5 (BR 0.57, 95%CI 0.37-0.77; PH 0.65, 95%CI 0.47-0.83). Agreement for boys PH was highest in T1 (0.73, 95%CI 0.59-0.87) and T2 (0.58, 95%CI 0.59-0.87). A greater level of agreement was found when female (F) and male (M) T stages were grouped by pre-puberty (T1; BR 0.65, FPH 0.57, MPH 0.73), early-mid puberty (T2-3; BR 0.60, FPH 0.52, MPH 0.59), and late puberty (T4-5; BR 0.76, FPH 0.74, MPH 0.79). Conclusion: Using self-staging of puberty, children and adolescents can distinguish between "puberty" and "no puberty", although differentiating between later pubertal stages is less reliable. These results contribute to defining utility and limitations of self-staging during telemedicine visits. Presentation: Thursday, June 15, 2023

Auxological and endocrine findings in narcolepsy type 1: seventeen-year follow-up from a pediatric endocrinology center.

Narcolepsy Type 1 (NT1) is a rare hypersomnia of central origin linked to hypocretin deficiency, most frequently arising at pediatric age. NT1 could be associated with endocrine comorbidities involving the neuroendocrine axis, predominantly obesity, and Central Precocious Puberty (CPP). The primary aim of this study is the evaluation of endocrine and auxological parameters at diagnosis and during follow-up in patients with NT1, treated with Sodium Oxybate (SO) or not. We retrospectively evaluated the auxological, biochemical, and radiological parameters of 112 patients referred to our Center between 2004-2022. The design of our study is cross-sectional at the time of diagnosis followed by a longitudinal follow-up. Our study confirms an increased frequency of CPP and obesity in patients with NT1. At first evaluation, obesity was found in 31.3% of patients, while overweight was found in 25.0%. A diagnosis of CPP was made in 19.6% of patients. Interestingly, this group showed a significantly lower level of CSF-hypocretin (hrct-1) at diagnosis compared to others. We found an improvement in BMI SDS in the SO-treated group compared to untreated patients, and this trend persisted also at 36 months of follow-up (0.0 ± 1.3 vs 1.3 ± 0.4; p<0.03). Sixty-three patients reached their final height, with a median SDS of 0.6 ± 1.1 in boys and 0.2 ± 1.2 in girls. To our knowledge, these are the first results regarding the final height in a large series of pediatric patients with NT1, with a normal range of IGF1-SDS levels and stature SDS.

Increase of jump performance during GH treatment in short children born SGA.

Short children born small for gestational age (SGA) often have low muscle mass. Studies on maximal isometric grip-force (MIGF) observed lower muscle strength in these children. In contrast to MIGF, jumping is an everyday muscle activity for children. Our hypothesis was that GH treatment would cause an increase in jumping strength. So, we aimed to study jumping by mechanography in short SGA children before and during GH treatment. Monocentric prospective longitudinal study in a tertiary pediatric endocrinology center. We studied 50 prepubertal short children (23 females) born SGA (mean age 7.2 y, height -3.24 SDS) during GH treatment (mean dose 45 µg/kg/d). Main outcome measures were Peak jump force (PJF) and peak jump power (PJP) measured by Leonardo® ground reaction force plate at baseline and after 12 months of GH treatment. Mechanography data were compared to sex, age and height related references (SD-Score). Fitness was estimated as PJP/kg body weight by use of the Esslinger-Fitness-Index (EFI). At start of GH treatment PJP/body weight was low at -1.52 SDS and increased significantly to -0.95 SDS during 12 months of treatment (p<0.001). PJF was low-normal compared to height dependent references and remained unchanged. PJP was normal compared to height dependent references and increased only slightly from -0.34 to -0.19 SDSHT. Jumping performance (EFI) measured by mechanography increased during one year of GH treatment in short children born SGA.

Epidemiological features of New-Onset Type 1 Diabetes Mellitus in children and adolescent during 2010-2014 in Albania - a unique experience.

Aim: Diabetes mellitus is a major public health problem worldwide. Type 1 diabetes mellitus (T1DM) is the most common metabolic chronic disease in genetically susceptible children and adolescents, due to an autoimmune process characterized by a selective destruction of insulin producing β-cells. The aim is to assess the epidemiological features of new-onset T1DM in children and adolescent at the national level during the period 2010-2014 in Department of Pediatrics, Endocrine Unit, University Hospital Center 'Mother Teresa', Tirana, as the unique center for pediatric endocrinology and diabetology in Albania. Methods: The clinical and laboratory characteristics of 152 patients aged &lt;15 years newly diagnosed with T1D from 1 January 2010 to 31 December 2014 were studied. T1D was diagnosed according to WHO 2006 criteria and DKA was diagnosed based on ISPAD 2014 criteria. Patients were classified into 3 sub-groups (I: 0-4 years, II: 5-9 years, and III; 10-14 years). Statistical analysis was performed using SPSS 26. Results: The incidence of new-onset of T1DM was 5.012/100.000/year. The mean age of children at diagnosis was 8.3 ± 3.6 years. The patients were mostly diagnosed at ages 5-9 years (40.1%), and 10-14 years (39.5%), followed by the 0-4 years age group (20.4%). Mean duration of symptoms was 23.35 ± 17.16 days; longer in the subgroup 5-9 years (P= 0. 0.013). Three quarters (75%) of children with T1DM live in urban areas. Viral infections or other circumstance triggers were in 41.9% of children aged 0-4 years compared to other subgroups (P=0.002). Most of the children were born in the spring−summer months (53.23%) compared to the autumn−winter months (46.77%). Approximately 1/4 of the children were born and diagnosed with type 1 diabetes in each of the seasons of the year and 52.63% of the patients studied were first born. Family history for DMT1 and DMT2 is observed in 15.8% and 17.8% of the children, respectively. Polyuria (99.3%), polydipsia (99.6%) and weight loss (98.1%) were the most common symptoms and 67.8% of patients presented with diabetic ketoacidosis (DKA). Misdiagnosis was in 21 (13.8%) patients. Mean glycosylated hemoglobin A1c (HbA1c) was 11.63%; 11.9 ± 2.0 in DKA positive children and 11.1 ± 2.4 in DKA negative children (p= 0.195). At diagnosis and during follow up of T1DM 25% (38/152) developed associated autoimmune diseases; 68.42% at diagnosis of T1DM and 65.79% (25/38) of patients were female. During follow up children with T1DM developed associated CD and SAT, 2.54, and 2.19 years, respectively. Conclusion: Diabetes mellitus is one of the major public health problems worldwide. Albania is a country with middle incidence of T1DM and the age at onset is decreasing. The symptoms lasted significantly longer and mean HbA1c levels were significantly higher in older children. The incidence

Central precocious puberty in Sudan: 10 years' experience of paediatric endocrinology centres.

Central precocious puberty (CPP) is frequently seen among cases presenting to our endocrine clinics. The purpose of this study was to have base line data on this condition with an attempt to point out any possible unique features of Sudan and to explore challenges faced in management and how that cultural and traditional practices may hamper care. Here, we are reporting the first data on this aspect from Sudanese subjects. Patients labelled as having CPP in Gafaar Ibnauf Children's Hospital and Soba University Hospital Endocrinology Clinics from January 2006 to 2016 are included in a descriptive hospital-based study which was conducted over 10 years in these two main paediatric endocrinology centres. Records of all patients with CPP were reviewed and challenges in diagnosis and management were identified. Most of the children with CPP presented late. Organic causes were more frequent among girls than what has been reported in the literature; in most boys, it was idiopathic. Almost half of the patients with underlying pathology were older than 6 years of age. Most cases including girls have an organic cause, thus magnetic resonance image should be done in all patients. Management of precocious puberty in a resource-limited country is faced with various challenges (e.g., expensive investigations and medications). We suggest establishing a unified protocol for managing these cases and creating collaboration between governmental, nongovernmental organisations and health services.

Intracranial Pathologies and Endocrine Results: Single Pediatric Endocrinology Center Experience

ABSTRACT Intracranial pathologies can affect pituitary hormone levels whether they are primarily related to the pituitary gland or not. In pituitary hormone deficiencies, the size and location of the pituitary gland may be normal, as well as one or more hormone effects may be observed after hypoplasia, partial empty sella, ectopic neurohypophysis, Rathke's cleft cyst, adenomas and other pituitary masses or surgeries. In early puberty, the pituitary dimensions are usually increased, rarely hypoplasia and rathke cleft cyst are seen as MRI findings. Non-pituitary pathologies cause especially early puberty, single or multiple pituitary hormone deficiency. In this study, we aimed to categorize the patients with pituitary/cranial lesions and hormonal pathology and to determine their frequency and distribution in the single pediatric endocrinology clinic for ten years. The data of 485 patients, 186 (38.3%) male, were retrospectively analyzed. Their mean age was 9.3 ± 3.2 years. The incidental pituitary lesion was found in 28 (5.77%) of all cases. There was no hormonal influence in 20 (71.4%) of them. In most of the 454 cases with hormonal disorders, MRI (Magnetic Resonance Imaging) findings were normal in most of the 454 cases with hormonal disorders (71.8%). The most common hormonal pathologies were precocious puberty and isolated Growth Hormone deficiency, 57.9% and 26.4% respectively. Non-pituitary lesions (n=23, 5%) were most frequently accompanied by early puberty (39.1%). The hypothalamus-pituitary axis may be affected by primary lesions in its own region, or it may be seen as a result of other cranial pathologies. Cranial evaluation is also important in addition to pituitary imaging in pituitary hormone disorders.

Epidemiological features of New-Onset Type 1 Diabetes Mellitus in children and adolescent during 2010-2014 in Albania - a unique experience.

Aim: Diabetes mellitus is a major public health problem worldwide. Type 1 diabetes mellitus (T1DM) is the most common metabolic chronic disease in genetically susceptible children and adolescents, due to an autoimmune process characterized by a selective destruction of insulin producing β-cells. The aim is to assess the epidemiological features of new-onset T1DM in children and adolescent at the national level during the period 2010-2014 in Department of Pediatrics, Endocrine Unit, University Hospital Center 'Mother Teresa', Tirana, as the unique center for pediatric endocrinology and diabetology in Albania.Methods: The clinical and laboratory characteristics of 152 patients aged &lt;15 years newly diagnosed with T1D from 1 January 2010 to 31 December 2014 were studied. T1D was diagnosed according to WHO 2006 criteria and DKA was diagnosed based on ISPAD 2014 criteria. Patients were classified into 3 sub-groups (I: 0-4 years, II: 5-9 years, and III; 10-14 years). Statistical analysis was performed using SPSS 26. Results: The incidence of new-onset of T1DM was 5.012/100.000/year. The mean age of children at diagnosis was 8.3 ± 3.6 years. The patients were mostly diagnosed at ages 5-9 years (40.1%), and 10-14 years (39.5%), followed by the 0-4 years age group (20.4%). Mean duration of symptoms was 23.35 ± 17.16 days; longer in the subgroup 5-9 years (P= 0. 0.013). Three quarters (75%) of children with T1DM live in urban areas. Viral infections or other circumstance triggers were in 41.9% of children aged 0-4 years compared to other subgroups (P=0.002). Most of the children were born in the spring−summer months (53.23%) compared to the autumn−winter months (46.77%). Approximately 1/4 of the children were born and diagnosed with type 1 diabetes in each of the seasons of the year and 52.63% of the patients studied were first born. Family history for DMT1 and DMT2 is observed in 15.8% and 17.8% of the children, respectively. Polyuria (99.3%), polydipsia (99.6%) and weight loss (98.1%) were the most common symptoms and 67.8% of patients presented with diabetic ketoacidosis (DKA). Misdiagnosis was in 21 (13.8%) patients. Mean glycosylated hemoglobin A1c (HbA1c) was 11.63%; 11.9 ± 2.0 in DKA positive children and 11.1 ± 2.4 in DKA negative children (p= 0.195).At diagnosis and during follow up of T1DM 25% (38/152) developed associated autoimmune diseases; 68.42% at diagnosis of T1DM and 65.79% (25/38) of patients were female. During follow up children with T1DM developed associated CD and SAT, 2.54, and 2.19 years, respectively.Conclusion: Diabetes mellitus is one of the major public health problems worldwide. Albania is a country with middle incidence of T1DM and the age at onset is decreasing. The symptoms lasted significantly longer and mean HbA1c levels were significantly higher in older children. The incidence of DKA in children with newly diagnosed T1DM is high.

Screening for acid-labile subunit deficiency in patients with growth hormone deficiency at a tertiary pediatric endocrinology center

Screening for acid-labile subunit deficiency in patients with growth hormone deficiency at a tertiary pediatric endocrinology center

Central and peripheral sensitivity to thyroid hormones and glucose metabolism in prepubertal children with obesity: pilot multicenter evaluation.

An alteration of central and peripheral sensitivity to thyroid hormones (THs) seems to be associated with an increased risk of prediabetes in adulthood. Aims of this study was to evaluate the relationship between the sensitivity to THs, the severity of overweight and the glyco-metabolic alterations in prepubertal euthyroid children with obesity. Prepubertal subjects with simple obesity and matched controls were recruited from three Italian pediatric endocrinology centers and underwent clinical and biochemical evaluations. HOMA-IR, HOMA-β, insulinogenic index, Matsuda index were evaluated in children with obesity. Indexes of peripheral sensitivity (FT3/FT4 ratio) and central sensitivity (TSH index, TSHI; TSH T4 resistance index, TT4RI; Thyroid Feedback Quantile-based Index, TFQI; Parametric TFQI, PTFQI) to thyroid hormones were calculated in both groups. Eighty prepubertal children with obesity (Group 1; mean age 7.60 ± 1.51 years) and 28 healthy normal-weight controls (Group 2) were recruited. BMI and leptin were higher in group 1 than in group 2. The FT3/FT4 ratio correlated negatively with HOMA-β (r = -0.29; p = 0.01) and was significantly positively associated with BMI (p = 0.03), IR (p = 0.03) and fasting blood glucose (p = 0.04) in group 1. TT4RI, TSHI, PTFQI, TFQI, were significantly negatively associated with Matsuda-index, IGI and BMI in group 1. Central and peripheral sensitivity to thyroid hormones is significantly affected by the severity of overweight and the presence of IR. Altered tissue sensitivity to THs in the prepubertal children with obesity could be implicated in the pathogenesis of glucose metabolism impairment.

PSAT104 Predicting Response to Growth Hormone Therapy with Pituitary Volume and The Growth Hormone Stimulation Test

Abstract Background Patients with diminished growth hormone (GH) secretion are candidates for GH therapy (GHT). The GH stimulation test (GHST) is considered the gold standard for the diagnosis of GH deficiency (GHD), yet its efficacy has been questioned. In this study we explore the GHST and PV's ability to define GHD and determine their individual ability to predict GHT outcomes. Subjects and Methods A database at a Pediatric Endocrinology center was queried for patients aged 6-18 yrs who underwent a GHST, MRI, and GHT between 1/2018 - 1/2021. Patients with a first follow up (FU) between 3 and 9 months were included; of these patients, second FUs were included if they occurred between 9 and 15 months. Patients with relevant comorbidities, those with GHST peak ≥ 10.0 ng/mL, and nonadherent patients were excluded. MRIs were acquired on a Philips 1.5 or 3.0 T scanner (2mm slices) and PV was calculated using the ellipsoid formula (LxWxH/2). PV and height were converted to SDS. Response to treatment was defined as change in height SDS over the assessed time interval. A multiple linear regression was utilized to analyze the response to GHT relative to peak GH and PV, with initial height and age at stimulation included as covariates. The relationship between peak GH and PV SDS was analyzed with a Pearson correlation Results The first FU ranged between 3.1 and 8.9 months, and the second FU ranged between 9.0 and 14.9 months. 145 patients had one FU, and 83 patients had two FUs. Peak GH and PV SDS were not correlated (r=0.03). Patients who were relatively shorter for their age and gender at stimulation had higher growth rates in the first interval, but not in the second interval. Both PV and peak GH provided information about response to GHT. PV SDS negatively predicted the relative growth response to treatment in the first interval (slope=-0.03, p=0.048). However, PV only explained 3.7% of variation in growth. PV SDS was not a useful predictor of response in the second interval (slope=-0.01, p=0.693). Peak GH was a predictor of response to GHT in the first interval only after accounting for age at stimulation and initial height (slope=-0.01, p=0.032; r2=0.01). Peak GH was a predictor of response in the second interval (slope=-0.02, p=0.040), explaining 5.1% of the variation in growth. Conclusion Since peak GH and PV were not correlated, they likely reflect different physiological processes. PV and peak GH both provide information about response to GHT, so they should both be utilized to determine eligibility for GHT. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Latent classifications of parental involvement in diabetes management for youth with type 1 diabetes: A randomized clinical trial.

Understanding how parent-child relationships influence diabetes management in youth with type 1 diabetes is critical for minimizing the risk of short- and long-term complications. We examined how classes of diabetes-specific parenting behaviors are associated with disease management and well-being for youth with type 1 diabetes. The Family Management of Diabetes clinical trial tested the efficacy of a 2-year behavioral intervention for families of youth with type 1 diabetes. Three hundred and ninety youth diagnosed with type 1 diabetes and their primary caregiver were recruited from four pediatric endocrinology centers in the US Classifications of parental involvement utilized baseline parent and youth reports of task involvement, collaborative involvement, and parent-youth conflict. Class differences in baseline glycemic control (HbA1c), regimen adherence, general and diabetes quality of life, and depressive symptoms, and 2-year change in HbA1c were examined. Latent profile analysis identified three classes: (1) high in task and collaborative involvement, low in conflict (Harmonious), (2) low in task involvement, collaborative involvement, and conflict (Indifferent), (3) high in task involvement and conflict, low in collaborative involvement (Inharmonious). The Harmonious group demonstrated the best adherence, glycemic control, and psychosocial well-being. The Inharmonious and Indifferent groups had similar diabetes management, but youth from Inharmonious families showed poorer psychosocial well-being. The intervention effect on glycemic control did not differ across the classes. The interplay of parental involvement and conflict resulted in distinct parenting classes that differed in disease management and well-being. However, the classes benefitted similarly from the behavioral intervention.

946-P: Multicenter Quality Improvement Project: Increasing Depression Screening across Six Pediatric Endocrinology Centers in the U.S.

Background: Depression contributes to the suboptimal health outcomes among people with type 1 diabetes (T1D) . American Diabetes Association recommends depression screening in individuals with T1D. We aim to demonstrate the use of QI tools in expanding depression screening in the T1D Exchange Learning Collaborative (T1DX-LC) Method: Six clinics in the T1DX-LC participated in expanding depression screening utilizing PHQ-2, PHQ-4, or PHQ-9. The clinics applied QI principles to design plan-do-study-act cycles to develop, improve, and adapt interventions. The interventions tested include use of a screener at visits, expanding screening to age 12, pulling weekly data to flag patients that should be screened, peer support group, standardizing screening workflow, use of EHR/health information technology, provider training, monthly meetings to discuss screening protocol, and streamlining referral process. The hospitals shared monthly aggregate data with the T1DX-LC Result: Participating clinics were successful at implementing depression screening. Screening increased from a baseline of 59% to 72% over 17 months Conclusion: Utilizing the PHQs for depression screening is feasible and QI principles are useful in expanding screening rates. Continued expansion of depression screening is necessary to improve emotional well-being and diabetes self-care management Disclosure O.Odugbesan: n/a. A.Mungmode: None. N.Rioles: None. D.Brimberry: None. G.Nelson: None. A.J.Feuer: None. J.Ilkowitz: None. S.A.Dei-tutu: None. O.Ebekozien: None. Funding The QI learning collaborative is supported by Helmsley Charitable Trust

778-P: Variations in Insulin Pump Use across Pediatric Endocrinology Centers in the U.S.

Background: The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a learning network of over forty US type 1 diabetes clinics. Clinics share best-practice ideas for quality improvement and use data for population health research. This study benchmarks insulin pump use across pediatric clinics in the T1DX-QI. Method: T1DX-QI clinics report monthly on critical metrics, including the percentage of patients with HbA1c &amp;lt;7% or using a pump, and other quality metrics. Median values for each site were calculated using Lahey P run charts between July 2020 and June 2021. These results are shared non-anonymized internally among participating T1DX-QI clinics. Results: Across 17 T1DX-QI clinics, the percentage of patients using pumps ranged from 23% to 79% (Figure 1, A; mean and median pump use were 51.5% and 49.0%, respectively) . Clinic-specific average percentage of patients with HbA1c &amp;lt; 7% ranged from 35% to 12% (Figure 1, B) . There were no observed differences in pump use by patient population size. Conclusion: The T1DX-QI benchmarks key clinical metrics to support quality improvement, share best practices, and promote learning across clinics. Disclosure A. Mungmode: None. B.V. Adams: None. O. Docter: None. N.R. Fogel: None. R. Izquierdo: None. J.M. Lee: Advisory Panel; GoodRx. Consultant; Tandem Diabetes Care, Inc. B. Miyazaki: None. A. Neyman: None. I. Reckson: None. J. Schmitt: None. O. Ebekozien: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Characteristics of Growth in Children With Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency During Adrenarche and Beyond.

ContextPatients with classic congenital adrenal hyperplasia (CAH) often do not achieve their full growth potential. Adrenarche may accelerate bone maturation and thereby result in decreased growth in CAH.ObjectiveThe study aimed to analyze the impact of growth during adrenarche on final height of adequately treated classic CAH patients.MethodsThis retrospective, multicenter study (4 academic pediatric endocrinology centers) included 41 patients with classical CAH, born 1990-2012. We assessed skeletal maturation (bone age), growth velocity, and (projected) adult height outcomes, and analyzed potential influencing factors, such as sex, genotype, and glucocorticoid therapy.ResultsPatients with classic CAH were shorter than peers (−0.4 SDS ± 0.8 SD) and their parents (corrected final height −0.6 SDS ± 1.0 SD). Analysis of growth during adrenarche revealed 2 different growth patterns: patients with accelerating bone age (49%), and patients with nonaccelerating bone age relative to chronological age (BA-CA). Patients with accelerating BA-CA were taller than the normal population during adrenarche years (P = 0.001) and were predicted to achieve lower adult height SDS (−0.9 SDS [95% CI, −1.3; −0.5]) than nonaccelerating patients when assessed during adrenarche (0.2 SDS [95% CI, −0.3; 0.8]). Final adult height was similarly reduced in both accelerating and nonaccelerating BA-CA groups (−0.4 SDS [95% CI, −0.9; 0.1] vs −0.3 SDS [95% CI, [−0.8; 0.1]).ConclusionPatients with and without significant bone age advancement, and thus differing height prediction during adrenarche, showed similar (predicted) final height when reassessed during pubertal years. Bone age alone should not be used during adrenarche as clinical marker for metabolic control in CAH treatment.