Pediatric Endocrinology Clinic Research Articles

ODP386 Growth Velocity and Growth Hormone Deficiency During Puberty

Abstract Background A subnormal growth velocity (GV) is a characteristic feature of growth hormone deficiency (GHD). During puberty growth hormone (GH) levels increase markedly in response to sex hormone secretion. The normal range for GV declines during childhood, increases during puberty with peak levels at mid-puberty. Hence, pubertal status rather than age alone must be considered in the evaluation of GV in children and adolescents. In most cases, a diagnosis of GHD is established by a subnormal response in GH levels following a stimulation with two pharmacological agents. Objective We determined the reliability of GV as a predictor of GHD during puberty. Methods We conducted a retrospective study of pubertal children and adolescents who underwent a GH stimulation test in our pediatric endocrinology clinic. Seventy-nine subjects (57 boys and 22 girls) were included in this study. Bone age was determined for all patients. Serum levels of insulin like growth factor-1 (IGF-1) were obtained prior to GH stimulation test. Serum IGF-1 levels, expressed as a standard deviation score were compared to the IGF-1 levels expected chronological age (CA), height age (HA), and bone age (BA). Serum GH levels were determined following the administration of arginine and levodopa. GHD was established by a peak GH level <10 ng/mL. IBM SPSS Statistics software version 28. 0. 0. 0 (190) was used for data analysis. Results Subjects ranged in age from 7.3-17.9 years. Thirty-nine patients (49.4%) had GV < 10 th percentile for CA; Forty patients (50.6%) had GV <10 th percentile for BA. Sixty percent of patients with GV <10 th percentile for CA had GHD. A similar number (59%) of patients with normal GV for CA also had GHD. Among patients with GV <10 th percentile for BA, 72.5% of subjects had GHD. By contrast, the percentage of patients who had normal GV for bone age and GHD (46.2%) was significantly less than that of subjects with GV <10 th percentile for BA (p = 0. 015). Positive predictive value, negative predictive value, sensitivity and specificity for GV <10 th percentile for BA in the diagnosis of GHD were 72.5%, 53.8%, 61.7%, and 65.6%, respectively. With respect to the diagnostic value of serum IGF-1, when the area under the ROC curve was used to measure how well the serum IGF-1 standard deviation score distinguished between GHD and normal, serum IGF-1 standard deviation score for CA, HA, and BA were not predictive of GHD (p = 0.1, 0.47, and 0.27, respectively). Conclusions During puberty, slow growth velocity for bone age (but not slow growth velocity for chronological age) was useful to predict a diagnosis of growth hormone deficiency. Presentation: No date and time listed

PMON188 Frequency of Hemoglobin A1c and Body Mass Index Increase in Youth at Risk for Developing Type 2 Diabetes Mellitus During the COVID-19 Pandemic

Abstract BACKGROUND: Childhood obesity rates continue to increase and have progressed with the COVID-19 pandemic. Obesity is associated with comorbidities, including prediabetes and type 2 diabetes mellitus (T2D). The frequency of HbA1c progression in overweight/obese children during the COVID-19 pandemic is not well reported. OBJECTIVES: To investigate the frequency of HbA1c and BMI increase in overweight/obese youth at risk of developing T2D during the COVID-19 pandemic. METHODOLOGY: A retrospective chart review of patients followed in a pediatric endocrinology clinic with overweight/obesity and concern of developing T2D was conducted. We included patients who were seen pre-pandemic (June 2019 to May 2020) and again after the pandemic onset (June 2020 to May 2021). We chose June 2020 as the pandemic onset since our clinic resumed in-person visits at this time. Demographic and clinical data, including BMI and HbA1c, were collected in the pre-pandemic and pandemic periods for each patient. We evaluated change in HbA1c using the following categories: Category 1: <5.7%, Category 2: 5.7-6%, Category 3: 6.1-6.4%, Category 4: 6.5-8.4%, and Category 5: >8.4%. HbA1c progression defined as increase in the HbA1c category. BMI progression defined as a z-score increase of at least 0.2 and we only included patients with 6-18 months between visits for this analysis. Chi-square or Fisher's exact test and t-test were used to evaluate HbA1c and BMI progression. RESULTS: A total of 64 patients (mean age 12.6 years, 58% female, 31% Black) were evaluated and had available HbA1c data. HbA1c progression was found in 18.8% (12 of 64) of patients during the pandemic. Based on pre-pandemic age, those with HbA1c progression had a mean (SD) age of 14.1 (2.3) years while those whose HbA1c did not progress had a mean (SD) age of 12.3 (2.7) years (p=0.04). Other characteristics including birth sex (p=0.18), race (p=0.54), and insurance (public/private/self-pay) (p=0.83) were not significantly different between those with and without HbA1c progression. We found that 9.1% of patients with HbA1c progression also had BMI progression compared to 6.7% without HbA1c progression (p= 1.0). SUMMARY: We found that 18.8% of overweight/obese youth with risk of developing T2D had HbA1c progression during the COVID-19 pandemic and that older age was a risk factor for HbA1c progression. Significant BMI increase was not associated with HbA1c progression. Further studies are needed to evaluate the impact of COVID-19 pandemic on HbA1c and BMI progression in youth at risk for T2D. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP398 A Novel NR5A1 Gene Mutation Causing 46, XY DSD Without Adrenal Insufficiency in an Immigrant Boy from Dominican Republic

Abstract Background The NR5A1 gene encodes steroidogenic factor-1 (SF1), a key transcription factor involved in adrenal and gonadal development. We present a 12-year old boy with a novel, dominant, heterozygous, and probably pathogenic variant of this gene (c.102+1G>C) resulting in incomplete masculinization [46, XY disorder of sex development (DSD)]. Clinical case: This 12-year-old boy, who had immigrated from the Dominican Republic to the United States, was referred at 8 years of age with a diagnosis of congenital adrenal hyperplasia (CAH). He received hCG injections as a neonate and had been prescribed hydrocortisone 7 mg/m 2 /day and fludrocortisone 0.1 mg/day orally for CAH, although compliance was poor. After migrating to the United States, his supply of medications depleted, and he was taken to a local emergency room with fatigue and abdominal pain. Vital signs and electrolyte levels were normal. There was no history of adrenal crisis, testes were not palpable, and inguinal testicles measuring 2.8×1.1 cm on the right and 2.2×1 cm on the left were reported on MRI. When he presented to the pediatric endocrinology clinic, his mother denied history of consanguinity, PCOS, or use of hormones during pregnancy. She reported a history of two spontaneous miscarriages with father of patient and a younger healthy son from another partner. Physical exam showed ambiguous genitalia with underdeveloped scrotum, mild hyperpigmentation, bilateral non-palpable testicles within scrotum, severe penoscrotal hypospadias, stretched penile length (SPL) of 2cm×1.5 cm, and chordee. He had axillary hair and a Tanner stage 2 for pubic hair. A high-dose ACTH stimulation study (250 mcg IV cosyntropin) showed a peak cortisol level at 19.6 μg/dL, peak 17-hydroxyprogesterone of 100 ng/dL, and baseline and peak pregnenolone levels of 6 ng/dL and 43 ng/dL, respectively, with low to normal values of other precursors ruling out CAH. Gonadotropin levels were prepubertal (LH < 0.3 mIU/mL, FSH 2.9 mIU/mL), testosterone <4 ng/dL, and dihydrotestosterone 0.73 ng/dL. Chromosomal studies confirmed 46, XY. With a clinical diagnosis of 46,XY DSD (undervirilized male) and male gender identity, a 2-stage orchiopexy was completed. After a six-month course of monthly 50 mg cypionate testosterone, SPL improved to 4 cm and pubic hair progressed to Tanner stage 3. Surgical repair of penoscrotal hypospadias and chordee were then completed. A 46, XY DSD/complete gonadal dysgenesis DNA panel sequencing identified a novel, dominant, heterozygous, likely pathogenic variant of the NR5A1 gene [c.102+1G>C]. This is a canonical splice donor site of intron 2. Conclusion A novel sequence change in the NR5A1 gene causing a severe phenotype of 46,XY undervirilized male is presented here in a boy originally misdiagnosed with CAH. This case emphasizes the need for complete evaluation with molecular genetic screening for those patients with 46,XY DSDs. Presentation: No date and time listed

Free Summer Day Camp to Address Childhood Obesity: Is There Demand?

Children from low-income households, and who are overweight or obese (OWOB), are at risk of accelerated weight gain during summer. Summer day camps (SDCs) have the potential to mitigate accelerated weight gain during summer as these settings can positively influence children's obesogenic behaviors (i.e., increase physical activity); however, barriers exist to attending, most notably cost. Little is known on whether low-income caregivers of children with OWOB would be interested in having their child attend SDC for free. Caregivers (n = 109, 82% mother respondents, >75% Medicaid and Minority Household) with a child attending pediatric endocrinology clinics completed a one-page survey to explore demand. Approximately 66% of respondents expressed interest for their child to attend SDC for free. Providing free SDC for children with OWOB and from low-income households is a possible strategy to tackle childhood obesity during summer.

EVALUATION OF INSULIN RESISTANCE IN PATIENTS WITH PREMATURE ADRENARCHE

Purpose: There is a conflicting result in terms of insulin resistance (IR) in children with Premature Adrenarche (PA). The study aimed to investigate the IR and Trıglycerıde-Glucose (Ty-G) index in patıents wıth PA.
 
 Material and Methods: This cross-sectional study was conducted in a tertiary pediatric endocrinology clinic with 160 children aged 6-8 years old. The study group (n=75) were selected cases diagnosed with PA. Seventy-nine age and sex-matched children were also selected as a control group. Ty-G İndex, Homeostasis Model of Insulin Resistance (HOMA-IR), and atherogenic index of plasma (AIP) were calculated. 
 
 Results: Trıglycerıde-Glucose index, AIP, and HOMA-IR were similar (p>0.05). Ty-G İndex was positively correlated with AIP (r=0.61, p

EVALUATION AND MANAGEMENT OF THYROID NODULES AT A TERTIARY CARE PEDIATRIC CANCER CENTER IN TURKEY

The object of this study is to search the characteristics of children and adolescents with thyroid nodules and analyze our institutional experience in the management of thyroid nodules.The complaints of these patients, physical examination findings, diagnostic features, results of radiologic researches, choise of the most appropriate modality to these patients' thyroid nodule assessment, and the management of the pathology results were revealed. Patients who applied to the pediatric endocrinology or oncology outpatient clinic of Ankara City Hospital with the diagnosis of thyroid nodule were examined. All patients who has pathology result as benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/ suspicious for a follicular neoplasm (FN/SFN), suspicious for malignancy (SM), and malignant were searched. A total of 130 patients presented with thyroid nodules. Female male ratio was 1,95:1. The youngest patient was 68 months old. At admission there was no goiter in 71.5% of the patients on physical examination. Of all patients 36% of them underwent fine needle aspiration biopsy and 8 of the 76 patients who underwent biopsy were diagnosed with papillary thyroid cancer. One patient diagnosed with follicular thyroid cancer Patients that diagnosed cancer, 4.6% of them treated with radioactive iodine. Although most pediatric thyroid nodules are benign, distinguishing benign from malignant lesions is crucial. Interdepartmental communication and competence are very important in the follow-up of patients with thyroid nodules. Because of an increased risk of cancer in the pediatric population, diagnostic and therapeutic procedures for pediatrics need further research including multicenter studies to attain universal consensus regarding the diagnosis and management.

CLINICAL FEATURES AND FOLLOW-UP RESULTS OF CHILDREN WITH HYPERTHROIDISM

ABSTRACT
 CLINICAL FEATURES AND FOLLOW-UP RESULTS OF CHILDREN WITH HYPERTHROIDISM
 Objective:
 Hyperthyroidism is a rare clinical condition in childhood that can cause serious problems. Information on the epidemiological features, follow-up and treatment of pediatric patients with hyperthyroidism is quite limited. In this study, clinical and laboratory findings and follow-up results of children with hyperthyroidism are presented.
 Materials and Methods:
 The data of children with hyperthyroidism between 2005-2022 at Atatürk University and Erzurum Health Sciences University Pediatric Endocrinology clinics were retrospectively analyzed.
 Results:
 43 (81.1%) female and 10 (18.9%) male patients aged 2-18 years (14.05±3.0) were included in the study. Graves' disease (GD) in 36 (67.9%) patients, Hashimoto's thyroiditis (HT) in 14 (26.4%) patients, subacute thyroiditis in 2 (3.8%) and hyperactive thyroid nodules in 1 (1.9%) were detected. The most common symptoms were palpitations (75.5%), sweating (60.4%), tremors in the hands (49.1%), heat intolerance (45.3%) and weight loss (32.1%). Mean SD values of height, body weight and body mass index at the time of diagnosis were -0.05±1.16, -0.67±1.20 and -0.77±1.25, respectively. Goiter and exophthalmos were present in 69.8% and 30.2% of the cases, respectively. At the time of diagnosis, mean serum thyroid stimulating hormone (TSH), free tri-iodothyronine, free tetra-iodothyronine, thyroglobulin, anti-thyroid peroxidase, anti-thyroglobulin and TSH receptor antibody levels were 0.03±0.09 mIU/L, 13.0.34±7.07 pg/ml, 3.30±1.70 ng/dl, 101.93±180.35 ng/ml, 600.30±858.58 IU/ml, 322.82±644.08 IU/ml, and 12.41 ±14.37 IU/L, respectively. While 42 (79.2%) patients were treated with propranolol and methimazole, 3 (5.7%) patients with propranolol and propylthiouracil, and 4 (7.5%) patients with propranolol, 4 (7.5%) patients were not treated. The mean duration of treatment was 14.67±17.51 months. The mean time to euthyroid after starting antithyroid drug (ATD) was 24.80±14.33 days. While no serious drug-related side effects were detected in any patient, urticaria rash developed in 1 (1.9%) patient in the 1st month of treatment. Total thyroidectomy was performed in 3 cases with GD and 1 case with hyperactive thyroid nodules. Radioactive iodine treatment was not given to any of the cases. The remission rate in patients with GD was 46.7% at the early stage of treatment and 16.7% during the whole follow-up. The recurrence rate was 71.4%. At the last visit, 15 (28.3%) patients were euthyroid, 1 (1.9%) hyperthyroid, and 5 (9.4%) hypothyroid. While 21 (39.6%) of the cases were still using antithyroid medication, 11 (20.8%) were excluded from follow-up.
 Conclusion:
 The first and second most common causes of hyperthyroidism in children and adolescents are GH and HT, respectively. TRAb positivity, thyroid scintigraphy findings and clinical follow-up can distinguish between GH and HT. ATD therapy is effective and safe in keeping GH in remission.
 Key Words: Hyperthyroidism, Graves' disease, Hashimoto thyroiditis, Hashitoxicosis, Thyrotoxicosis

Do type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction?

Background Diabetes mellitus is a major illness in which cardiac problems play a significant role in patient mortality. Objectives We aimed to evaluate whether children with diabetes mellitus type 1 have early echocardiographic signs of subclinical cardiac dysfunction and whether their sex, metabolic control, and duration of diabetes have an effect. Patients and methods A case–control study was performed from January 2022 to November 2022 that included 29 children and adolescents with type 1 diabetes aged from 4 to 15 years. A control group of 15 healthy children was also included. They were recruited from the pediatric endocrinology clinic, Al-Fayoum University Children’s Hospital, Al-Fayoum University, Egypt. Conventional echocardiographic study and tissue Doppler imaging measurements were done. Results With glycated hemoglobin levels less than 7%, the study group of diabetic children had inadequate glycemic control. There was a statistically significant low mean of fractional shortening and high mean of left ventricular septal wall thickness in diastole among diabetic children in comparison with controls, with P values of 0.04 and 0.038, respectively, but still within normal range. Conclusion Children with diabetes have poor glycemic control and scanty echocardiographic evidence of subclinical cardiac dysfunctions. According to the study, cardiac dysfunction in children with diabetes is uncommon. For the early identification of any potential cardiac dysfunctions, distant periodic cardiac examination using both conventional and tissue Doppler echocardiography is advised.

The effect of an educational program on the Self-Efficacy among adolescents with juvenile diabetes

Background: Juvenile diabetes is the most common endocrine disease during infancy and adolescence causing serious coping problems so adolescents must adapt to and effectively manage their illness. Aim of the study: this study aimed to evaluate the effect of an educational program on the self-efficacy among adolescents with juvenile diabetes. Research design: A quasi-experimental design was utilized in the current study. Setting: This study was conducted at outpatient pediatric endocrinology clinic at Beni Suef university Hospital. Subjects: A purposive sample of 84 adolescents with juvenile diabetes. Tools of data collection: Three tools were used: tool (1) interviewing questionnaire, tool (2) checklist of reported practices, tool (3) self-efficacy scale. Results: this study noted there was a high statistically significant positive correlation between the studied adolescents' total knowledge and their self- efficacy post program implementation. As well as, there was a statistically significant correlation between the studied adolescents' total practice and their self- efficacy post program implementation. Conclusion: The current study concluded that, implementation of an educational program has a positive effect on improving self-efficacy among adolescents with juvenile diabetes. Recommendation: Continuous educational programs to improve knowledge and self-efficacy among adolescents with juvenile diabetes.

Pattern of presentation of paediatric endocrine disorders in a Nigerian tertiary institution: an 11-year survey.

There is need to generate epidemiological data regarding paediatric endocrine disorders (PEDs) in sub-Saharan Africa, since little attention has been given endocrine disorders in children in this sub-region over the years. The aim of the study was to determine the sociodemographic characteristics of children with endocrine disorders in our paediatric endocrinology clinic, as well as the pattern of presentation of these disorders. This study included paediatric patients who presented to the endocrine clinic over an 11-year period. Data of patients seen during the study period were retrieved from the case notes and were analyzed using SPSS version 23. A total of 188 patients were seen over the study period, with an almost equal male:female ratio. Five of thepatients (2.7%) could not be classified into any gender because of genital ambiguity. The age of the patients at diagnosis ranged from 0 to 18 years of age with a median age of 9.03 (9.94) years. All the 14 subdivisions of paediatric endocrine disorders were documented among the patients, with thyroid disorders ranking highest among thePEDs seen. Type 1 diabetes mellitus, obesity and pubertal disorders were the most prevalent PEDs (in descending order), after thyroid disorders. Congenital hypothyroidism accounted for 14.3% of patients with thyroid disorders. Thyroid disorders, type 1 diabetes mellitus and obesity rank highest among the PEDs in our locality. There is the need to create awareness among healthcare workers and the general public regarding these disorders, in order to improve appropriate and timely presentation of patients to the clinic.

Prevalence of Diabetes Distress Among Adolescents With Type 1 Diabetes Mellitus

Adolescents with type 1 diabetes mellitus (T1DM) are at increased risk for diabetes distress. This cross-sectional study used the Diabetes Distress Scale (DDS) to determine diabetes distress among adolescents with T1DM in a pediatric endocrinology clinic. Sixty-one percent of respondents reported moderate to significant diabetes distress levels, with overall diabetes distress of M = 2.409 (SD = 0.853). Emotional burden subcategory had the highest distress (M = 3.214, SD = 1.449). Minimal distress levels were reported in the physician burden subcategory (M = 1.133, SD = 0.276). Results support the need for routine diabetes distress screening.

Psychosocial screening in a pediatric diabetes clinic: Adolescents' and mothers' perspectives.

Adolescents with type 1 diabetes (T1D) frequently experience psychosocial concerns, and mental health screening is becoming increasingly common in routine diabetes care. However, little is known about what adolescents or their caregivers think about the role of mental health screening and intervention within the context of comprehensive diabetes care, or how their diabetes care providers should be involved in navigating mental health concerns. This study used qualitative methods to obtain the perspectives of adolescents with T1D and their caregivers regarding these issues. Participants were 13 adolescents with T1D (ages 12-19 years; M = 15.1 years; 53.8% female; 61.5% Hispanic/Latinx White) and 13 mothers, recruited from an outpatient pediatric endocrinology clinic in South Florida, who participated in semi-structured interviews via video teleconference. Thematic content analysis was used to evaluate participants' responses. Adolescents and their mothers reported positive experiences with the clinic's psychosocial screening procedures and appreciated meeting with the psychology team during visits. They wanted the clinic to offer more opportunities for peer support. Mothers highlighted barriers to seeking mental health care outside of the clinic and the importance of mental health professionals understanding diabetes. Mothers also wanted the clinic to offer more on-site therapeutic services. Study participants valued psychosocial screening and supported addressing mental health as a routine part of diabetes comprehensive care.

Growth hormone deficiency in a boy with Wiedemann-Steiner syndrome: a case report and review.

Wiedemann-Steiner syndrome (WSS) is a rare genetic disorder characterized by a broad phenotypic spectrum, including facial dysmorphism, hypertrichosis, hypotonia, short stature, and developmental delay. Mutations in the lysine (K)-specific methyltransferase 2A (KMT2A) gene are known to cause WSS. A 2 year-old boy with a short stature visited our pediatric endocrinology clinic for a diagnostic examination. In addition to his short stature, he had other symptoms characteristic of WSS including dysmorphic features and developmental delay. Whole-exome sequencing was performed in order to diagnose any underlying genetic condition; the test detected the presence of the mutant variant of KMT2A:c.731T>G(p.Leu244*). Since the patient showed a decreased growth velocity after 18 months of age, a growth hormone provocation test was performed to check for growth hormone (GH) deficiency. The patient's peak GH level was found to be 6.96 ng/mL and recombinant human GH treatment was started. This case of WSS along with growth hormone deficiency (GHD) in a pediatric patient is the first report of its kind in Korea, to the best of our knowledge. WSS should be considered as a possibility in pediatric patients with short stature, especially in the presence of additional clinical symptoms, such as dysmorphic features and developmental delay.

Autoimmune diseases accompanying Hashimoto thyroiditis in pediatric patients

AIM: Hashimoto thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adolescents living in iodine-sufficient regions. In this study, we aimed to investigate the coexistence of other accompanying autoimmune diseases in patients aged 5–18 years who were diagnosed and followed up at the Pediatric Endocrinology Clinic of our hospital.MATERIAL AND METHODS: A total of 220 patients aged 5–18 years who were diagnosed with HT at the Pediatric Endocrinology Clinic of the University of Health Sciences Ankara City Hospital. Patient’ age at admission, sex, family history, complaints at admission, comorbidities, physical examination and laboratory findings, and clinical follow-up information were retrospectively reviewed.RESULTS: Of the 220 patients, 77.7% were female and 22.2% were male, with a mean age of 13.8±3.3 years. Of the 51.4 had euthyroidism, 40.4% had subclinical hypothyroidism,and 8.2% had overt hypothyroidism, respectively. Anti-thyroid peroxidase antibody was detected in 97% of patients and anti-thyroglobulin antibody (anti-Tg) was detected in 74% of patients. There was a family history of autoimmune disease in 36.4% of the patients. Autoimmune disease were present in 45 patients (20.4%). The most common autoimmune diseases in the patients were type 1 diabetes mellitus (T1DM) (14%), celiac disease (5%), skin diseases (2.7%), and rheumatologic diseases (1.3%). No statistically significant differences were found between the sex, age at diagnosis, current age, family history of autoimmune disease and thyroid function status of patients with HT and T1DM.The mean age of the patients followed up with HT with and without additional autoimmune disease was similar (p=0.644). In both groups, female sex was dominant. However, the number of male patients (35.6%) in the group with additional autoimmune disease was statistically significantly elevated than the group without autoimmune disease (19.9%) (p=0.016). The rate of subclinical hypothyroidism was statistically significantly elevated in the group without additional autoimmune disease (p<0.001). A statistically significant relationship was found between elevated Anti-Tg and additional autoimmune disease (OR=2.32 (95% CI; 1.16–4.56). The prevalence of additional autoimmune disease was increased 2.32 times in patients with elevated anti-Tg levels.There was no statistically significant correlation between the sex of the patients, their thyroid function status and thyroid autoantibodies (p=0.507). However, the prevalence of celiac disease was statistically significantly elevated in female patients (43.5%) than in male patients (6.7%) (p=0.014). In addition, the prevalence of T1DM was found to be statistically significantly elevated in males (93.8%) compared to females (52.2%) (p=0.007). 13.3% of patients with additional autoimmune disease were under the age of 10 and 64.4% were above the age of 10, this was statistically significant (p<0.01). T1DM was the most common autoimmune disease in both groups.CONCLUSION: As shown in our study, autoimmune diseases, especially T1DM and celiac disease, are associated with HT. It should be kept in mind that there is an increased risk of autoimmune disease in HT that affects both sexes and increases with age. In particular, regular follow-up of HT patients with elevated anti-Tg levels in terms of autoimmune disease development is important in terms of earlier diagnosis of diseases and reducing their morbidity.

Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting.

Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors. A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA1C) and children who had HbA1C within three to six months of the data collection were recruited. A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control. A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.

Motivational interviewing to improve self-management in youth with type 1 diabetes: A randomized clinical trial

PurposeEffective interventions are needed to help adolescents with T1D develop independent self-management skills to prevent commonly observed deterioration of disease self-management resulting in poor health outcomes. Using a prospective RCT design, we assessed the impact of a nurse-led education program based on motivational interviewing (MI) in youth with Type 1 diabetes (T1D). Design and methodsAfter parental consent and youth assent, we prospectively randomized 66 adolescents 13–18 years old with T1D to either usual care (every 3 months visit with pediatric endocrinologist) or usual care supplemented by 2 in-person and 4 follow-up phone calls with a nurse educator in a pediatric endocrinology clinic of the University Hospital Farhat Hached, Sousse, Tunisia. We used MI sessions to support youth general and disease specific self-management skills. Outcomes were change, between baseline and 6 months, in TRAQ (a validated measure of youth self-management) scores and HbA1c values. ResultsMean TRAQ scores (based on a 5-point Likert scale) increased by 1.44 points (s.d. = 0.56) in the Intervention Group versus 0.26 points (s.d. = 0.34) in the control group (p < 0.001). The mean HbA1C value decreased in the intervention group by 0.95 units versus a decrease of 0.12 units in the control group (p = 0.047). ConclusionWe found that a brief, nurse-led MI-based educational intervention, integrated into specialty pediatric care, resulted in a significant improvement in both self-reported self-management skills and in HbA1c values.Trial registration: Registered in ClinicalTrials.gov Identifier: NCT04798937

Variability of response to early puberty induction demonstrated by transverse uterine diameter measurement and a novel method of 3D breast imaging.

Induction of puberty with exogenous oestrogen results in considerable variability in final uterine and breast volumes. We set out to quantify the variability of these two outcome measures with a view to establishing monitoring methods that could be used to individualise treatment protocols. A prospective observational study. Sixteen participants with pubertal delay and primary amenorrhoea, due to hypogonadism were recruited from paediatric gynaecology and endocrinology clinics at University College London Hospital. A standardised protocol of transdermal 17β oestradiol (17βE) was used (Evorel™), with a starting dose of 12.5 mcg increasing to 25 mcg (patch changed twice weekly) after 4 months. Follow up was every 2 months for a total of 8 months. Uterine dimensions using ultrasound, oestradiol concentrations and breast development assessed by both Tanner staging and 3D photographic imaging. After 8 months of treatment, the changes in oestradiol concentrations (0-174 pmol), uterine volume growth (4.4-16.4 ml) and breast volume (1.76-140.1 ml) varied greatly between individuals. Of uterine parameters, transverse uterine diameter was most closely associated with serum oestradiol levels at 8 months (beta standardised coefficient = 0.80, p = .001). Change in breast volume was associated with age of treatment initiation (beta standardised coefficient 0.55 p = .04). We demonstrate variation in response to exogenous oestrogen, emphasising the necessity for individualised dose titration. In the absence of sensitive oestradiol assays, uterine transverse measurements may be used as a surrogate marker of oestrogen sensitivity to guide early dose adjustment. 3D breast imaging may provide a quantitative assessment of breast development to complement Tanner breast staging.

The impact of COVID-19 in children and adolescents with obesity in Brazil.

The primary goal of the study was to evaluate weight gain in children and adolescents with obesity during the COVID-19 pandemic period, and compare it with the period before the pandemic. The sample comprised 68 children with obesity aged between 7 and 18 years, 30 (44.1%) boys and 38 (55.9%) girls, who were attended at the pediatric endocrinology clinic of the Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil. Weight gain in the sample in the pre-lockdown period (December 2, 2018 to March 11, 2020) was compared with that in the lockdown period (March 11, 2020 to February 21, 2021). Approximately one year before the start of the pandemic period, the mean (SD) chronological age was 10.1 years old (± 2.4), and an average weight gain of 4.4 kg (± 4.8) was observed during the pre-lockdown period described. One year after the start of the pandemic, mean (SD) chronological age was 11.8 years old (± 2.4), and an average weight gain of 8.5 kg (± 7.6) was observed in the lockdown period described. When we compared the weight gain in the two periods, it was higher in the pandemic period, both in girls and boys (p = 0.013 and 0.035, respectively). The results of the study show that the period of social isolation adopted to mitigate the COVID-19 pandemic was associated with increased weight gain in the studied population, probably due to a reduction in physical activities and an increase in energy consumption.

Differences in Puberty of Girls before and during the COVID-19 Pandemic.

In the COVID-19 pandemic, there was an increase in consultations for precocious puberty. We aim to analyze differences in female puberty before and during the COVID-19 pandemic. A cross-sectional analytical study was designed at the Pediatric Endocrinology Clinic of the University Hospital of the Federal University of Maranhão in São Luis, Brazil. We included 55 girls with precocious puberty, 22 who started puberty during the pandemic and 33 who started puberty before the pandemic. Clinical, anthropometric, laboratory and imaging variables were compared between groups. Statistics were performed to determine if there was a statistical difference between the groups. Girls with puberty during the pandemic had higher Z-scores for weight (1.08 ± 1.29 versus 0.69 ± 0.83; p = 0.04), lower ovarian volume (1.88 ± 0.95 versus 3.15 ± 2.31; p = 0.01), and smaller differences between thelarche noticed by the parents and the diagnosis (6.63 ± 5.21 versus 12.15 ± 9.96; p = 0.02). The association between precocious puberty during the pandemic with higher Z-scores for weight, lower ovarian volume, and a reduction in the time between the perception of pubertal findings by parents and the diagnosis suggests the influence of the pandemic on the normal time of puberty.

Text Messages and Financial Incentives to Increase Physical Activity in Adolescents With Prediabetes and Type 2 Diabetes: Web-Based Group Interviews to Inform Intervention Design.

BackgroundPhysical activity is a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes; however, sedentary behavior remains pervasive. An SMS text message–based intervention paired with financial incentives may be an effective way to promote physical activity in this population.ObjectiveThis study aims to obtain end-user feedback on SMS text message content and assess the acceptability of a planned SMS text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity.MethodsAdolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts on the use of SMS text messages and financial incentives to remind and motivate them to be more physically active. They rated and provided feedback on specific messages to be used in clinical trials. Participants were also asked about their personal experience with rewards to motivate behavior change and their anticipated reactions to rewards provided for goal attainment (gain-framing) versus those provided and then taken away if a goal was not met (loss-framing). The interviews were conducted by 2 trained interviewers and a note-taker. Content analysis was used to explore themes.ResultsGroup interviews were completed with 20 participants (11/20, 55% women; 15/20, 75% with type 2 diabetes; 5/20, 25% with prediabetes) with a mean age of 15 (SD 1; range 12-18) years and a mean BMI of 41 (SD 5) kg/m2 (all >95th percentile for age and sex). Most participants were non-Hispanic Black (14/20, 70%) and 10% (2/20) were Hispanics. Participants frequently cited near-continuous smartphone use and agreed that SMS text messages would serve as good reminders to be physically active, but the consensus about the need for short messages was strong. Favorable content included references to what they were likely to be doing when messages were sent (eg, homework or watching television) and messages that were upbeat or informative. Specific physical activity suggestions were rated favorably. Attitudes toward financial incentives varied, with differing opinions about whether loss-framed incentives would be motivating or discouraging. Many participants highlighted the role of intrinsic, rather than extrinsic, motivation in achieving and sustaining behavior change.ConclusionsThe engagement of adolescents with obesity and diabetes or prediabetes allowed for the refinement of SMS text messages for our planned intervention, with an emphasis on short, upbeat, relatable, and informative messages. Although an SMS text messaging intervention using financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, the impact on actual activity levels in this population requires prospective evaluation in a clinical trial.