Pediatric endocrinology

Last updated

Pediatric endocrinology (British: Paediatric) is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more.[ citation needed ]

Contents

By age, pediatric endocrinologists, depending upon the age range of the patients they treat, care for patients from infancy to late adolescence and young adulthood.[ citation needed ]

The most common disease of the specialty is type 1 diabetes, which usually accounts for at least 50% of a typical clinical practice. The next most common problem is growth disorders, especially those amenable to growth hormone treatment. Pediatric endocrinologists are usually the primary physicians involved in the medical care of infants and children with intersex disorders. The specialty also deals with hypoglycemia and other forms of hyperglycemia in childhood, variations of puberty, as well other adrenal, thyroid, and pituitary problems. Many pediatric endocrinologists have interests and expertise in bone metabolism, lipid metabolism, adolescent gynecology, or inborn errors of metabolism.[ citation needed ]

Most pediatric endocrinologists in North America and many from around the world can trace their professional genealogy to Lawson Wilkins, who pioneered the specialty in the pediatrics department of Johns Hopkins School of Medicine and the Harriet Lane Home in Baltimore in between the late 1940s and the mid-1960s.[ citation needed ]

Professional training

In the United States and Canada, pediatric endocrinology is a subspecialty of the American Board of Pediatrics or the American Osteopathic Board of Pediatrics, with board certification following fellowship training. It is a relatively small and primarily cognitive specialty, with few procedures and an emphasis on diagnostic evaluation. [1]

Training for pediatric endocrinology consists of a 3-year fellowship following completion of a 3-year pediatrics residency. The fellowship, and the specialty, are heavily research-oriented and academically based, although less exclusively now than in past decades.

Professional organizations

The principal North American professional association was originally named the Lawson Wilkins Pediatric Endocrine Society, [2] now renamed the Pediatric Endocrine Society. Other longstanding pediatric endocrine associations include the European Society for Paediatric Endocrinology, the British Society for Paediatric Endocrinology, the Australasian Paediatric Endocrine Group and the Japanese Society for Pediatric Endocrinology. Professional associations of the specialty continue to proliferate.

Controversial treatment guidelines

In 2021, the Pediatric Endocrine Society offered updated recommendations for use of growth-promoting hormone therapy and related medications in children. The Guidelines for Growth Hormone and Insulin-Like Growth Factor-1 Treatment in Children and Adolescents were updated from 2003 and reflect the continuing controversy over how to diagnose, categorize and treat growth failure in children. [3] The guideline was developed following the GRADE approach (Grading of Recommendations, Assessment, Development, and Evaluation). [4]

In 2021, the Pediatric Endocrine Society released a position statement in support of Gender Affirming Care (GAC). In it the society states, "Puberty suppression and/or gender-affirming hormone therapy is recommended within this evidence-based approach on a case-by-case basis as medically necessary and is potentially lifesaving." [5] This position is at odds with the position of England's National Health Service (NHS) which maintains that evidence for puberty blockers and hormone treatment for gender transition wholly is inadequate, [6] and has decided to stop routine prescribing of puberty blockers. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Endocrinology</span> Branch of medicine pertaining to the endocrine system

Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones. Specializations include behavioral endocrinology and comparative endocrinology.

<span class="mw-page-title-main">Growth hormone deficiency</span> Medical condition

Growth hormone deficiency (GHD), or hyposomatotropism, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood sugar or a small penis size. In adults there may be decreased muscle mass, high cholesterol levels, or poor bone density.

Growth hormone therapy refers to the use of growth hormone (GH) as a prescription medication—it is one form of hormone therapy. Growth hormone is a peptide hormone secreted by the pituitary gland that stimulates growth and cell reproduction. In the past, growth hormone was extracted from human pituitary glands. Growth hormone is now produced by recombinant DNA technology and is prescribed for a variety of reasons. GH therapy has been a focus of social and ethical controversies for 50 years.

In medicine, precocious puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age and simply represents a variation of normal development. There is early development of secondary sex characters and gametogenesis also starts earlier. Precocious puberty is of two types: true precocious puberty and pseudoprecocious puberty. In a minority of children with precocious puberty, the early development is triggered by a disease such as a tumor or injury of the brain.

Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormonal signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15. Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 14. Delayed puberty affects about 2% of adolescents.

Pubarche refers to the first appearance of pubic hair at puberty. It is one of the earliest physical changes of puberty and can occur independently of complete puberty. It is usually the second sign of puberty, after thelarche in females and gonadarche in males.

Gonadarche refers to the earliest gonadal changes of puberty. In response to pituitary gonadotropins, the ovaries in females and the testes in males begin to grow and increase the production of the sex steroids, especially estradiol and testosterone. The ovary and testis have receptors, follicle cells and leydig cells, respectively, where gonadotropins bind to stimulate the maturation of the gonads and secretion of estrogen and testosterone. Certain disorders can result in changes to timing or nature of these processes.

<span class="mw-page-title-main">Zvi Laron</span> Israeli pediatric endocrinologist

Zvi Laron is an Israeli paediatric endocrinologist. Born in Cernăuţi, Romania, Laron is a professor emeritus at Tel Aviv University. In 1966, he described the type of dwarfism later called Laron syndrome. His research opened the way to the treatment of many cases of growth hormone disorders. He was the first to introduce the multidisciplinary treatment for juvenile diabetes.

<span class="mw-page-title-main">McCune–Albright syndrome</span> Mosaic genetic disorder affecting the bone, skin and endocrine systems

McCune–Albright syndrome is a complex genetic disorder affecting the bone, skin and endocrine systems. It is a mosaic disease arising from somatic activating mutations in GNAS, which encodes the alpha-subunit of the Gs heterotrimeric G protein.

<span class="mw-page-title-main">Triptorelin</span> GnRH-agonist

Triptorelin, sold under the brand name Decapeptyl among others, is a medication that acts as an agonist analog of gonadotropin-releasing hormone, repressing expression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

The Endocrine Society is a professional, international medical organization in the field of endocrinology and metabolism, founded in 1916 as The Association for the Study of Internal Secretions. The official name of the organization was changed to the Endocrine Society on January 1, 1952. It is a leading organization in the field and publishes four leading journals. It has more than 18,000 members from over 120 countries in medicine, molecular and cellular biology, biochemistry, physiology, genetics, immunology, education, industry, and allied health. The Society's mission is: "to advance excellence in endocrinology and promote its essential and integrative role in scientific discovery, medical practice, and human health."

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

Adolescent medicine, also known as adolescent and young adult medicine, is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, at which time adulthood begins. Typically, patients in this age range will be in the last years of middle school up until college graduation. In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.

<span class="mw-page-title-main">Melvin M. Grumbach</span> American pediatric endocrinologist (1925–2016)

Melvin Malcolm Grumbach was an American pediatrician and academic who specialized in pediatric endocrinology. Called Edward B. Shaw Distinguished Professor of Pediatrics, Emeritus at the University of California, San Francisco School of Medicine, Grumbach was noted for his research and writing on the effect of hormones and the central nervous system on growth and puberty and their disorders; the function of the human sex chromosomes; and disorders of sexual development.

Robert M. Blizzard was an American pediatric endocrinologist and a founding member of the Lawson Wilkins Pediatric Endocrine Society.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. Since the 1990s, they are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity under what became known as the "Dutch Protocol". They have been shown to reduce depression and suicidality in transgender and nonbinary youth. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

<span class="mw-page-title-main">Gynecomastia</span> Enlargement of the human male breast

Gynecomastia is the non-cancerous enlargement of one or both breasts in men due to the growth of breast tissue as a result of a hormone imbalance between estrogens and androgens. Physically speaking, gynecomastia is completely benign, but it is associated with significant psychological distress, social stigma, and dysphoria.

Ruth Illig was a Swiss pediatric endocrinologist and a professor of pediatrics at the University of Zurich.

References

  1. ↑ "Specialties & Subspecialties". American Osteopathic Association. Archived from the original on 13 August 2015. Retrieved 25 September 2012.
  2. ↑ "Pediatric Endocrine Society".
  3. ↑ "Idiopathic Short Stature Addressed in Guidelines". www.medcentral.com. 2021-06-28. Retrieved 2024-05-30.
  4. ↑ Grimberg, Adda; DiVall, Sara A.; Polychronakos, Constantin; Allen, David B.; Cohen, Laurie E.; Quintos, Jose Bernardo; Rossi, Wilma C.; Feudtner, Chris; Murad, Mohammad Hassan; on behalf of the Drug and Therapeutics Committee and Ethics Committee of the Pediatric Endocrine Society (2016-11-25). "Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency". Hormone Research in Paediatrics. 86 (6): 361–397. doi:10.1159/000452150. ISSN   1663-2818.
  5. ↑ "Medical Association Statements in Support of Health Care for Transgender People and Youth | GLAAD". glaad.org. 2023-06-21. Retrieved 2024-05-30.
  6. ↑ "Evidence for puberty blockers and hormone treatment for gender transition wholly inadequate | BMJ" . Retrieved 2024-04-30.
  7. ↑ O’Dowd, Adrian (2024-03-14). "NHS services in England are told to stop routine prescribing of puberty blockers". BMJ. 384: q660. doi:10.1136/bmj.q660. ISSN   1756-1833. PMID   38485137.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.