Hello to the Pediatric Endocrine Family. I am so excited to finally have our in-person meeting—only days away. I am thankful to the Program Committee under the leadership of Dr. Leena Nahata and Dr. Takara Stanley who organized a conference with such a variety of topics. I am thankful to both my fellow PES Board leaders and Degnon for their commitment, creativity, and time towards the meeting.
The meeting is not just about learning new science and about interesting topics in endocrinology. It is about connecting with old colleagues and meeting new ones. It is about guiding new endocrinologists and budding endocrinologists. I remember my first conference as a fellow in San Antonio where Tom Moshang mentored me on what to do at the meeting. He told me to relax, learn, and read the name tags and speak to my colleagues. (Relax meant not to feel disturbed if I wanted to be in three places at once). The environment for interacting is superb. For those that cannot attend, we hope to see you at the next meeting in a year, with details in upcoming newsletters. Speaking of, I will have one more newsletter before Dr. Tom Carpenter takes the reigns. I invite others to send me any cases and will pick my favorite two to be the two featured ones in the May newsletter. (You can submit the cases at info@pedsendo.org).
Case 1: When men get red eyes
A 14-year-old visits the ophthalmologist because his “eyes are red and hurt all the time”.
Throughout his life, strangers would even ask if he was on “drugs” as his eyes would get red and irritated. Ophthalmological exam revealed severe inflammation of the lid margins with normal vision. After 1.5 years’ (failure not A failure?) of topical prescriptions, he went for a surgical procedure to modify his eye lids. In the operating room, they noted enlarged corneal nerves as well as neuromas of the conjunctiva. They proposed a differential diagnosis of: Refsum (storage) syndrome, Hansen disease (leprosy), Riley-Day, NF1, Acanthamoeba perineuritis, and Multiple Endocrine Neoplasia 2b amongst others.
Who you gonna call—endocrine to the rescue…
Because MEN2b was mentioned, the ophthalmologist called up endocrine for a consultation. On exam, he had a Marfanoid habitus, a pectus excavatum, and normal blood pressure. He had a 1 cm very firm thyroid nodule (the firmest I ever felt). Calcitonin was 816 pg/ml (0-8.4). He had MEN 2b. Off to the otolaryngologist….
In MEN2b, prominent corneal nerves is quite common so the ophthalmologist may, as in this case, be the first to uncover the diagnosis. Neuromas of the conjunctiva are seen. The eyelids can be thickened and with nodules. There may be decreased tearing and poor pupillary dilation.
Lam D, Villaret J, Nguyen Kim P, Gabison E, Cochereau I, Doan S. In Vivo Confocal Microscopy of Prominent Conjunctival and Corneal Nerves in Multiple Endocrine Neoplasia Type 2B. Cornea. . 2019;38(11):1453-1455.
Case 2: Diabetes Camp – need I say more.
For any of you who started a diabetes camp, well, I am sure you can appreciate the ups and downs, and I do not mean about the blood glucose levels. August 2001, Day 1 of the new Diabetes Camp. Protocols PREPPED; counselors trained, meters, insulin, ketone strips, all at the ready. Of the 100 campers, perhaps 20 % had a blood glucose high enough to need urinary ketones measured. No problem. Yes problem! “Hey doc, where should we check for ketones? How about in the woods?” Yup, no toilet in the area of the first activity. Day 2. New nurse asks me what would happen if someone without diabetes took insulin? Fun question, I thought. I told her of the insulin GH provocative test and how we would administer 0.1 units per kg….. Day 3. “Hey Doc, guess what, I just took 0.1 units per kg.” At least she earned herself a buffet of camp snacks and learned how it feels to check 6 blood glucose levels per hour (Blood glucose 6 times per hour?). Then there are the stories which I titled “the not so ease of injecting”, “the wrong punch”, and….for those stories, I suggest you ask me in person in San Diego.
Sincerely,
Craig A. Alter, MD
Drug Recall from the PES Drugs and Therapeutics Committee
Abbott pharmaceuticals has issued a warning impacting four million readers for glucose monitors after reports that devices were overheating and catching fire when patients used non-Abbott charging cords. Learn more: https://pedsendo.org/drug-alerts/abbott-recall/
New Meds and Tech from the PES Drugs and Therapeutics Committee: Solu-Cortef Shortage
March 2023: Pfizer announced a supply disruption of Pfizer’s Solu-Cortef® (hydrocortisone sodium succinate for injection, USP) 100 mg/2 mL (50 mg/mL) ACT-O[1]VIAL™ Single Dose Vial presentations and provide guidance on how to access product reserved for patient specific emergency needs. Currently, all Solu-Cortef® (hydrocortisone sodium succinate for injection, USP) inventory is available from Pfizer through direct order only, and Pfizer is allocating limited quantities to institutions with a history of product purchases. Pfizer provides guidance to clinicians for utilizing emergency request process for obtaining the medication. The disruption is anticipated until June 2023.
Learn more: https://pedsendo.org/drug-shortages/solu-cortef-shortage/
New from the PES Drugs and Therapeutics Committee: Weight Management Medications Appeal Letter
March 18th, 2011 (pedsendo.org)
Industry Sponsored Symposium
Current Management of Central Precocious Puberty (CPP) & Update on Subcutaneous (leuprolide acetate) for Injectable Suspension Pre-Connected Syringe System
Monday, April 24, 2023: 1pm (ET) Noon (CT) 11am (MT) 10am (PT)
Description: This virtual symposium, sponsored by Tolmar Pharmaceutical, will address Central Precocious Puberty: diagnosis, treatment objectives, treatment options, when to treat and when to stop. Subcutaneous (leuprolide acetate) for injectable suspension and the updated Pre-connected Syringe System. This program is sponsored by, and the speaker is presenting on behalf of Lilly USA, LLC. It is being presented consistent with FDA guidelines and is not approved for continuing education credit.
Speaker: Dr. Philippe Backeljauw, Cincinnati Children’s Hospital Medical Center, Professor, University of Cincinnati College of Medicine, Cincinnati, OH
Register here: Webinar Registration – Zoom
Industry Sponsored Symposium
Lyumjev® (insulin lispro-aabc) Pediatric Product Theater
Tuesday, May 16, 2023: 12:30 PM – 1:30 PM ET
Description: Join a discussion with one of your peers on the efficacy, safety, dosing, and administration of Lyumjev, and learn about how to get your pediatric patients with diabetes started on this treatment. Attendees will have the opportunity to pose questions to the faculty speaker about the data presented. Refreshments will be provided.
This program is sponsored by, and the speaker is presenting on behalf of Lilly USA, LLC. It is being presented consistent with FDA guidelines and is not approved for continuing education credit.
Speaker: Gnanagurudasan Prakasam, MD, MRCP, MHA
Register here: https://attendee.gotowebinar.com/register/4883914532477278044
Annual Meeting Update
2023 EDI Plenary: Foundations for Child Advocacy in 2023
Speaker: Mark Del Monte, JD, CEO/Executive VP AAP
Learning Objectives:
- Understand changes in the political and social context of child advocacy.
- Identify opportunities for individual and collective action to advance shared goals.
- Recognize how the mission of AAP and PES encourages and supports advocacy by clinicians inside and outside the clinical setting.
The Great Giveback Game Show – LIVE Pediatric Endocrine Quiz Show!
Each participant is given instructions on how to log into a secure game portal (NO APP DOWNLOAD REQUIRED!) to register on the scoreboard and select one of three San Diego local charitable causes to play in support of. After registering on your smart device, which you will use to answer questions, individuals will compete in a fast-paced series of exciting trivia questions hosted by our very own Dr. Craig Alter, earning points for questions you get correct and more points for being the first individual to answer the question correctly. The game show will result in financial donations made to the three San Diego local causes on behalf of the Pediatric Endocrine Society. While there is a winning team based on the trivia challenge, the real winners are the individuals being supported by the meaningful donations from the Pediatric Endocrine Society. Are you up for the challenge? Come join the fun! Saturday, May 6, 2023 at 6:15pm.
Visit our PES 2023 Annual Meeting Web page for up to the minute information: PES 2023 Annual Meeting – Pediatric Endocrine Society (pedsendo.org)
EDI Spotlight
May is an important month for Equity-Diversity-Inclusion. It is the Mental Health Awareness month as well as the Asian American and Pacific Island Heritage month; it includes the International Day against Homophobia, Transphobia and Biphobia (May 17th), Malcolm X’s birthday (May 19th) and the birthday of the Buddha (May 26th). Read more here: Equity, Diversity and Inclusion Initiative – Pediatric Endocrine Society (pedsendo.org)
APP Spotlight: Sarah Kelly DNP, APRN, NP-C
Meet Sarah: April APP Spotlight: Sarah Kelly DNP, APRN, NP-C – Pediatric Endocrine Society (pedsendo.org)
Historical Tidbit: Philip Edward Smith, Ph.D. (January 1, 1884-December 8, 1970)
Submitted by: Alan D. Rogol, MD, PhD
News from the NIH: NIH Clinical Trials Reporting Compliance: A Shared Commitment
By Mike Lauer
To assess our progress with results information submission to ClinicalTrials.gov beyond 2020, we conducted analyses of NIH-grant-funded clinical trials for which main results were due in fiscal year (FY) 2020, FY 2021, or FY 2022.
Read more: NIH Clinical Trials Reporting Compliance: A Shared Commitment – NIH Extramural Nexus
Trends in Extramural Research Integrity Allegations Received at NIH
By Mike Lauer
At the start of the year, we briefly touched on our efforts to address research integrity violations in our 2022 Year In Review. Today we are sharing some more information on the overall trends in research integrity allegations associated with the NIH grants process.
Trends in Extramural Research Integrity Allegations Received at NIH – NIH Extramural Nexus