February may be the shortest month, but not in terms of events and challenges we encounter.  We are all affected by the continued growth hormone shortage.  We have developed a letter which you may find useful (please see details in the GH Shortage Section below).

Celebrating the Life of Dr. Samir Najjar

For those lucky enough to have met Dr. Samir Najjar, or better yet, having worked with him, I have no doubt that he sizzled the desire to pursue or further the field of pediatric endocrinology. He joined the American University of Beirut in 1960, and later relocated in 1987 to the Children’s Hospital in Boston and Harvard Medical School.   Dr. Joe Majzoub credits Dr. Najjar for teaching him the pediatric side of endocrinology.  In 1987, as a medical student, I had the fortune of rotating with both Dr. Najjar and Dr. John Crigler.  Dr. Crigler would state that he started his career with a “Najjar” (discovering Crigler-Najjar syndrome with another “Najjar”) and would end his career with another amazing “Najjar”.  Dr. Najjar was an amazing teacher and would return to the AUB in 1994 as Dean of the Faculty of Medicine. 

For more details about his life, click here:  In Memorium – Samir Najjar, MD – Pediatric Endocrine Society (pedsendo.org)

Earthquake Victims in Turkey and Syria    
I am sure you are aware of the recent devastating earthquake that hit Turkey and northern Syria. Unfortunately, the earthquake affected over 10 million people just in Turkey, has claimed lives of nearly 40,000 people, and left millions without homes, and access to basic needs such as food or blankets in harsh winter conditions.

Members have supplied me with the following information as well as a link for those who would like to donate through a US-based organization, Whitetulip Health Foundation. With a team of dedicated professionals and a network of local and international partners, Whitetulip Health Foundation plans to ensure that those affected by the earthquake receive the aid and support they need to rebuild their lives and recover from this disaster.

https://www.gofundme.com/f/eeduyd-help-earthquake-victims-in-turkey?utm_campaign=p_cf+share-flow-1&utm_content=undefined&utm_medium=copy_link&utm_source=customer&utm_term=undefined

Cases:

As usual, I present two cases each with an interesting twist.

A) Regulating a Prolactinoma

7-year-old girl with marked neurological delays Gastric tube dependency,  presented with both breast and pubic hair. The growth chart was challenging to establish as she was wheelchair bound.  Laboratory analysis confirmed pubertal levels of LH, FSH and estradiol. The thyroid studies were normal but the prolactin was 110 ng/ml, confirmed by another sample at 98 ng/ml. 

MRI revealed a 5 mm mass in the pituitary, consistent with an adenoma or prolactinoma.  Should dopamine agonist therapy be initiated to regulate the prolactinoma? The patient was also on metoclopramide (Reglan).  We discontinued the Reglan and repeat prolactin was 5 ng/ml.  The prolactin was indeed REG-ulated. The MRI finding was felt to be an incidentally found benign non-functioning lesion.  (Whenever you diagnose someone with a prolactinoma with modest hyperprolactinemia, research each medication for possible causes of medication induced hormone elevation). 

Speaking of medications…..I present a case of …

B) Graves disease – much room for improvement

A 12-year-old boy presented with classic features of hyperthyroidism due to Graves disease.  His initial laboratory studies showed T4 > 25 ug/dL, T3 > 8 ng/ml, and elevated Thyroid Stimulating Immunoglobulin. Baseline liver studies were unremarkable. He was started on methimazole with doses as high as 55 mg per day. 

At 5 months into therapy, he developed marked elevation of transaminases (ALT 621 U/L) but normal bilirubin.  A repeat study confirmed these results. He had nausea, vomiting and abdominal cramps. 

What would you do with the methimazole therapy?

Additional information:

The follow-up visit with me was actually 2 months after this set of labs.  I was not the one who ordered the labs; they were drawn at an emergency room visit where both he and his dad felt ill.  I saw that the follow-up lab study a month later had completely normal liver studies.

Both the patient and his father had ingested a poisonous mushroom and developed liver toxicity.  (I would have held the methimazole and added back the original beta blocker, but I was not informed of this incident).  So—-yes, there was indeed mush-ROOM for improvement, and they no longer pick wild mushrooms.