Hello everyone and hoping you are surviving these high temperature records. Our Canadian family members perhaps are enjoying the ambient temperatures of 75 degrees F (24 C) while it is 100 degrees F (38 C) in many US locations.
Again, I want to keep the newsletter informative yet also entertaining. Of course, some of you may want to skip all the information and go right to the fun parts, and other skip the entertaining parts and are looking for “data.”
So, I offer you again a choice as I present two short cases both with an ectopic posterior pituitary:
You can read A for the Entertaining Case titled “Why is the growth hormone not working?” or skip to B titled “Stalking your patients with Ectopic Posterior Pituitary”.
Case A “Why is the growth hormone not working”
A 15-year-old boy with a history of GH deficiency (and ectopic posterior pituitary) has been on GH for 4 years. He initially was growing well on the GH but the endocrinologist noted that his growth velocity was poor at the current 6-month visit. Three careful measurements were obtained at each visit and averaged. The endocrinologist considered the differential diagnosis of poor growth. Compliance has always been superb (and the IGF1 was appropriate). His pubertal exam was only approaching early Tanner 4, and the bone age consistent at 13 -13 ½ years. His thyroid was normal and workup would reveal no suggestion of a systemic disease. And now the answer: The previous height measurement was plotted incorrectly. By moving the mouse over the data point on the previous visit’s measurement, the raw data consisting of 3 identical measurements, was 1.5 cm lower than the erroneous data point entered in the EMR. This was a human error transcribing the measured height.
Case B “Stalking your patients with Ectopic Posterior Pituitary”
A child with poor growth and low iGF-1 is proven to have severe GH deficiency. The pituitary MRI report indicates the presence of an Ectopic Posterior Pituitary. The family asks if their child is at risk for other pituitary hormone deficiencies. An ectopic posterior pituitary is a developmental abnormality but there are variations. The bright spot is seen on a non-contrast film, though the stalk is best visualized on a contrast film. Some present with the bright spot high up by the median eminence with associated non-visualization of the pituitary stalk, but others present with the bright spot closer to the pituitary and with a visualized stalk. In the former group, the risk of multiple pituitary hormone deficiencies (other than DI) is high, but in the latter, it is much lower. For those more interested, here are two references:
Jagtap VS, Acharya SV, Sarathi V, Lila AR, Budyal SR, Kasaliwal R, Sankhe SS, Bandgar TR, Menon PS, Shah NS. Ectopic posterior pituitary and stalk abnormality predicts severity and coexisting hormone deficiencies in patients with congenital growth hormone deficiency. Pituitary. 2012 Jun;15(2):243-50. doi: 10.1007/s11102-011-0321-4. PMID: 21667124.
Chen S, Léger J, Garel C, Hassan M, Czernichow P. Growth hormone deficiency with ectopic neurohypophysis: anatomical variations and relationship between the visibility of the pituitary stalk asserted by magnetic resonance imaging and anterior pituitary function. J Clin Endocrinol Metab. 1999 Jul;84(7):2408-13. doi: 10.1210/jcem.84.7.5849. PMID: 10404812.
I am hoping we all share tips that can help your pedi endo colleagues. (please email your tips to email@example.com with “PES Tips” as the subject and they will be reviewed by the Board and me). Here is one of the submitted tips:
Try to have sentences that would be correct even if copied a year later. For example, instead of writing, “brother is 8 years old”, write “brother DOB 3/2/14”.
Craig A. Alter, MD
News from the EDI Action Team
August 2022: Celebrating the Right to Vote
On August 6, 1965, the Voting Rights Act (VRA) was signed into law. The VRA outlawed the discriminatory voting practices that had been adopted in many Southern states after the Civil war post-Reconstruction to deny Black Americans the right to vote, such as literacy tests, poll taxes (not to mention the harassment, intimidation, physical violence and economic reprisals many faced when attempting to register to vote). Visit the website to learn more: Equity, Diversity and Inclusion Initiative – Pediatric Endocrine Society (pedsendo.org)
New! Mentor / Mentee Match is Now Open
When you ask PES members what inspired them or helped them to become successful in their career, the most common response is “I had a fantastic mentor!” Fostering these meaningful mentor/mentee relationships is a priority for PES, and so we have improved our matching system to make it better than ever! This new system is now available through our PES Connects platform. Please visit our tutorial for step-by-step instructions to volunteer to be a mentor or find a mentor for the 2023-24 academic year. You can find the video tutorial here.
PES Adrenal SIG State of the Art Webinar
August 25, Thursday, 4:00 – 5:00 PM EDT presented by Maria G. Vogiatzi, MD
PES DSD SIG State of the Art Webinar
August 26, Friday, 1:00 – 2:00 PM EDT presented Dr. Christa Flück
See events calendar for details on upcoming education: https://pedsendo.org/events/
Rising Star Research Award (RSA)
Applications now being accepted! Deadline September 15, 2022
The purpose of this small grant award is to support and encourage research efforts of fellows. The maximum amount of funding available for each of these grants is $2500 for one year. The PES plans to fund approximately 5 grants per year. NEW THIS YEAR – One of these awards, the named RSA; The Raphael David, MD Rising Star Award, will be given preferentially to an application related to the developmental biology of the testes or adrenal gland. There will only be one round of applications per year. The RSA program is in addition to the already established and larger Research Fellowship Award (RFA) program. Visit the website for criteria and application: Rising Star Award – Pediatric Endocrine Society (pedsendo.org)
Industry Sponsored Symposium
Pediatric Growth Patterns and Their Impact on Health: Achondroplasia in Focus
Date/time: Launch August 3, 2022 at 15:00hrs BST, UK
Available immediately after on demand!
Session Description: In this activity, experts in pediatric endocrinology respond to questions from the endocrinology and paediatrics community on the normal and abnormal physiology of bone growth, detecting and assessing achondroplasia, including the use of growth charts, and the role of emerging targeted therapies in the management of achondroplasia.
Dr. Nadia Merchant, Assistant Professor, Division of Endocrinology and Diabetes, Children’s National Hospital, Washington, DC, USA
Dr. Andrew Dauber, Chief of Endocrinology, Children’s National Hospital, Washington, DC, USA
- Explain how the mechanisms behind various bone growth control systems contribute to bone health and bone abnormalities
- Use appropriate growth charts to detect abnormal growth patterns in children
- Summarize the linear growth patterns, and physical and radiographic findings indicative of achondroplasia, and the impact of emerging treatments
CME Being Offered:
USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Kara Beliard, MD
The Adjustable Micropipette
Submitted by Walter Miller
From the NIH
By Mike Lauer
More Early-Stage Investigators Supported in FY 2021
Last summer, we reported that in fiscal year 2020 NIH supported 1,412 early-stage investigators (ESIs) as first-time Principal Investigators on R01-equivalent awards. This all-time high was seen after several years of steady growth in the number of ESIs supported since implementing NIH’s Next Generation Researchers Initiative five years ago. Today, we take a look specifically at how ESIs and other targeted groups fared last fiscal year. More Early-Stage Investigators Supported in FY 2021 – NIH Extramural Nexus
News from K12 National DiabDocs-K12 Program
Letters of Intent (LOIs) for the National NIH DiabDocs-K12 Program are due next Monday, August 1, 2022. Please feel free to distribute further to applicants, mentors, and other interested parties. All LOI materials need to be e-submitted to firstname.lastname@example.org.
We have created a new program website https://med.stanford.edu/pedsendo/physician-scientist-diabdocs-k12-program.html. Please visit our website for more information on the program.
The National NIH DiabDocs-K12 Program is now on Twitter! Please feel free to follow us @diabdocsk12 or visit our Twitter webpage here https://twitter.com/diabdocsk12
We recorded an informational podcast with The Sugar Science group in July related to the application process for the program. Please feel free to listen to the recording and download it here https://thesugarscience.podbean.com/e/introducing-the-diabdocs-national-physician-scientist-training-program/
We had two informational webinars in July 2022 to discuss the program, application process and eligibility criteria. The webinars were on Zoom and were recorded. Please feel free to visit the links below to listen to the recordings
Monday, July 11, 2022: Recording available here
Wednesday, July 13, 2022: Recording available here
PES Leadership Advantage Program
After a six-year successful run, the PES Leadership Advantage Program has now concluded. Over 60 PES members have participated in one or more of the in person or virtual workshops since its 2016 inception. Congratulations to the 8 PES members who successfully completed all four modules and received their PES Leadership Advantage Certificate! PES Leadership Advantage (PESLA) – Pediatric Endocrine Society (pedsendo.org)