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The histrelin implant has been used to treat central precocious puberty (CPP) for more than 15 years. Although approved for annual use, limited published reports suggest that a single implant is efficacious well beyond a year. Our objective was to report our long-term experience using a single histrelin implant for more than 12 months in children with CPP. We performed a retrospective study of 170 children with central precocious puberty treated with a single histrelin implant for more than 1 year. Implants were left in situ for an average of 24 months. Pubertal development regressed or remained stable in the vast majority of patients and biochemical suppression was maintained. No correlation between time since an implant was placed and complications such as implant breakage or a second incision was seen. A single histrelin implant provides excellent pubertal suppression well beyond a year. Extended use of a single histrelin implant should be considered standard of care in children with CPP. [ABSTRACT FROM AUTHOR]

Background: We sought to determine the frequency with which genital exams (GEs) are performed in children with disorders of sex development (DSD) and ambiguous genitalia (AG) during routine visits to the pediatric endocrine clinic. Methods: Medical records of children with DSD and AG seen at one large academic center since 2007 were reviewed. Data analyzed included diagnosis, sex of rearing, age, initial or follow up visit, number of individuals present and sex of the pediatric endocrinologist. Repeated measures analysis was performed to evaluate associations between GEs and patient/physician factors. Results: Eighty-two children with DSD and AG who had a total of 632 visits were identified. Sex of rearing was female in 78% and the most common diagnosis was congenital adrenal hyperplasia (CAH) (68%). GEs were performed in 35.6% of visits. GEs were more likely in patients with male sex of rearing (odds ratio [OR] 17.81, p = 0.006), during initial vs. follow-up visits (OR 5.99, p = 0.012), and when the examining endocrinologist was female (OR 3.71, p = 0.014). As patients aged, GEs were less likely (OR 0.76, p < 0.0001). Conclusions: GEs were performed in approximately onethird of clinic visits in children with DSD and AG. Male sex of rearing, initial visits and female pediatric endocrinologist were associated with more frequent GEs. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding baseline characteristics of children and adolescents with gender dysphoria (GD). The purpose of this retrospective study was to describe baseline characteristics of pediatric patients referred for GD. Methods: A retrospective chart review of pediatric patients with GD referred to the pediatric endocrine clinic between 2002 and 2017 was conducted. Body mass index (BMI) percentiles and z-scores were calculated based on height and weight at the initial visit. Results: Seventy-eight patients aged 14.9±2.37 years were identified. Of these, affirmed gender was more often male than female (63% vs. 37%, p=0.024). Although no difference was seen in average BMI z-scores between female to male (FTM) and male to female (MTF) patients, approximately 50% were overweight or obese. A higher incidence of anxiety was present in FTM compared with MTF youth (p=0.05). Fifty-six patients were referred in January 2014 or later, of whom 27% had a history of early expression of GD compared with 55% of those seen prior to 2014 (p=0.061). Conclusions: The high prevalence of overweight in TG youth at baseline represents a potential risk for adverse health consequences. There appears to be a change in the age of first manifestation of GD over time. [ABSTRACT FROM AUTHOR]

Primary adrenal insufficiency (AI) in children usually presents with non-specific symptoms such as fatigue, nausea, vomiting, and anorexia. Here, we report an unusual case of a 15 year old girl who presented with acute mental status change and was ultimately diagnosed with AI due to autoimmune polyglandular syndrome type II (APS2). Central nervous system imaging revealed a cerebral infarction. To our knowledge, the constellation of APS2, stroke and acute mental status change has not been previously reported. We review the literature with regard to the presentation of AI as well as the association between vasculitis and APS2. [ABSTRACT FROM AUTHOR]

Background: Severe acquired hypothyroidism often results in significant height deficit due to rapid bone age advancement following treatment. Whether gradual correction of hypothyroidism and/or adjunctive growth-promoting therapies (GPTs) augment final adult height (FAH) is controversial. Objective: To investigate time to euthyroidism, pace of bone age advancement (ΔBA/ΔCA), and impact of GPTs on FAH. Methods and patients: Retrospective review of 21 children (10.1 ± 3.0 years) with profound hypothyroidism. Results: Baseline bone age standard deviation score (SDS) was -4.1 ± 1.8, whereas height SDS was -3.0 ± 1.1. Average time to euthyroidism was 9.7 months (2.3 - 33.7 months). Average ΔBA/ΔCA was 2.3 ± 0.9. Six of 13 patients at FAH received GPTs. No correlation was found between time to euthyroidism and rate of skeletal maturation. No difference in height outcome was seen between those who received GPTs and those who did not. Conclusions: Neither time to euthyroidism nor use of GPTs significantly affected height potential in our patients. [ABSTRACT FROM AUTHOR]

The article discusses the case of a child with Down syndrome who was diagnosed with congenital hypothyroidism due to left thyroid hemiagenesis and later developed Graves' disease. Increased thyroid stimulating hormone (TSH) was shown on the repeat newborn screen done on the patient. Issues on thyroid hemiagenesis, autoimmune hyperthyroidism, and thyroid disease in children with Down syndrome are discussed.

The article discusses a study which aimed to investigate the incidence of thyroid stimulating immunoglobulin (TSI) negativity in children and adolescents diagnosed with Graves' disease (GD). The study also aims to determine whether any aspects of the disease were different in patients with TSI negative versus TSI positive GD. Charts of children with GD seen in a pediatric endocrinology clinic over the past five years were reviewed in this study. The study concluded that in patients with GD, the finding of a negative TSI titer usually creates diagnostic uncertainty.

Mixed gonadal dysgenesis (MGD) is a form of sex chromosome disorder of sex development with large phenotypic variability. Patients with MGD typically have asymmetric and ambiguous genitalia with a combination of Müllerian and Wolffian duct derivatives. Prenatal androgen exposure results in variable degrees of phallic enlargement and a urogenital sinus. Here, we report an infant with ambiguous genitalia due to MGD. Despite marked evidence of prenatal androgen exposure, there was a completely intact distal vagina. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective chart review of children referred for short stature (SS) to a pediatric endocrine clinic in Indianapolis, Indiana from July 1998 to June 1999 and July 2005 to June 2006 in order to ascertain any changes in referral patterns before and after the U.S. Food and Drug Administration approved the use of growth hormone (GH) to treat children with idiopathic short stature (ISS) in 2003. It also stresses the importance of educating the general public about the factors influencing the eligibility of patients for GH therapy.

The article discusses a research study on the unexpected identification of Grave's disease in identical twins who exhibited polydipsia. Review of systems as to weight loss, palpitations and irritability were negative while physical examination showed enlarged thyroid gland and the test for diabetes was negative. Conclusions indicated that polydipsia is an unusual and rare presenting feature of pediatric hyperthyroidism and it stresses the importance of having a high index of suspicion for thyroid disease among children.