Endocrine Abstracts

Transition from pediatric to adult care is a challenging turning point for patients, physicians and health care system that need to be planned and adapted to each center. Endocrine conditions present some specific concerns at transition that need to be clarified to insure optimal care during adulthood. We had the opportunity to set up a network to evaluate transition process of patient with a chronic endocrine condition at the Department of Endocrinology and Reproductive Medicine of the GH Pitié-Salpêtrière, to establish basis of an optimal transition program and to improve follow-up of those patients presenting with rare diseases, including hypogonadotropic hypogonadism. Prospective and retrospective assessment of transition period was conducted through elaboration of standardized surveys that were sent or given for completion to targeted transition patients. Two categories of surveys were developed: i) one general survey addressing universal aspects of transition and ii) specific surveys exploring precise concerns for certain endocrine condition. Three chronic endocrinopathy, congenital adrenal hyperplasia, hypogonadotropic hypogonadism and growth hormone deficiency, have been kept for evaluation since they present specific challenges for both the patient and physician that need to be characterized. Answers where analysed and compared to actual recommendations for successful transition. Since the last decade, 273 patients in transition were listed in our department and 153 were kept for evaluation since they present one of the three endocrinopathy retains for assessment. A total of 73 subjects fulfilled both general and specific surveys. Over 80% of patients were satisfied about actual transition process in terms of organization, accessibility and medical care. Actual and optimal age felt by patients for transition correspond for most subjects (19.4 vs 18.4 years). Main concerns of patients about transfer have been identified. Finally, specific endocrine surveys allowed identification of psychological concerns, essentially around sexual life and fertility in patients with hypogonadotropic hypogonadism, that need to be address more systematically at first consultation. The present organisation allowed our medical team to improve transfer of pediatric patients and to identify the basis of a transition program tailored for our center and for each of the endocrine condition studied.