Endocrine Abstracts

Introduction: Fracture incidence is increased during and after treatment for childhood acute lymphoblastic leukaemia (ALL). Studies using DXA, which measures a composite of both trabecular and cortical bone mineral density (BMD), have shown reduced BMD during treatment. We therefore used peripheral quantitative computed tomography (pQCT) to investigate changes in compartmental (cortical and trabecular) volumetric BMD (vBMD) and bone geometry, and evaluated the influence of tre...

Background: General Medical Council (GMC) guidance describes an intimate examination as one that may be embarrassing for the patient, for example, breast or genitalia examination. Documentation of consent and use of a trained impartial observer (chaperone) is recommended for intimate examinations. Pubertal staging is often necessitated for assessment of growth and puberty. We assessed current practice in pubertal staging by paediatricians and paediatric endocrinology nurse spe...

Background: Children with type 1 diabetes mellitus (T1DM) are at increased risk of other autoimmune conditions including thyroid, coeliac and Addison’s diseases. Hyperpigmentation is a recognized feature of Addison’s disease. We present a case with unusual diabetes-technology related hyperpigmentation.Case report: A 12-year-old male with known T1DM (glutamic acid decarboxylase antibody positive), coeliac diseas...

Background: Reports from several countries have suggested an increased incidence of diabetic ketoacidosis (DKA) at presentation of type 1 diabetes mellitus (T1DM) during the COVID-19 pandemic. Published data on this from the United Kingdom is sparse. We examined the frequency and severity of DKA at diagnosis of T1DM in children presenting to a university hospital during the first year of the pandemic in comparison to preceding years.Methods: In England, ...

Background: Current guidance recommends screening for coeliac disease (CD) at diagnosis of type 1 diabetes mellitus (T1DM) using measurement of serum anti tissue transglutaminase immunoglobulin A (tTG-IgA). It is recognized that tTG-IgA levels can fluctuate and there are reports of transient rises in tTG-IgA levels in response to acute stress, such as infection and acute coronary syndrome. The effect of diabetic ketoacidosis (DKA) on tTG-IgA has not been reported. We investiga...

Introduction: Post-traumatic hypopituitarism (PTHP) is a recognised sequel of traumatic brain injury (TBI), occurring in 25–69% of adult patients, but there are few data on the prevalence or natural history in childhood. Our aim was to determine pituitary function in children at least 4 years after TBI requiring paediatric intensive care unit (PICU) admission. At the same time body composition was evaluated.Methods: Children discharged from the regi...

Introduction and Case report: Congenital adrenal hyperplasia (CAH) is a heterogenous group of conditions resulting from inborn errors of steroidogenesis, of which over 95% are due to 21-hydroxylase deficiency.We present a 15-year-old Nepalese female, who was referred to the endocrine clinic for management of CAH. This diagnosis had been at 11 months of age, whilst resident in Hong Kong, when she presented acutely with vomiting and seizures. She had since...

Background: Children with undiagnosed coeliac disease are at risk of low bone mineral density (BMD), but whether this translates to fracture predisposition is unclear. In adults with coeliac disease anti-osteoprotegerin (anti-OPG) antibodies have been identified. OPG inhibits RANK ligand activation of osteoclastic bone resorption, and thus anti-OPG antibodies promote bone loss. We report a case of osteoporosis with elevated anti-OPG antibodies in a child with coeliac disease.<...

Background: Children who are overweight and obese have a higher incidence of fracture, but it is unknown if this varies by fracture site. Indeed, obesity in adult women protects against forearm fracture, but increases the risk of humeral fractures. We aimed to determine if adiposity differed by fracture site in children with upper limb fractures.Methods: Children aged 3–18 years were recruited within 60 days of fracture. Height, weight, waist circum...

Background: Glucocorticoids are frequently used to treat childhood inflammatory disorders, and may cause increased fracture predisposition with reduced bone mineral density (BMD), particularly from trabecular bone loss. The contribution of the underlying inflammatory disease processes to these outcomes is poorly understood. Childhood nephrotic syndrome (NS) is a useful model to investigate the effects of steroids on bone, as recurrent courses are often required, but systemic i...