Endocrinology is fun!

We hope that since the takeover of the @ADC_BMJ and @ArchivesEandP accounts by our social media team, you’ve enjoyed (and learnt something from) the flurry of thematic tweeting occurring each week as much as we have had generating them. The last week @ADC_BMJ has been focussed on the subspecialty of paediatric endocrinology and diabetes, and as a trainee in the field it has been a pleasure to find so many gems (particularly excellent “How do I…” type reviews) on the topic in the “blue journal” over the last few years!
My personal top five favourite articles featured this week:

1) Investigation and management of short and tall stature (https://adc.bmj.com/content/99/8/767 and https://adc.bmj.com/content/99/8/772
Two excellent back-to-back summaries by Tim Cheetham (consultant paediatric endocrinologist, Newcastle) and Justin Davies (consultant paediatric endocrinologist, Southampton) on the bread and butter of all paediatric endocrinologists.
2) Recognition, assessment and management of hypoglycaemia in childhood (https://adc.bmj.com/content/101/6/575)
Another very useful summary by the paediatric metabolic medicine and endocrinology teams at the Royal Manchester Children’s Hospital about which tests to take to assist with the differential diagnosis of paediatric hypoglycaemia and how to manage it. See associated tweet (https://twitter.com/ADC_BMJ/status/1054772061762142208) for the interesting discussion this generated on Twitter.
3) Recognition and assessment of atypical and ambiguous genitalia in the newborn (https://adc.bmj.com/content/102/10/968)
Another “How do I…” type review by Tim Cheetham and Justin Davies on which tests you need to do (and when you need to do it) before slightly panicking and beginning that difficult conversation with parents.
4) Retrospective review of synacthen testing in infants (https://adc.bmj.com/content/103/10/984)
Establishing adrenal insufficiency in the neonatal and infant period can be fraught with difficulty, as indicated by this review of the Royal Manchester Children’s Hospital experience where over two-fifths of infants tested had suboptimal cortisol responses to synacthen stimulation, but just over three-fifths of these subsequently had normal responses in later childhood and came off hydrocortisone supplementation. This article really highlights our lack of normative data on testing adrenal function in infants, and why starting hydrocortisone should always be done in liaison with your friendly paediatric endocrinologist in this age group.
5) Pituitary dysfunction after traumatic brain injury: are there definitive data in children? (https://adc.bmj.com/content/102/6/572)
We rarely think of monitoring for endocrine deficits after traumatic brain injury in children, and yet there is longstanding adult and paediatric data to show that hypopituitarism is not an uncommon finding. This paper by Paula Casano-Sancho (consultant paediatric endocrinologist, Barcelona) reviews the current evidence on its prevalence in children, reminding us that the pituitary gland, our hormone “control centre”, is vulnerable to almost any insult (think surgical sieve: congenital, neoplasia, infection, inflammation, trauma, vascular etc.), and that deficits can evolve over time.
Of course there were many other interesting articles and I had trouble selecting my top five favourites so do have a look through the Twitter feed and let us know what you think! And if you are ever stuck with an endocrine question, do have a look at the very useful Clinical Resources section on the British Society for Paediatric Endocrinology & Diabetes here: https://www.bsped.org.uk/clinical-resources/
Hoong-Wei Gan (@hwganendodoc) is a Clinical Research Fellow at UCL Great Ormond Street Institute of Child Health and an ST7 in Paediatric Endocrinology and Diabetes at the Royal London Children’s Hospital.

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