Role of vitamin D in modulating the immune response to SARS-CoV-2 and other coronavirus infections

In recent years, new data have been obtained on the significant prevalence of vitamin D (VD) deficiency in the population, and knowledge about the role of vitamin D in the regulation of many physiological processes in the body, including the functioning of the immune system, has increased. The SARS-CoV-2 pandemic has further highlighted the issue of an adequate immune response in vitamin D deficiency. Objective of the review. To present and summarize the evidence on the role of VD in different parts of the immune response in COVID-19, to analyze available studies of the VD status effect on the course and outcome of COVID-19 in patients from different population groups. Material and methods. A search of domestic and foreign literature on the role of VD in the immune response in respiratory viral infections and SARS-CoV-2, as well as practical measures of VD-status correction in COVID-19, was performed. We used Scopus, Web of Science, PubMed, Google Scholar, eLibrary, and Cyberleninka databases. Results. Numerous clinical and observational studies have found an association between 25-hydroxyvitamin D levels, COVID-19 severity, and mortality. This association can be explained by the multifaceted role of vitamin D in the physiology of the human immune and endocrine systems. On the immunological side, the active form of VD promotes the secretion of antimicrobial peptides responsible for inhibiting viral replication and stimulates autophagy by increasing the level of Beclin1 protein and decreasing the level of mTOR protein regulating cellular homeostasis. It leads to the presentation of antigens followed by activation of the antiviral pathway of type I interferons. VD also stabilizes intercellular junctions, including those in the airway epithelium, reducing their permeability to pathogens, stimulates the activity of angiotensin-converting enzyme-2, whose receptors are a conduit for SARS-CoV-2 into cells, and several pathophysiological responses associated with the disease symptoms and acute lung injury. Adequate vitamin D status can provide significant benefits during the pandemic. Conclusion. To date, ideas about the role of vitamin D in regulating the immune response in respiratory infections have significantly expanded. However, its use in the complex preventive measures and adjuvant therapy of viral infections, including COVID-19, should be the subject of further scientific research.

NOISE POLLUTION AND ARTERIAL HYPERTENSION

Environmental noise significantly impacts human health and well-being. It is a widespread problem in Europe, where at least one in five people are exposed to harmful levels of noise. Hearing loss is the most known health effect related to noise exposure. There is, however, growing data that links noise exposure to hypertension, coronary artery disease, and stroke. According to some theories, this relationship may be explained by the indirect pathway of noise exposure, which can cause sympathetic and endocrine activation, as well as several cognitive and emotional responses, including annoyance. Noise exposure leads to stress reactions independent of cognitive involvement. There is a possibility that noise exerts its effects directly through synaptic interactions, as well as through cognitive and emotional effects. Epidemiological studies indicate that nocturnal noise exposure has more profound health consequences. Nighttime noise exposure is associated with an increase in heart rate due to sympathetic activation or parasympathetic withdrawal, and with an increase in blood pressure as well as endothelial dysfunction. Hypertension is a common condition and is an important risk indicator for other cardiovascular diseases. Previous studies showed an association between noise exposure, blood pressure and arterial hypertension. Meta-analysis of cross-sectional studies found an increase of hypertension prevalence per 10 dB increase in daytime average road traffic noise level. There is, however, some heterogeneity among these studies. Prospective studies have also found an association between aircraft noise exposure and hypertension, supporting the cross-sectional findings. The analyses, of data from the large Hypertension and Exposure to Noise near Airports (HYENA) study, showed that an increase in nocturnal aircraft noise exposure per 10 dB was associated with an increased incidence of hypertension. The meaningful effect of night-time aircraft noise on arterial hypertension was also observed in the prospective observation of the subset of individuals from that study. In a longitudinal observation of 420 participants, higher aircraft noise exposure during the night significantly associated with the incidence of hypertension. Previous cross-sectional case-control study conducted in 2015, in 2 suburban areas of Krakow, Poland, revealed an increase in blood pressure and arterial stiffness as determined by carotid - femoral pulse wave velocity in individuals exposed to increased aircraft noise levels. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects. As a result of these observations, noise mitigation strategies are important for cardiovascular health.

Safety of and antibody response to the BNT162b2 COVID-19 vaccine in adolescents and young adults with underlying disease

Background: Data are limited regarding the safety of and antibody response to the BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger ribonucleic acid vaccine in adolescents and young adults with underlying disease. Methods: This prospective observational study enrolled patients age 12–25 years with chronic underlying disease who received 2 doses of BNT162b2. A 18-item questionnaire was used to assess adverse events within 7 days post-vaccination, and data regarding severe adverse events were collected from electronic medical records. An antibody titer for the receptor-binding domain of the spike protein in SARS-CoV-2 was used to assess antibody response after the second vaccine dose. Results: Study participants were 429 patients (241 [56.2%] age 12–15 years;188 [43.8%] age 16–25 years). The most common underlying diseases were genetic or chromosomal abnormalities and/or congenital anomalies, followed by endocrine or metabolic diseases;32% of participants were immunocompromised. Severe adverse events were observed after the second dose in 1 (0.4%) patient age 12–15 years and in 2 (1.1%) patients age 16–25 years;all patients recovered. Seropositivity after the second vaccine dose was 99.0%. The geometric mean antibody titer was higher in patients age 12–15 years versus 16–25 years (1603.3 [1321.8–1944.7] U/mL vs. 949.4 [744.2–1211.0] U/mL). Compared with immunocompetent patients, immunocompromised patients had a lower antibody titer (2106.8 [1917.5–2314.7] U/mL vs. 467.9 [324.4–674.8] U/mL). Conclusions: Vaccination with BNT162b2 was acceptably safe and immunogenic for adolescents and young adults with underlying disease. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Endocrine Disruptor Chemicals and Children's Health.

We are all exposed to endocrine-disrupting chemicals (EDCs) starting from embryonic life. The fetus and child set up crucial developmental processes allowing adaptation to the environment throughout life: they are extremely sensitive to very low doses of hormones and EDCs because they are developing organisms. Considering the developmental origin of well-being and diseases, every adult organism expresses consequences of the environment in which it developed. The molecular mechanisms through which the main EDCs manifest their effects and their potential association with endocrine disorders, such as diabetes, obesity, thyroid disease and alteration of adrenal hormones, will be reviewed here. Despite 40 years having passed since the first study on EDCs, little is yet known about them; therefore, our purpose is to take stock of the situation to establish a starting point for further studies. Since there is plenty of evidence showing that exposure to EDCs may adversely impact the health of adults and children through altered endocrine function-suggesting their link to endocrinopathies-it is essential in this context to bear in mind what is already known about endocrine disruptors and to deepen our knowledge to establish rules of conduct aimed at limiting exposure to EDCs' negative effects. Considering that during the COVID-19 pandemic an increase in endocrine disruptor effects has been reported, it will also be useful to address this new phenomenon for better understanding its basis and limiting its consequences.

Getting Your Foot in the Door: Access to Surgical Care for Thyroid Disease.

INTRODUCTION: Access to specialty care can be challenging for patients, often involving multiple evaluations, laboratory tests, and referrals. To better understand the different pathways to specialty care, we examined the outcomes of patients evaluated for surgical thyroid disease at a single tertiary referral clinic. METHODS: We reviewed 691 patients seen in the endocrine surgery clinic for thyroid disease (2018-2021). Patient demographics, referral source, referral reason, and reason for not receiving an operation were collected. The number of days from referral to initial clinic visit and from initial clinic visit to an operation were also collected. The Chi-square test, the independent t-test, the Kruskal-Wallis test, the Dunn-Bonferroni post hoc test, and multiple logistic regression tests were performed using SPSS. RESULTS: The top reasons for referral were thyroid nodules (54.4%), hyperthyroidism (26.5%), and multinodular goiter (10.3%). Specialty clinic referrals came from endocrinologists (56.0%), self-referrals (15.5%), and primary care physicians (PCP; 14.4%). Self-referred patients had a shorter waiting time for an appointment than those referred by endocrinologists and PCPs. [median (IQR) (days) 12 (6-17) versus 16 (9-24) versus 16 (9-25), P < 0.001]. Overall, 450 (72.7%) patients underwent thyroid surgery. For those who underwent thyroidectomy, self-referred patients had a shorter time between initial clinic visit and the operation compared to those referred by endocrinologists and PCPs [median (IQR) (days) 2 (1-19) versus 19 (8-33) versus 16 (1-48), P < 0.001]. Patients referred for hyperthyroidism (odds ratio [OR] = 2.2, 95% confidence interval [CI] 1.3-10.5, P = 0.012 were more likely to undergo an operation than those referred for other reasons. CONCLUSIONS: Access to specialty care for thyroid disease is facilitated and optimized when self-referrals are permitted. Reducing or eliminating the requirement for a provider referral may improve patients' access.

Diamond-blackfan anemia in an adult

Case Report: A 25-year-old woman with history of Diamond-Blackfan anemia (DBA) presented with a 3- week history of weakness and fatigue. The patient was in her usual state of health until 3 weeks prior when she was diagnosed with COVID-19, at which time she experienced cough, congestion, weakness, and fatigue. She reported that the cough and congestion improved after a few days, but the fatigue and weakness progressively worsened. Admission labs were notable for a hemoglobin of 5.5 g/dL with a MCV of 119.3 fL. She received 2 units of packed RBCs with improvement in hemoglobin to 8.9 g/dL. The patient was diagnosed with DBA at birth via bone marrow biopsy and had been stable on chronic prednisone with a baseline hemoglobin around 8 g/dL. Prior to this admission, she has only required one transfusion at 3 months old. Her outpatient management involved close monitoring of her hemoglobin and increasing/decreasing prednisone based on her trending hemoglobin. She had been stable on 15 mg/day of prednisone for the past few years. Her hematologist was consulted, and the decision was made to increase her dose of prednisone to 20 mg/day resulting in resolution of symptoms and stabilization of her hemoglobin level. Discussion(s): We present a rare case of DBA with worsening anemia in the setting of a recent COVID-19 infection. The literature regarding the risk and complications of COVID-19 in these patients is severely limited, with no current data on disease management, outcomes, or predictors of morbidity. DBA is a rare, congenital erythroid red cell aplasia that typically presents in infancy with an estimated incidence of 5 cases per 1 million births. DBA is characterized by progressive macrocytic anemia, congenital malformations, and increased risk of endocrine dysfunction and malignancies. Glucocorticoids are the first-line therapy for DBA, although the exact mechanism of how they stimulate erythropoiesis in DBA remains unknown. In terms of patient prognosis, approximately 40% are steroid-dependent, 40% are transfusiondependent, and 20% go into remission by age 25 years. Copyright © 2023 Southern Society for Clinical Investigation.

Neoadjuvant endocrine therapy in postmenopausal women with HR+/HER2- breast cancer.

INTRODUCTION: While endocrine therapy is the standard-of-care adjuvant treatment for hormone receptor-positive (HR+) breast cancers, there is also extensive evidence for the role of pre-operative (or neoadjuvant) endocrine therapy (NET) in HR+ postmenopausal women. AREAS COVERED: We conducted a thorough review of the published literature, to summarize the evidence to date, including studies of how NET compares to neoadjuvant chemotherapy, which NET agents are preferable, and the optimal duration of NET. We describe the importance of on-treatment assessment of response, the different predictors available (including Ki67, PEPI score, and molecular signatures) and the research opportunities the pre-operative setting offers. We also summarize recent combination trials and discuss how the COVID-19 pandemic led to increases in NET use for safe management of cases with deferred surgery and adjuvant treatments. EXPERT OPINION: NET represents a safe and effective tool for the management of postmenopausal women with HR+/HER2- breast cancer, enabling disease downstaging and a wider range of surgical options. Aromatase inhibitors are the preferred NET, with evidence suggesting that longer regimens might yield optimal results. However, NET remains currently underutilised in many territories and institutions. Further validation of predictors for treatment response and benefit is needed to help standardise and fully exploit the potential of NET in the clinic.

Our Experience Establishing Food Insecurity Screening in the Pediatric Endocrinology Clinic During the Beginning of the COVID-19 Pandemic

Objectives In 2019, food insecurity was estimated to affect approximately one fifth of the Pittsburgh population. Food insecurity may be linked to other barriers affecting the care of children with chronic health conditions including endocrinopathies. We established a systematic, sustainable method of screening to determine the prevalence of food insecurity in our practice. Methods For 12 months, beginning in May 2020, a written version of the validated questionnaire, The Hunger Vital SignTM (Hager et al), was administered during the patient triage process. The results were documented in the EMR. Patients and families with positive screens met with a social worker and received information about local resources. Screening rates and the frequency of positive screens for food insecurity were reviewed weekly. Results The screening rate was 26% in the first month after implementation;screening increased to 80% by the third month of the project, as the clinic visits transitioned from telemedicine to face-toface (Figure 1). The prevalence of food insecurity in our patient population in this year was 3.5%, which was lower than the reported prevalence in the city of 19.4% in 2018 (Feeding America, 2018) and the projected prevalence for the city, 15.4%, for 2020. Forty-one percent of the patients with food insecurity were attending diabetes clinic and 59% were attending endocrinology clinic. Sixteen percent of the families with food insecurity also reported issues with paying rent/utilities and 14% identified transportation as a barrier to attending medical appointments. Thirteen percent identified negative financial repercussions of COVID-19 such as job loss or reduction of work hours. Approximately 8% identified the patient's medical diagnosis and related dietary requirements as factors contributing to food insecurity. Conclusions Ascertaining food insecurity in our clinic provided a valuable tool to identify and address socioeconomic determinants influencing health. Families appreciated the printed materials and verbal education regarding available local resources. This screening method was sustainable, has been incorporated into EMR, and will continue to support our patients' families. Future studies will increase understanding how food insecurity impacts management of chronic pediatric endocrine conditions.

Feasibility and acceptability of virtual career development workshop for pediatric endocrine trainees: A PedsENDO365 initiative

Objectives The identification of goals and development of skills that align with an individual's values provides a professional pathway for success and aids in preventing burnout. This process has been threatened by the COVID 19 pandemic, thus, we created a virtual professional development program for pediatric endocrine fellows training in the United States. Methods PedsENDO 365 is a Pediatric Endocrine Society initiative launched to address year-round learning needs of pediatric endocrine fellows. The workgroup engaged with fellowship program directors across the US as key stakeholders. Lack of resources and expertise, partly due to small program size, were noted as major barriers. Fellow participants completed a pre-workshop inventory to elucidate their personal values, skills and career interests, and to create short and long term learning and career goals. A two-hour session included a presentation about career trajectories, description of individual learning planning process and I-SMART (Important - Specific, Measurable, Actionable, Realistic, Time-limited) goal setting. Learners participated in small group discussions facilitated by program directors about the assessment and alignment of skills, interests, and values when developing goals. Results 39 fellows (1st to 4th year) participated in the workshop. 24 attendees (83% women, 13% men and 4% non-binary, 1st year=17%, 2nd year=54%, 3rd year=25%, 4th year=4%) completed an evaluation of the program. 96% fellows found the session relevant and would recommend it to other fellows. The three major takeaways were the importance of aligning values and skills with career goals, setting I-SMART goals, and the importance of time management and work-life balance. The fellows enjoyed the flexibility afforded by the remote session for connecting with participants and leaders across the country. Conclusions A virtual professional development for pediatric endocrine trainees is feasible and well received by participants. Professional societies can provide virtual career development programs to allow networking opportunities with individuals outside their institutions.

Viruses and Endocrine Diseases.

Viral infections have been frequently associated with physiological and pathological changes in the endocrine system for many years. The numerous early and late endocrine complications reported during the current pandemic of coronavirus disease 2019 (COVID-19) reinforce the relevance of improving our understanding of the impact of viral infections on the endocrine system. Several viruses have been shown to infect endocrine cells and induce endocrine system disturbances through the direct damage of these cells or through indirect mechanisms, especially the activation of the host antiviral immune response, which may lead to the development of local or systemic inflammation or organ-specific autoimmunity. In addition, endocrine disorders may also affect susceptibility to viral infections since endocrine hormones have immunoregulatory functions. This review provides a brief overview of the impact of viral infections on the human endocrine system in order to provide new avenues for the control of endocrine diseases.

Transition to online teaching and learning for clerkship activities during COVID-19 in Malaysia

Prior-to the COVID-19 outbreak, undergraduate PharmCare II Clerkship activities consisted of two phases. The first phase requires pharmacy students to clerk infectious disease and endocrine-related cases of patients admitted into wards at a teaching hospital, whilst in the second phase, the students are required to present the clerked cases in front of their group members with a thorough assessment by lecturers at Universiti Sains Malaysia. Due to sudden outbreak of COVID-19, presentations at hospitals and face-to-face learning were no longer feasible;therefore an online methodology was executed. Each student was assigned a real completed case clerked by a previous Master's in Clinical Pharmacy graduate. The students then critically evaluated any pharmaceutical care issues (PCIs) in each of the cases, recorded a video presentation for assessment by the lecturers and discussed each case with other group members in a synchronous online session via web-conferencing software. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Precocious puberty and other pubertal disorders in females during the Italian lockdown and the coronavirus 2019 (COVID-19) pandemic

Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.

Incidence and severity of Coronavirus Disease 2019 (COVID-19) in children with primary and secondary adrenal insufficiency during the pandemic in Italy

Background: Adrenal insufficiency (AI) is a rare condition caused by an inadequate production of glucocorticoids. Preliminary data in adults suggest that AI could be associated with an increased susceptibility to infections;moreover, AI patients are at risk to develop a severe course of infectious diseases and to experience a life-threatening adrenal crisis. The aim of our study is to evaluate the severity and the outcome of COVID-19 in pediatric AI patients in comparison to subjects affected with other endocrinopathies not involving adrenal gland. Patients and Methods: This was a retrospective, multicenter study involving 11 Italian tertiary-centers of pediatric endocrinology. Data regarding symptoms, severity and duration of the disease, the need to increase the dose or receive parenteral administration of hydrocortisone and the outcome were collected through a telephone interview and review of patient's medical files. From March 2020 to October 2021, 80 children with a history of COVID-19 were collected: 49 subjects affected by AI (42 primary AI, 7 central AI) and 31 subjects as controls. Result(s): Mean age was comparable between patients and controls (11.4+/-4.4 years vs 10+/-3.5 years, respectively). The frequency of signs/symptoms during COVID-19 in AI patients was as follows: fever 68%, rhinorrhea 34%, headache 34%, sore-throat 30%, cough 28%, anosmia/ageusia 21%. Less common symptoms were characterized by arthralgia, abdominal pain, diarrhea and vomiting. The severity of infection was comparable between patients and controls: paucisymptomatic 40.8% vs 25.8%;mild 55.1% vs 61.3%;severe 4.1% vs 12.9%, respectively (Chi-square=0.19). Time between the first positive nasopharyngeal swab and the first negative one in patients vs controls was: <=15 days, 39% vs 56.6%;>15 days, 61% vs 43.3%, showing a tendency to longer infection in AI children, although this difference did not reach statistical significance (Chi-square=0.14). In 64% of AI patients the dose of hydrocortisone was increased during the infection and in 6.4% parenteral hydrocortisone was needed. 94% of AI subjects did not require hospitalization while only 6% were hospitalized with a complete recovery in 100% of cases. Within the entire cohort of AI subjects, 2 children (4%) experienced an adrenal crisis during infection. No fatal events occurred. Conclusion(s): Our data, suggest that children with AI adequately treated are not at increased risk of severe course of COVID-19. In comparison to controls, subjects with AI have a slightly longer duration of the disease, although this data need to be confirmed on larger sample of patients.

Project to improve paediatric post-neurosurgical fluid management and to reduce the risks associated with Diabetes Insipidus (DI), Syndrome of Inappropriate ADH (SIADH) and Cerebral Salt Wasting (CSW)

Background. Complex fluid balance problems are well established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output as patients shift between DI and SIADH. Prevalence of CSW is controversial;but ensuring sodium homeostasis is central to safe fluid management. To improve clinical care for these complex patients an audit of existing institutional guidelines was undertaken. New guidelines were developed with structured educational packages for specialist teams involved, and subsequent assessment of their impact. Method(s): Two periods were audited using set standards (table-1), before and after the quality improvements. All data was collected from the CQUIN neurosurgical database and electronic medical records;included were all paediatric patients having neurosurgical operations for posterior fossa (PFT) and supratentorial tumours (STT), plus TBI. A literature review of evidence-based practice, initial audit data and stakeholder feedback was used to develop new clinical guidelines and nursing standard operating procedures. Principles were of strict monitoring and adaptive fluid management strategies, implemented for all with active step down. Structured educational packages were designed for specialty medical and nursing teams involved to improve knowledge, consistency of approach and team working. Result(s): Audit-1 January2017-June2018, n=80;Audit-2 January2020-June2021, n=30 (reduced neurosurgical operation numbers due to COVID-19 pandemic). All patients were managed within a high dependency setting;26-33% initially in paediatric intensive care. Step-down was to a neurosurgical/neurorehabilitation ward. Results comparison (table-1) demonstrated clinical, fluid balance and biochemical monitoring improvement. The number of clear fluid management plans documented post-operatively increased, leading to early recognition and management of evolving fluid-balance abnormalities. However, the recommended adaptive fluid management strategy was not always used. The endocrine team were involved earlier and in all complex cases. Significant Na fluctuations (>12mmol in 24 hours) remained similar (5vs6patients). These represented complex pituitary-hypothalamic pathology, plus one TBI. Feedback from patients and professional teams was of increased awareness, improved consistency of approach and communication. Conclusion(s): * Clinical guidelines revised using audited data, evidence-based literature review and stakeholder consultation have been adopted with effective change. * Patient safety improved through effective post-neurosurgical fluid management and multi-professional team working. * Regular feedback and continued education will identify areas for further improvement.

Precocious puberty before and after the COVID-19 pandemic

Introduction: A novel coronavirus defined as coronavirus disease 2019 (COVID-19) was first detected in China at the end of 2019 and spread rapidly all over the world. As the covid 19 pandemic has led to changes in life all over the world, the prognosis of diseases have also been affected. This study presents how early puberty has been affected during the pandemic period. Method(s): A total of 210 subjects;113 individuals ( 94 girls;3 boys) after the covid19 (2020-2021) and 97 individuals (104 girls;9 boys) before covid19 (2018-2019) evaluated with suspicion of precocious puberty at the Pediatric Endocrinology department of Erciyes university. Age, sex, the time of pubertal signs, initial admission findings, exposure to endocrine disruptors, bone age, anthropometric measurements and tanner stages at the first examination, MRI results, peak FSH, peak LH and basal E2 levels, the time between bone age and chronological age, uterine long axis and ovarian measurements were collected from clinical records. Result(s): Before covid19, the median age of 97 patients was 7,58 (3.6-9.8) years while after covid19, the median age of 113 patients was 8,04 (5,1-10,6) years. The increase was observed in patients with precocious puberty during covid19 period. The mean of bone ages before covid19 were 8.5 years (+1.81) while after covid19 was 9.4 years (+1.51). The time between bone age and chronological age;pre-pandemic mean was 1.1 (+1.14);post-pandemic was 1.4 (+1.24). The body mass index (BMI) SD value was:0.81 (+1.1) at the first admission before the pandemic, it was 1.14 (+1.08) after the pandemic. Before and after the pandemic statistically bone ages (p<0.01), BMI (p:0.032) SD value, patient ages (p<0.01), FSH peaks (p:0.034) were evaluated and the results were significant. Girls presented with precocious puberty more frequently in both periods before and after the pandemic. The most common complaint was thelarche in both periods. Endocrine disruptor exposure was found to be increased in the post-pandemic group and it was statistically significant. Conclusion(s): The Covid 19 epidemic was effective in precocious puberty cases as well as in many diseases. During this period, a significant increase was observed in endocrine disrupting exposure and the increase in bone age and BMI SD value of the patients were notable.

Challenges in the era of COVID-19: Starting from the clinical examination

Introduction: Physical examination remains the cornerstone of medical practice. However, its importance has been underestimated during COVID-19 pandemic because of concerns related to exposure risk and use of personal protective equipment. Solitary median maxillary central incisor (SMMCI) may be an isolated clinical trait or associated with other anomalies and endocrine pathologies including hypopituitarism, hypothyroidism, isolated growth hormone (GH) deficiency, precocious or delayed puberty, short stature without GH abnormalities. Aim(s): The aim of this case presentation is to underline the significance of clinical examination, as in SMMCI, an important clinical finding that may lead to an early diagnosis of hidden endocrine abnormalities. Material(s) and Method(s): A 78/12-year-old girl was hospitalised because of an episode of acute headache with walking instability. Her past medical history was uneventful except for premature adrenarche since the age of 56/12 years. A paediatric endocrinologist had estimated her 2 years before, at the onset of the COVID-19 pandemic and ordered hormone assays and a Synachten test. Because of her past medical history and the positive family history for type 2 diabetes, she underwent a detailed hormone laboratory evaluation including oral glucose tolerance test (OGTT) and LHRH test. Furthermore, because of the borderline response in 17-hydroxyprogesterone following ACTH stimulation, CYP21A2 gene analysis was performed. Result(s): Her clinical examination revealed excessive body mass index (18.9 kg/m2, 90th percentile) and B I and PH II-III Tanner stage with axillary hair and odor. OGTT revealed insulin resistance (HOMA-IR 3.38). Based on the increased LH response in GnRH test (LH at 30 min 3.8 IU/L) in association to the increased ovarian volume (3.25 and 5.3 ml with 6 and 9 follicles respectively), she was diagnosed with central precocious puberty (CPP). At the time of final clinical and laboratory overview by the Chief of the Unit, the girl was asked to put off her mask, unraveling a SMMCI, a finding not having been identified and correctly evaluated until then. Consequently, a pituitary gland magnetic resonance imaging (MRI) was mandatory, revealing ectopic posterior pituitary at the pituitary stalk with hypoplasia of anterior pituitary, possibly implicated in the CPP aetiology. The patient was prescribed triptorelin and is on regular endocrine follow-up. Conclusion(s): SMMCI, so easily diagnosed, may be the cardinal clinical feature guiding further physical, endocrine laboratory and imaging investigation and leading to early diagnosis of endocrine pathology. Clinical examination remains the key of paediatric endocrine evaluation, overcoming any potential risk in the era of COVID-19.

The impact of the COVID-19 pandemic, lockdown and school closure on weight and body mass index in low-income children and adolescents with previous overweight in Southern Brazil

Lockdown and school closure related to COVID-19 pandemic increased sedentary time and greater consumption of ultra-processed foods, an environment that may exacerbate the childhood obesity epidemic. In Brazil, public schools remained closed for more than 40 weeks. In Brazil, prior to the current pandemic, 15.9% of children under 5 yr.-old, 29.3% of those between 5 and 9 yr.-old and 30.8% of adolescents were overweight. Aim(s): To verify the impact of school closure on the weight, body mass index (BMI), changing lifestyle habits and increasing the prevalence of obesity in children and adolescents at the pediatric obesity clinic of a public tertiary hospital in Southern Brazil. Method(s): Cross-sectional observational study of overweight/ obese patients aged 6 to 15 years who attended a medical appointment from November 2019 to May 2021. Patients with an organic or endocrine cause of obesity, monogenic obesity and genetic syndromes were excluded. The study protocol was approved by the Ethics Committee. Data of the last pre-pandemic visit were extracted from the clinical records and anthropometric measurements were assessed in the first visit during the pandemic. A survey was aimed to assess whether nutritional and consumer habits have been affected under quarantine conditions. Result(s): 50 patients (31 girls) aged 11.6+/-2.4 yr.-old were included. All of them were from low-income families and had not been returned to school. The interval between visits was 382.7+/-76.6 days. Over 58% reported snacking more, greater consumption of ultra-processed foods and increased sedentary time. Forty-five patients (88%) experienced weight gain [9 kg (-3.6 to 25.5)] and there was a gain of 19.6% compared to pre-pandemic weight. The median BMI and its z-score variation between visits were +1.9 kg/ m2 (-2.9 to +7.7) and +0.07 (-0.93 to +1.47), respectively. The change in adjusted BMI to the median for sex and age was +1.65 kg/m2 (-3.60 to +6.90). There was an increase in the prevalence of obesity of 12% in this group. Conclusion(s): Defining the longitudinal change in BMI in the pediatric age group is a challenge. This study showed an unhealthy weight gain in a group of previously overweight pediatric patients, increased sedentary time and some difficulties faced by children during quarantine in Brazil. The study highlights that lockdown imposed by SARS-CoV-2 affected eating behaviors, dietary and sedentary habits, and advocates for organized nutritional support during future epidemic-related quarantines, particularly for the most vulnerable groups, including children with overweight or obesity.

COVID-19 and increased prevalence of female precocious puberty in Germany

Background: Several studies observed a positive secular trend for the occurrence of earlier puberty. Genetic background, weight gain, and environmental factors are assumed as contributors. In March 2020, WHO declared a worldwide pandemic of COVID-19. To reduce transmission, Germany and many other countries imposed regulations of social distancing and lockdowns leading to significant changes in daily life for children followed by an increase in obesity but also in the incidence of psychological disturbances. As reported from Italy, we noticed an unusual high number of girls diagnosed with central precocious puberty (CPP). Aims of the Study: Retrospective single center evaluation of newly diagnosed CPP incidence during the pandemic (group A), comparing data with previous five years (2015-2019;group B). In addition, a German-wide survey of all pediatric-endocrinological centers on the frequency of CPP was conducted. Patients and Methods: Auxological, clinical, endocrinological and radiological data from patients who presented with CPP 2015-2021. Result(s): Number of patients with CPP remained stable (n<10/ year) for 2015-2019. In 2020 numbers more than doubled (n=23) with a further increase (n=30) in 2021[WJ3]. This was confirmed by the survey: 28/43 (65%) reported an increase, confirmed by those who could quantify their patient number (2019: n=608;2020: n=845;2021: n=1140). Differences were observed between the two groups. Although mean BMI-SDS was not different between the two groups at time of diagnosis, it was already in the upper normal range in group B at the age of five years (0.74;SD 0.9) with no significant change thereafter (0.87;SD 0.8) whereas a significant increase was observed in group A (BMI-SDS at 5yrs: 0.002 (SD 1.1);at diagnosis: 0.55;SD 1.1;p=0.04). Patients diagnosed during the pandemic were significantly younger than those diagnosed previously (6.86 yrs SD 1.9 vs 7.6 SD 1.3;p<0.05). Tanner stages at diagnosis in girls out of group B were significantly more advanced than those diagnosed during the pandemic. No significant differences were found for endocrine or sonographic parameters. In both groups mean time of menarche of mothers was comparably early (11.7 yrs SD 1.4 vs 11.9 yrs SD 1.4). Conclusion(s): Our data confirms Italian data showing an increased incidence of newly diagnosed CPP during and after lockdown compared to previous years. The known positive secular trend for thelarche might be aggravated by psychosocial and environmental factors e.g. disproportional weight gain. Additionally greater awareness of the family for physical changes of their children could be assumed.

Managing pediatric diabetes and other endocrine disorders in the midst of the COVID-19 pandemic presents a number of difficult challenges

Background: It determined the frequency, dimensions, treatment, and results of the COVID-19 pandemic in children who had endocrine problems and diabetes. Method(s): A worldwide network of endocrine societies was sent an internet survey in the form of a cross-sectional questionnaire. The professional and practice characteristics of respondents, the size of their clinics, the nation in which they practiced medicine, and the influence that COVID-19 had on endocrine illnesses were explored. Result(s): The study was completed by respondents from 134 pediatric endocrine institutions located in 51 different countries and across all seven continents. The majority of pediatric endocrinology clinics have made adjustments to their standard checkups as well as their educational programming. More than twenty percent of clinics reported experiencing a lack of availability of crucial supplies or drugs. Patients diagnosed with diabetes and COVID-19 needed therapy in an intensive care unit. It has been clearly stated that pediatric patients with endocrine abnormalities have alterations in their biopsychosocial functioning as well as their behaviors. Conclusion(s): This extensive worldwide study was carried out during the COVID-19 pandemic, and its findings underscore the fact that diabetes is more difficult to control than any other juvenile endocrine illness, and it also carries a higher risk of morbidity. It is necessary to acknowledge and treat the psychological anguish that has been caused by COVID-19. Every patient ought to have easy access to medical supplies, and it is essential that they maintain frequent interaction with the medical staff who are responsible for their treatment. Copyright © 2023 Ubiquity Press. All rights reserved.

Esicon 2022

The proceedings contain 193 papers. The topics discussed include: prevalence of auto-antibodies in children and adolescents with type 1 diabetes, and their association with the clinical parameters;steroid induced recurrent central serous chorioretinopathy in thyroid orbitopathy;androgen insensitivity in Klinefelter Syndrome: a rare cause of genital ambiguity;picking up Digeorge Syndrome in hypoparathyroidism: a hit-and-miss 'thumbing' diagnosis;lithium in graves' disease: role for endocrine-nuclear synergy?;changes in long term glycemic CONTROL post covid infection -an observational study;trichotomous presentation of a rare NROB 1 mutation in a single family;a cross sectional study on the metabolic and hormonal profile of patients on lithium;reproductive manifestation of coeliac disease in males;low bone mineral density, hypovitaminosis D, hypophosphatemia, increased fractional excretion of phosphorous and sarcopenia in persons living with human immunodeficiency virus (Plhiv) taking tenofovir based anti-retro viral therapyin a tertiary care center in south India;and melorheosteosis-fluorosis conundrum in a patient of hypoparathyroidism.