Update on pediatric hyperlipidemia.

PURPOSE OF REVIEW: The purpose of this study is to review the National Heart Lung and Blood Institute (NHBLI) guidelines on screening and management of hyperlipidemia in children and to discuss the critics concerns regarding universal screening. RECENT FINDINGS: Data derived from the National Health and Nutrition Examination Survey has shown favorable trends in serum lipid levels among children and adolescents aged 6-19 years between 1988-1994 and 2007-2010. Mean total cholesterol (TC) decreased from 165 to 160 mg/dl, and the prevalence of elevated TC decreased from 11.3 to 8.1%. However, between 2007 and 2010, approximately 20% of children aged 9-11 years had either low high-density lipoprotein cholesterol (HDL-C) or high non-HDL-C This warrants additional evaluation as per the NHBLI guidelines. SUMMARY: The NHBLI guidelines present physicians with a balanced perspective for screening and managing hyperlipidemia in children. These guidelines provide a schematic approach that helps primary care physicians to make treatment decisions. The hope is that this will lead to decreased healthcare system expense and overall improved health through early identification and intervention.

Disorders of childhood growth and development: precocious puberty.

Precocious puberty is defined as pubertal development that begins at an earlier age than expected; most US pediatric endocrinology subspecialists use cutoff ages of 8 years for girls and 9 years for boys. Early activation and maturation of the hypothalamic-pituitary-gonadal axis leads to hormonal changes, physical signs of puberty, and acceleration of linear growth. Factors affecting puberty include race/ethnicity, obesity, and endocrine disruptors. The 2 forms of precocious puberty are central (gonadotropin-dependent precocious puberty) and peripheral (gonadotropin-independent precocious puberty). Most cases of the former have no identifiable etiology, whereas the latter is caused by increased secretion of sex hormones by the gonads or adrenal glands. It is important to differentiate progressive from nonprogressive precocious puberty to avoid unnecessary treatment for the latter; if diagnosis is uncertain, the child should be reassessed within several months. Evaluation begins with a detailed history and physical examination followed by an x-ray for bone age; in precocious puberty, bone age is greater than chronologic age. If indicated, additional serum testing (basal luteinizing hormone) and imaging studies should be obtained. Patients should be referred to a pediatric endocrinology subspecialist for treatment. It is essential to manage underlying etiologies. Gonadotropin-releasing hormone agonists should be considered only for children with progressive central precocious puberty to prevent short stature. For children with apparent nonprogressive precocious puberty, follow-up every 3 to 6 months between ages 6 and 7 years is recommended to assess for progression.