Friday’s In-Depth Symposium on transitioning pediatric endocrine patients to adult care will help adult endocrinologists to best appreciate the management of disease in adolescents and allow for optimization of care and a smooth transition process, according to session organizers.
“The Transition Process: Key to Continued Best Endocrine Care” begins at 9:15 am Friday in Room 16B and will be led by co-chairs Robert Rapaport, MD, and Jay Cohen, MD, FACE.
“We know that adolescents and young adults are changing in many ways; not just in terms of their hormone levels, but they are changing psychologically, educationally, etc. By smoothing the transition of their medical care for endocrine dysfunction, we hope to improve outcomes and decrease gaps that can occur,” said Dr. Cohen, Medical Director of The Endocrine Clinic in Memphis, Tenn, and Clinical Assistant Professor at the University of Tennessee.
Speakers will address type 2 diabetes, issues related to being born small for gestational age, transgender patients and the late effects of pediatric cancers.
Stuart Brink, MD, a Massachusetts pediatric endocrinologist, will talk about managing adolescents with type 2 diabetes, a problem that didn’t exist 15 to 20 years ago.
“Now with the obesity epidemic and lack of exercise and food behavior issues, the pediatric endocrinologist and pediatrician are seeing an avalanche of type 2 diabetes. These young people have a very high risk of diabetic complications. They have an accelerated risk of eye, nerve, and kidney damage and a higher risk of heart attack and stroke than one would think based on age,” said Dr. Cohen.
That knowledge is critical for the adult endocrinologist, he noted, adding that it’s not only the patient the clinician is managing but the whole family as well. Families must be educated on food changes, exercise changes and other overall health adjustments. As patients transition to adult endocrinologists, they come with not only health problems, but vast differences from patients in their 30s, 40s and 50s in terms of maturity and socioeconomic position.
“They don’t often have the financial resources. They may or may not have certain types of insurance issues. They are still maturing as human beings. Both the pediatric and adult endocrinologist must be aware that psychosocial and socioeconomic environment is critical to the success of the medical part of the health of the patient,” said Dr. Cohen.
Next, Dr. Rapaport, Professor of Pediatrics and the Chief of the Division of Pediatric Endocrinology and Diabetes at the Icahn School of Medicine at Mount Sinai, will address how being born small for gestational age has metabolic consequences into adulthood, including increased risk of polycystic ovary syndrome (PCOS) and increased risk of developing insulin resistance, type 2 diabetes and obesity.
“We see PCOS starting as young as age 8. These are symptoms of insulin resistance that way precede adulthood and affect fertility as well. Having this knowledge exposure allows clinicians to see the patient in a different way. It is refreshing as well as illuminating,” said Dr. Cohen.
Also on the agenda for the symposium is a presentation by Ximena Lopez, MD,
Assistant Professor of Pediatrics in the Pediatric Endocrinology Division of
UT Southwestern Medical Center, who will discuss issues surrounding care of transgender adolescents.
“Transgender is an evolving area in our society. Staying abreast of what’s new and realizing there are a number of different philosophies, and learning from each other is important as much as making sure the family and the patient is involved with counseling and other resources. Dr. Lopez will do a superb presentation,” said Dr. Cohen.
Wrapping up the symposium will be a look at late effects of cancer in pediatric patients presented by Charles Sklar, MD, Director, Long-Term Follow-Up Program at Memorial Sloan-Kettering Cancer Center, who is one of the world’s experts in this area.
“Up 75 to 80 percent of pediatric and adolescent patients who undergo treatment for a cancer end up having endocrine late effects of the tumor or the therapy of tumor,” said Dr. Cohen. “There are multiple examples of chemotherapy or radiation therapy or surgery therapy that have unintended consequence of endocrine malfunction.”
It is critical for the adult endocrinologist to understand how and why this happens so as the adolescent patient transitions to adulthood, the adult endocrinologist will be well prepared to treat their patients’ future medical challenges, noted Dr. Cohen.
“My hope is that this symposium encourages a thirst for knowledge to continue to learn more about these transition issues; that this will be just a taste that stimulates more knowledge and ultimately better patient care,” he said.