LRT was not infrequent in ill newborns. Most were premature and half were not very low birth weight. We recommend monitoring of thyroid function by serum specimen in ill newborns with prolonged ICU care regardless of birth weight.

Currently recommended screening of obese youth by FPG is normal in 91.5%, but lacks further information to detect increased risk for youth-onset T2D. Evaluation of obese youth by LCA identified one third (class 3) in whom the combination of higher levels of BMIz, HOMA-IR, and family history suggests the greatest risk for T2D and targets them for further evaluation and intensive preventative management.

A 12-yr-old boy initially presented with chronic urticaria. Autoimmune thyroid disease was then diagnosed during routine evaluation. He developed type 1 diabetes shortly after thyroid hormone replacement was initiated. This case emphasizes the importance of routine screening for other autoimmune disorders in patients in whom one disorder is already present.

No abstract

Cushing syndrome (CS) is a state of glucocorticoid excess in which there is loss of the normal hypothalamic-pituitary-adrenal feedback axis. First described in 1912 by American neurosurgeon Dr Harvey Williams Cushing in reference to a 23-yearold patient with obesity, hirsutism, and amenorrhea, CS has since been recognized as a rare, yet serious and significant, condition in the pediatric population. Under normal circumstances, hypothalamic corticotropin-releasing hormone (CRH) is delivered to the anterior pituitary via the portal circulation, resulting in adrenocorticotropin hormone (ACTH) release from the anterior pituitary into the systemic circulation. ACTH acts on the zona fasciculata of the adrenal cortex to stimulate release of cortisol. The secretion of cortisol results in negative feedback, downregulating production of both ACTH and CRH. Cortisol has metabolic and cardiovascular effects. It plays an important role in hepatic glucose metabolism by increasing gluconeogenesis and glycogenolysis, as well as affecting proteolysis and lipolysis. In addition, it influences myocardial contractility, cardiac output, and blood pressure. It also has a variety of effects on the immunologic and inflammatory systems, musculoskeletal and connective tissue, and fluid and electrolyte homeostasis, as well as neuropsychiatric, behavioral, gastrointestinal, and developmental effects. In the general population, there are approximately 2 to 5 new cases per million per year of CS; only approximately 10% of these cases occur in the pediatric population. Although adolescents with CS, similar to adults, have a slight female to male predominance, this predilection goes away in younger patients and may even be reversed in infants with CS. Pediatric CS can be divided into 2 distinct categories: ACTH dependent and ACTH independent (Table 1). The most common cause of CS is exogenous administration of corticosteroids, which have become the first-line treatment of multiple pediatric disorders. Although oral corticosteroids are generally implicated in the development of CS, long-term use of inhaled and topical corticosteroids, commonly used as treatment for asthma and atopic dermatitis, respectively, can also result in CS. In addition, ACTH, used as treatment in certain seizure disorders, can stimulate adrenal cortisol release, resulting in CS. When exogenous causes of CS have been ruled out based on a careful history, endogenous causes should be sought. In children older than 5 years, Cushing disease (hypercortisolism resulting from oversecretion of pituitary ACTH from a corticotroph adenoma) is the most common cause of CS. In contrast, infants are most likely to have a primary adrenal condition, such as an adrenocortical tumor (adenoma or carcinoma). Although adrenocortical tumors are fairly rare in the pediatric age group, comprising only approximately 0.6% of childhood tumors, upward of one-third manifest with signs and symptoms of CS. Nearly all are unilateral (90% to 98%) and more than 70% are malignant. Most unilateral adrenal tumo...