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Commonly Referred Pediatric Conditions

Diagnoses Listed Disorder • Diabetes Mellitus without mention of complication, • Congenital Hypothyroidism (Neonate) Type I • Thyroid Cancer/Nodule • Diabetes Mellitus without mention of complication, • Acquired Hyperthyroidism/Autoimmune Type II Hyperthyroidism (Graves Disease) & Growth • Congenital Hypothyroidism (Child)/Acquired • Short Stature/Tall Stature Hypothyroidism/Autoimmune Hypothyroidism • Small for Gestational Age/Intrauterine Growth (Hashimoto Thyroiditis) Retardation • Thyroid Enlargement/Goiter • Failure to Thrive • Abnormal Thyroid Function Test • Hirsutism Additional Disorders • Irregular Menses • Adrenal Insufficiency • Klinefelter Syndrome • Congenital Adrenal Hyperplasia • Noonan Syndrome • Craniopharyngioma/ Tumor • Precocious Puberty/Premature Thelarche – Girls • • Precocious Puberty – Boys • Fractures • Premature Pubarche/Adrenarche – Girls • Glucocorticoid Excess (Cushing Syndrome) • Premature Pubarche/Adrenarche – Boys • Hypo/Hypercalcaemia • Delayed Puberty • Hypo/Hyperparathyroidism • Female Hypogonadism • Hyperprolactinemia/Prolactinoma • Male Hypogonadism • Hypertension/Pheochromocytoma • Primary/Secondary Amenorrhea • • Turner Syndrome • Hypo/Hypernatraemia • Micropenis • Osteoporosis and Metabolic Bone Disease • Ambiguous Genitalia • Pituitary Disorders • and • Rickets

Commonly Referred Pediatric Endocrinology Conditions

Suggested Pre-Referral Workup This is a general suggestion of possible testing to confirm a suspected diagnosis. Although referrals will be accepted without the suggested work up being complete, to ensure referrals are processed timely we do require that items listed in the Referral Documentation section be submitted with the initial referral. In addition to the suggested Pre-Referral Workup in the tables below, it is recommended that the following information is also provided:

• Name, Office Address and Phone Number • Clinic Name or Physician Name for the referral • Patient Name, Date of Birth and Parent or Guardian's Name • Insurance Information for Patient • Reason for Referral* • Authorization (when required)

DIABETES DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED ICD-10 CODE: E10.65 DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED ICD-10 CODE: E11.65 When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Hyperglycemia  Blood glucose with chemistry panel  Initial and most recent clinic notes relevant to referring diagnosis  Elevated Hemoglobin A1c  Urinalysis for glucose and ketones  Lab test results including most recent  Increased thirst & urination  Hemoglobin A1c relevant ones and initial test leading to  Weight loss  2-hour oral glucose tolerance test referring diagnosis  Vomiting (DKA)  Growth chart, including parental heights  Lethargy (DKA) If completed:  Abnormal respirations (DKA)  Any additional test leading to referring IF URGENT: Call (323) 660-2450 and ask for the diagnosis Endocrinology doctor on call to be paged.

Commonly Referred Pediatric Endocrinology Conditions

PUBERTY & GROWTH Short Stature, Small for Gestational Age/Intrauterine Growth Retardation (ICD-10: R62.52) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Poor growth  Free T4, TSH  Initial and most recent clinic notes relevant to referring diagnosis  Severe headaches and/or blurry vision  IGF-I, IGFBP-3  Lab test results including most recent  Current height less than 3rd percentile for age  Complete blood count relevant ones and initial test leading  Crossing percentiles on repeated growth  Sedimentation rate (ESR) to referring diagnosis measurements  Comprehensive chemistry panel  Growth chart, including parental  Current height greater than 3rd percentile, but heights  still concerned for growth Celiac screen (IgA, Tissue Transglutaminase IgA) If completed: IF URGENT: Call (323) 660-2450 and ask for the  Bone age results (bring CD/films to Endocrinology doctor on call to be paged. appointment)  Brain MRI or CT results (bring CD/films to appointment) Tall Stature (ICD-10: E34.4) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Current height greater than 97th percentile  Free T4, TSH  Initial and most recent clinic notes relevant to referring diagnosis  Crossing percentiles on repeated height  GH, IGF-I, IGFBP-3 measurements  Lab test results including most recent  High-resolution karyotype (males) relevant ones and initial test leading  Current height less than 97th percentile, but still  to referring diagnosis concerned for growth Early AM pediatric LH/FSH   Growth chart, including parental  Estradiol/Testosterone Severe headaches and/or blurry vision heights  Bone age If completed: IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.  Bone age results (bring CD/films to appointment)  Brain MRI or CT results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions Failure-to-Thrive (ICD-10: R62.51) When to Refer Suggested Pre-Referral Workup Referral Documentation Requirements  Hypoglycemia and short stature  Free T4, TSH  Initial and most recent clinic notes relevant to referring diagnosis  Current height/length AND weight less than 3rd  IGF-I, IGFBP-3 percentile  Lab test results including most recent  Complete blood count relevant ones and initial test leading  Consider referral to if current  to referring diagnosis height/length at 3rd percentile or greater, but Comprehensive chemistry panel rd weight less than 3 percentile  Sedimentation rate (ESR)  Growth chart, including parental heights  Celiac screen (IgA, Tissue Transglutaminase IgA) IF URGENT: Call (323) 660-2450 and ask for the If completed: Endocrinology doctor on call to be paged.  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions

Hirsutism (ICD-10: L68.0/ Q84.2) Irregular Menses (ICD-10: N92.7) When to Refer Suggested Pre-Referral Workup Referral Documentation Requirements  Hirsutism  Total testosterone  Initial and most recent clinic notes relevant to referring diagnosis  Cushingoid features (weight gain, central fat  Free Testosterone distribution, thin skin, easy bruising, purple  Lab test results including most recent striae, buffalo hump)  Sex- binding globulin (SHBG) relevant ones and initial test leading  to referring diagnosis  Masculinization (clitoromegaly, deepening voice) LH, FSH  Prolactin  Growth chart, including parental  Irregular menses heights  Fasting glucose  Elevated testosterone level If completed:  Fasting lipids IF URGENT: Call (323) 660-2450 and ask for the  Pelvic/abdominal imagining (bring Endocrinology doctor on call to be paged. CD/films to appointment) Precocious Puberty/Premature Thelarche – Girls ( ICD-10: E30.1) When to Refer Suggested Pre-Referral Workup Referral Documentation Requirements Girls < 8 years old  Early AM pediatric LH/FSH  Initial and most recent clinic notes with physical examination and  Breast development  Estradiol Tanner stage  Accelerated linear growth velocity  Free T4, TSH  Lab test results including most recent  Vaginal bleeding  Bone age relevant ones and initial test leading to referring diagnosis  Headaches and/or visual changes  Growth chart, including parental  Multiple café-au-lait spots >1.5 cm (possible heights McCune-Albright Syndrome) If completed: IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions

Precocious Puberty – Boys (ICD-10: E30.1) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements Boys < 9 years old  Early AM pediatric LH/FSH  Initial and most recent clinic notes with physical examination and  Testicular enlargement (>4 mL in volume or >2.5  Testosterone Tanner stage cm in length)  Free T4, TSH  Lab test results including most recent  Penile enlargement  Bone age relevant and initial test leading to IF URGENT: Call (323) 660-2450 and ask for the referring diagnosis Endocrinology doctor on call to be paged.  Growth chart, including parental heights If completed:  Bone age results (bring CD/films to appointment) Premature Pubarche/Adrenarche - Girls (ICD-10: E27.0) When to Refer Suggested Pre-Referral Workup Referral Documentation Requirements Girls < 8 years old  Early AM:  Initial and most recent clinic notes with physical examination and With one or more of the following signs  17-hydroxyprogesterone Tanner stage  Pubic hair  Testosterone  Lab test results including most recent  Axillary hair  DHEA-S relevant and initial test leading to referring diagnosis  Body odor  Bone age  Growth chart, including parental  Clitoral enlargement (at any age) heights  Accelerated linear growth If completed: IF URGENT: Call (323) 660-2450 and ask for the  Bone age results (bring CD/films to Endocrinology doctor on call to be paged. appointment)

Commonly Referred Pediatric Endocrinology Conditions

Premature Pubarche/Adrenarche – Boys (ICD-10: E27.0) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements Boys < 9 years old  Initial and most recent clinic notes with physical examination and With one or more of the following signs without  Early AM Pediatric LH/FSH Tanner stage testicular enlargement (<4 mL or <2.5 cm)  17-hydroxyprogesterone  Lab test results including most recent  Pubic hair  Testosterone relevant and initial test leading to  Axillary hair referring diagnosis  DHEA-S  Body odor  Growth chart, including parental  Bone age heights  Accelerated growth If completed: IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.  Bone age results (bring CD/films to appointment) Male Hypogonadism (ICD-10: E23.0/ Q98.0/ Q98.1/Q98.4) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Suspected hypopituitarism  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination and  Confirmed hypogonadism  Testosterone Tanner stage  Severe headache and/or blurry vision  Prolactin  Lab test results including most recent  No signs of puberty by 14 years old  Bone age relevant and initial test leading to referring diagnosis IF URGENT: Call (323) 660-2450 and ask for the  Growth chart, including parental Endocrinology doctor on call to be paged. heights If completed:  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions Female Hypogonadism (ICD-10: E230) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Suspected hypopituitarism  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination and  Confirmed hypogonadism  Estradiol Tanner stage  Severe headache and/or blurry vision  Prolactin  Lab test results including most recent  No signs of puberty by 13 years old  Karytoype relevant and initial test leading to referring diagnosis IF URGENT: Call (323) 660-2450 and ask for the  Bone Age Endocrinology doctor on call to be paged.  Growth chart, including parental heights If completed:  Bone age results (bring CD/films to appointment) Primary Amenorrhea / Secondary Amenorrhea (ICD-10: N910/N911) When to Refer Suggested Pre-Referral Workup Referral Documentation Requirements  No period by 15 years old  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination and  No period for > 3 months  Estradiol Tanner stage IF URGENT: Call (323) 660-2450 and ask for the  Prolactin  Lab test results including most recent Endocrinology doctor on call to be paged.  Beta-hCG relevant and initial test leading to referring diagnosis  Free T4, TSH  Growth chart, including parental  Total testosterone, free testosterone, sex- heights hormone binding globulin (SHBG) If completed:  Bone age  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions Klinefelter Syndrome (ICD-10: Q985) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Confirmed diagnosis 47,XXY  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination and IF URGENT: Call (323) 660-2450 and ask for the  Testosterone Tanner stage Endocrinology doctor on call to be paged.  Lab test results including most recent relevant and initial test leading to referring diagnosis  Growth chart, including parental heights If completed:  Bone age results (bring CD/films to appointment) Noonan Syndrome (ICD-10: Q871) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Characteristic facial features  Genetic work-up confirming Noonan Syndrome  Initial and most recent clinic notes with physical examination and  Cardiovascular findings Tanner stage  Poor growth  Lab test results including most recent IF URGENT: Call (323) 660-2450 and ask for the relevant and initial test leading to Endocrinology doctor on call to be paged. referring diagnosis  Growth chart, including parental heights If completed:  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions

Delayed Puberty (ICD-10: E300) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  No signs of puberty in females by 13 years old  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with and males by 14 years old physical examination and Tanner stage  Estradiol/Testosterone  Lab test results including most recent  Bone age relevant and initial test leading to IF URGENT: Call (323) 660-2450 and ask for the referring diagnosis Endocrinology doctor on call to be paged.  Growth chart, including parental heights If completed:  Bone age results (bring CD/films to appointment) Turner Syndrome (ICD-10: Q9690) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  45,X Karotype  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination and Tanner stage  Short stature  Karotype (if not done)  Lab test results including most recent  Webbed neck  Estradiol relevant and initial test leading to  Bicuspid aortic valve / Coarctation of aorta referring diagnosis  Horseshoe  Growth chart, including parental heights IF URGENT: Call (323) 660-2450 and ask for the If completed: Endocrinology doctor on call to be paged.  Bone age results (bring CD/films to appointment)

Commonly Referred Pediatric Endocrinology Conditions

THYROID DISORDER Thyroid Cancer/Nodule/Thyroid Enlargement/Goiter (ICD-10: C801/E041/E049) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Thyroid nodule > 1 cm  Free or Total T4  Initial and most recent clinic notes with physical examination  Family history of thyroid cancer or MEN (multiple  TSH endocrine neoplasia)  Lab test results including most recent  Anti-thyroid peroxidase (TPO) and Anti- relevant and initial test leading to thyroglobulin antibodies  Increasing size of nodule referring diagnosis  Thyroid ultrasound  Concerning features on ultrasound  Growth chart, including parental heights  Hoarse voice, dyspnea, dysphagia, stridor If completed:  Thyroid enlargement/Goiter  Thyroid US (bring CD/films to appointment) If URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.  Fine needle aspiration, if performed Acquired Hyperthyroidism (ICD-10: E05.90) Autoimmune Hyperthyroidism (Graves Disease) (ICD-10: E05.00) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Goiter  Free or Total T4  Initial and most recent clinic notes with physical examination  Hypertension  Total T3  Lab test results including most  TSH  Tachycardia recent relevant and initial test  Exophthalmos  Thyroid-stimulating immunoglobulin (TSI) leading to referring diagnosis   TSH < 0.1 µIU/mL  Anti-thyroid peroxidase (TPO) and Anti- Growth chart, including parental thyroglobulin antibodies heights  Elevated total or free T4, and/or total or free T3  Thyrotropin-binding Inhibitory Immunoglobulin If completed: IF URGENT: Call (323) 660-2450 and ask for the (TBII)  Thyroid US (bring CD/films to Endocrinology doctor on call to be paged. appointment)

Commonly Referred Pediatric Endocrinology Conditions

Congenital Hypothyroidism (Neonate) (ICD-10: E03.1) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Neonate with abnormal Newborn Screening Test  Confirmatory TSH  Initial and most recent clinic notes with physical examination  TSH >10 µIU/mL in neonate  Free or total T4  Lab test results including most recent IF URGENT: Call (323) 660-2450 and ask for the relevant and initial test leading to Endocrinology doctor on call to be paged. referring diagnosis  Growth chart, including parental heights Congenital Hypothyroidism (Child)/Acquired Hypothyroidism/Autoimmune Hypothyroidism/Hashimoto Thyroiditis /Abnormal Thyroid Function Test (ICD-10: E03.10) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Known or treated child with abnormal thyroid  TSH  Initial and most recent clinic notes with function test physical examination  Free or total T4  TSH >10 µIU/mL  Lab test results including most recent  Anti-thyroid peroxidase (TPO) and Anti- relevant and initial test leading to  Low free or total T4 thyroglobulin antibodies (if not congenital) referring diagnosis  Constipation  Growth chart, including parental heights  Poor growth  Increased weight gain If completed:   Fatigue Thyroid US (bring CD/films to appointment) IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.

Commonly Referred Pediatric Endocrinology Conditions

ADDITIONAL DISORDERS Adrenal Insufficiency (Addison Disease) (ICD-10: E2740,E271) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements Acute:  Basic Metabolic Panel  Initial and most recent clinic notes with  Cessation of glucocorticoid physical examination  CBC with differential  Adrenal hemorrhage in severe illness  Lab test results including most recent Chronic:  8 AM cortisol relevant and initial test leading to referring  diagnosis  Autoimmune, TB, other primary adrenal disease   Growth chart, including parental heights  Hypopituitarism   Fatigue ACTH  Hyperpigmentation  Weight loss IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged. Glucocorticoid Excess (Cushing Syndrome) (ICD-10: E249) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Weight gain with poor linear growth  24-hour free cortisol & creatinine  Initial and most recent clinic notes with physical examination  Central fat distribution  ACTH & Cortisol  Lab test results including most recent  Hirsutism/Virilization relevant and initial test leading to referring  Easy bruising diagnosis  Purplish striae (stretch marks)  Growth chart, including parental heights  Buffalo hump IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.

Commonly Referred Pediatric Endocrinology Conditions

Hypercalcemia/Hyperparathyroidism (ICD-10: E8352/E213) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Confusion, weakness, polyuria, anorexia, nausea,  Complete metabolic panel  Initial and most recent clinic notes with vomiting physical examination  Ionized calcium  Renal stones  Lab test results including most recent  Phosphate, magnesium relevant and initial test leading to referring  Pancreatitis  PTH diagnosis  Total calcium >10.5 mg/dL  25-OH vitamin D  Growth chart, including parental heights IF URGENT: Call (323) 660-2450 and ask for the Endocrinology doctor on call to be paged.  1,25-(OH)2 vitamin D  Sedimentation rate (ESR)  Urine calcium/creatinine (random) Hypertension/Pheochromocytoma (ICD-10: I10/D3500) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Resistant, severe hypertension  Basic metabolic panel  Initial and most recent clinic notes with physical examination  Unexplained hypokalemia  Renin  Lab test results including most recent  Adrenal mass  Aldosterone relevant and initial test leading to referring IF URGENT: Call (323) 660-2450 and ask for the  24-hour urine catecholamines/metanephrines/ diagnosis Endocrinology doctor on call to be paged. creatinine  Growth chart, including parental heights  Consider re-routing referral to or

Commonly Referred Pediatric Endocrinology Conditions Hypoglycemia (ICD-10: E162) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements

   Blood glucose <70 mg/dL Fasting glucose Initial and most recent clinic notes with physical examination  Fasting insulin IF URGENT: Call (323) 660-2450 and ask for the  Lab test results including most recent Endocrinology doctor on call to be paged. relevant and initial test leading to referring diagnosis  Growth chart, including parental height

Hypocalcaemia/Hypoparathyroidism (ICD-10: E8351/E209) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Total calcium < 8 mg/dL  Complete metabolic panel  Initial and most recent clinic notes with physical examination  Lethargy, anorexia, vomiting, seizures, apnea,  Ionized calcium twitching, cramping, laryngospasm  Lab test results including most recent  Phosphate relevant and initial test leading to referring IF URGENT: Call (323) 660-2450 and ask for the diagnosis Endocrinology doctor on call to be paged.  Magnesium  Urine Calcium/Creatinine (random)  Growth chart, including parental height  PTH  25-OH vitamin D

 1,25-(OH)2 vitamin D

Commonly Referred Pediatric Endocrinology Conditions Hypo/ (ICD-10: E871/E870) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  <130 mEq/L or >150 mEq/L, particularly  Basic metabolic panel  Initial and most recent clinic notes with if an acute change physical examination  Osmolality IF URGENT: Call (323) 660-2450 and ask for the  Lab test results including most recent Endocrinology doctor on call to be paged.  Urine sodium, creatinine, osmolality relevant and initial test leading to referring diagnosis  Growth chart, including parental height

Osteoporosis/Metabolic Bone Disease/Fractures/Rickets (ICD-10: M818/M8080/E550) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  History of frequent, non-traumatic fractures  Complete metabolic panel  Initial and most recent clinic notes with physical examination  History of severe bone  Ionized calcium  Lab test results including most recent  Low alkaline phosphatase  PTH relevant and initial test leading to referring IF URGENT: Call (323) 660-2450 and ask for the  25-OH vitamin D diagnosis Endocrinology doctor on call to be paged.  1,25-(OH)2 vitamin D  Growth chart, including parental height  TSH, free T4 If completed:   LH/FSH (post-puberty) DEXA/QCT bone density results  X-ray results  Estradiol/Testosterone (post puberty)

Commonly Referred Pediatric Endocrinology Conditions Pituitary Disorders/Craniopharyngioma/Brain Tumor/Hyperprolactinemia/Prolactinoma (ICD-10: E237/D444/E221/D352) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Pituitary adenoma > 10 mm in size  Early AM Pediatric LH/FSH  Initial and most recent clinic notes with physical examination  Pituitary hormone excess or deficiency  GH/IGF-I/IGFBP-3  Lab test results including most recent  Visual impairment &/or severe headaches with  Free T4 and TSH relevant and initial test leading to referring pituitary mass  8 AM cortisol diagnosis IF URGENT: Call (323) 660-2450 and ask for the  Growth chart, including parental height Endocrinology doctor on call to be paged.  24-hour urine free cortisol & creatinine  Prolactin If completed:  Estradiol/Testosterone  results (brain and pituitary MRI with and without contrast)  Basic Metabolic Panel

 Brain/pituitary MRI with & without contrast

Polydipsia and Polyuria/Diabetes Insipidus (ICD-10: R631/R358/E232) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Frequent urination  Basic metabolic panel  Initial and most recent clinic notes with physical examination  New nocturnal enuresis  UA  Lab test results including most recent IF URGENT: Call (323) 660-2450 and ask for the relevant and initial test leading to referring Endocrinology doctor on call to be paged. diagnosis

 Growth chart, including parental height

Commonly Referred Pediatric Endocrinology Conditions Congenital Adrenal Hyperplasia (ICD-10: E250) When to Refer Suggested Pre-Referral Work-up Referral Documentation Requirements  Ambiguous genitalia  Early AM 17-OH progesterone  Initial and most recent clinic notes with physical examination  Pubic hair in girls < 7 years old or boys < 9  Early AM Androstenedione years old  Lab test results including most recent  Early AM Testosterone relevant and initial test leading to referring  Apocrine odor, acne, axillary hair diagnosis IF URGENT: Call (323) 660-2450 and ask for the  Growth chart, including parental height Endocrinology doctor on call to be paged.