Total clinic visits: 11,882 ENDOCRINOLOGY, METABOLISM AND DIABETES METABOLISM ENDOCRINOLOGY,
Total discharges: 553
ENDOCRINOLOGY, METABOLISM AND DIABETES Supporting the Physical, Mental and Psychosocial Health of Transgender Patients and Their Families As of Fall 2014, the Transgender Clinic associated with the THRIVE/Disorders of Sexual Development Clinic at Nationwide Children’s Hospital has seen and Average evaluated over 30 transgender patients, through outpatient services. length of stay: 1.9 days
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Supporting the Physical, Mental and Psychosocial Health of Transgender Patients and Their Families
As of Fall 2014, the Transgender Clinic associated with the THRIVE/Disorders of Sexual Development Clinic at Nationwide Children’s Hospital has seen and evaluated over 30 transgender patients, through outpatient services. For patients and their families, these services include routine consultations with endocrinology, psychology and social work, as well as options for reversible treatment to delay or halt the effects of puberty among gender-questioning patients while the individual grows into adulthood. The THRIVE Program also houses the DSD Clinic, specializing in care for Disorders of Sexual Development (DSD) and complex urological cases.
“We all have a sense of ourselves as male or female. However, for some that self-awareness does not match the physical body,” says Justin A. Indyk, MD, PhD, an attending physician in the section of Endocrinology, Metabolism and Diabetes at Nationwide Children’s and a lead endocrinologist for the Transgender Clinic. “Many transgender persons live in conflict every day, and become severely distressed at the time of puberty when their bodies begin to dramatically mature.”
Prior to the formation of the Transgender Clinic, the Ethics Committee took into consideration the consensus guidelines on treatment of transgender persons published by the Endocrine Society. These guidelines address the safety and reversibility of pubertal suppression, a well-known and effective treatment. Such treatment can avoid the irreversible pubertal changes that increase distress and likelihood of suicide for untreated individuals.
Multidisciplinary care teams such as the THRIVE Program are dedicated to providing optimal and comprehensive care for individuals who do not identify with their natal sex. Studies demonstrate that treatment and support through counseling and education can help these children avoid psychosocial issues, reduce emergency department visits, decrease suicide rates and lessen the likelihood of bullying.
“Our mission is to provide best-practice, patient-specific, evidence-based care in a manner that values mental health and emphasizes emotional support for patients and families,” says Leena Nahata, MD, who works alongside Dr. Indyk. “On their behalf, we are committed to working with community physicians and organizations, and we are hearing from more and more families, both locally and regionally, as our presence increases in the community.”
Dr. Leena Nahata and Dr. Justin Indyk
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Section of Pulmonary Medicine, both the Prader-Willi Henry RK, Bowden SA. “A macroprolactin level today, may keep healthcare cost and the ENDOCRINOLOGY, METABOLISM & DIABETES surgical knife at bay.” Clinical Pediatrics. [Epub 2014 Mar 28]. Clinic and the Turner Syndrome Clinic are staffed by The Section of Endocrinology, Metabolism and Diabetes at Nationwide Children’s Hospital provides Hickey SE, Walters-Sen L, Mosher TM, Pfau RB, Pyatt R, Snyder PJ, Sotos JF, Prior genetics and endocrinology, and the Endocrinology TW. “Duplication of the Xq27.3-q28 region, including the FMR1 gene, in an X-linked comprehensive services for the diagnosis and treatment of pediatric endocrinology and glucose metabolism Section collaborates with hematology/oncology in hypogonadism, gynecomastia, intellectual disability, short stature, and obesity syndrome.” American Journal of Medical Genetics Part A conditions. These include abnormalities of hormone systems, conditions treated with hormones, type 1 and the care of patients in the long-term follow-up Bone . Vol. 161, No.9 (2013): 2294 – 9. Marrow Transplant Clinic. The section also participates Hoffman RP. “Vascular endothelial dysfunction and small molecules in early type 1 type 2 diabetes, insulin resistance, and related abnormalities such as polycystic ovarian syndrome. diabetes.” Current Diabetes Reviews. Vol. 10, No.3 (2014): 201 – 7. in research and the clinical care of patients in the Hsu CW, Yamamoto KT, Henry RK, De Roos AJ, Flynn JT. “Prenatal risk factors for STAFF PHYSICIANS AND FACULTY multidisciplinary Duchenne Muscular Dystrophy Clinic. childhood CKD.” Journal of the American Society of Nephrology. [Epub 2014 April 17]. Additional multidisciplinary specialty clinics include Manmohan K. Kamboj, MD and pseudohypoparathyroidism to Turner syndrome Rauch LB, Erdman SH, Aldrink JH, Ranalli MA, Prasad V, Hoffman RP. “Fatal type 2 diabetes, thyroid nodule, and high-risk diabetes extra-intestinal adrenal malignancy in a 12 year old female with familial adenomatous Interim Chief and Klinefelter syndrome, among others. The section polyposis.” Journal of Pediatric Gastroenterology and Nutrition. Vol. 58, (2014): e19 – 20. clinics. Associate Professor of Clinical Pediatrics is a major referral center for children and adolescents Sotos JF. “Sotos syndrome 1 and 2.” Pediatric Endocrine Reviews (PER). Vol. 12, No.1 in and beyond Central Ohio and is a consultative Members of the Section of Endocrinology, Metabolism (2014): 374 – 88. resource for the State of Ohio Newborn Screening and Diabetes are actively involved in research to identify Sotos JF, Argente J. “Beckwith-Wiedeman syndrome.” In: Huhtaniemi I, Bartini L, eds. FULL-TIME NCH FACULTY Program for congenital hypothyroidism and congenital optimal treatments and improve patient care. Research Biomedical Sciences – Endocrine. 2014. Sasigarn A. Bowden, MD interests include innovations in care for diabetes and Sotos JF, Argente J. “Postnatal non-endocrine overgrowth.” In: Huhtaniemi I, Bartini L, adrenal hyperplasia. eds. Biomedical Sciences – Endocrine. 2014. Associate Professor of Clinical Pediatrics hypoglycemia in type 1 diabetes and insulin resistance Currently, there are 12 pediatric endocrinologists Sotos JF, Tokar NJ. “Growth hormone significantly increases the adult height of children Monika Chaudhari, MD as well as research projects investigating effects of within the section. All are faculty members at The with idiopathic short stature: comparison of subgroups and benefit.”International Journal Clinical Associate Professor of Pediatrics diabetes on the cardiovascular system. The section of Pediatric Endocrinology. [Epub 2014 Jul 16]. Ohio State University College of Medicine. The faculty is also investigating several aspects of the unique Starkoff BE, Petosa RL, Balk EK, Eneli IU, Bonny AE,Hoffman RP, Devor ST. Janet Chuang, MD physicians collaborate with four advanced practitioners pathophysiology of patients with Prader-Willi syndrome, “Sedentary and physical activity habits of adolescents with obesity.” Medicine & Science in Assistant Professor of Clinical Pediatrics and three pediatric endocrinology fellows in patient Sports & Exercise. Vol. 46, (2014): 229. and faculty members are working to identify optimal Rohan K. Henry, MD, MS care and research. Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, care for congenital adrenal hyperplasia. Additional Assistant Professor of Clinical Pediatrics Harris B, Dubose SN, Miller KM, Beck RW; T1D Exchange Clinic Network. “Severe Annually, an average of 200 patients from infancy through research interests include calcium/metabolic bone hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the Robert P. Hoffman, MD T1D Exchange clinic registry.” The Journal of Clinical Endocrinology and Metabolism. Vol. adolescence are diagnosed with diabetes and treatment disorders; pediatric osteoporosis; disorders of the 89, No.8 (2013): 3411 – 9. Professor of Pediatrics is initiated at Nationwide Children’s. Approximately adrenal gland; endothelial function; puberty, growth, Wood JR, Miller KM, Maahs DM, Beck RW, DiMeglio LA, Libman IM, Quinn M, Justin A. Indyk, MD, PhD 1,500 are followed on a regular basis, 90 percent of which and overgrowth disorders; and the role obesity plays in Tamborlane WV, Woerner SE; T1D Exchange Clinic Network. “Most youth with type 1 Assistant Professor of Clinical Pediatrics have type 1 diabetes. Comprehensive services include a pediatric endocrinologic and metabolic conditions. diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines.” multidisciplinary team approach that utilizes the expertise Leena Nahata, MD Investigators are involved in several multicenter trials, Diabetes Care. Vol. 36, No.7 (2013): 2035 – 7. of nurse practitioners, diabetes nurse educators, pediatric Assistant Professor of Clinical Pediatrics including a trial examining growth hormone treatment dietitians, social workers, and therapeutic recreation FAST FACTS for disorders involving short stature. Kathryn Stephens Obrynba, MD and behavioral scientists. Initial inpatient education is July 2013 – June 2014 Assistant Professor of Clinical Pediatrics coordinated with follow-up outpatient education and PUBLICATIONS Inpatient Discharges: 484 Juan F. Sotos, MD diabetes management visits. The diabetes program offers Bowden SA, Cozzi C, Hickey SE, Thrush DL, Astbury C, Nuthakki S. “Autosomal dominant pseudohypoaldosteronism type 1 in an infant with salt-losing crisis associated Observation and Outpatient-in-a-Bed Discharges: 69 Professor of Pediatrics comprehensive insulin pump- and continuous glucose- Case Reports in Endocrinology with urinary tract infection and obstructive uropathy.” . Total Discharges: 553 monitoring programs designed to enable patients to [Epub 2013 Dec 19]. COMMUNITY-BASED FACULTY Average Length of Stay*: 1.9 effectively utilize state-of-the-art therapy for diabetes. A Bowden SA, Patel HP, Beebe A, McBride KL. “Successful medical therapy for hypophosphatemic rickets due to mitochondrial complex I deficiency induced de Toni- Average Daily Census*: 2.5 William B. Zipf, MD distinct education program is available for patients with Debré-Fanconi syndrome.” Case Reports in Pediatrics. [Epub 2013 Dec 10]. Patient Days*: 925 Clinical Professor of Pediatrics type 2 diabetes. Using these approaches, the program Campbell MS, Schatz DA, Chen V, Wong JC, Steck A, Tamborlane WV, Smith J, Beck Inpatient Consults: 395 The section evaluates and treats growth hormone has seen an overall improvement in metabolic control RW, Cengiz E, Laffel LM, Miller KM, Haller MJ;T1D Exchange Clinic Network. “A in patients with diabetes and a decrease in the number contrast between children and adolescents with excellent and poor control: the T1D *Excludes observation and outpatient-in-a-bed patients. deficiency and other pituitary abnormalities, such Exchange clinic registry experience.” Pediatric Diabetes. Vol. 15, No.2 (2014): 110 – 7. as hyperprolactinemia, genetic and acquired growth of emergency department visits and hospitalizations for Chuang J, Vallerie A, Breech L, Saal HM, Alam S, Crawfird P, Rutter MM. Canal Winchester Endocrinology Clinic Visits: 686 disorders, thyroid abnormalities, disorders of puberty, established patients. “Complexities of gender assignment in 17ß-hydroxysteroid dehydrogenase type 3 Dublin Endocrinology Clinic Visits: 2,069 adrenal disorders including Addison and Cushing deficiency: is there a role for early orchiectomy?”International Journal of Pediatric The section provides comprehensive evaluation and Endocrinology. No. 1 (2013): 15. doi: 10.1186/1687-9856-2013-15. East Broad Endocrinology Clinic Visits: 850 diseases and congenital adrenal hyperplasia, calcium and treatment for a variety of growth disorders and, Chuang J, Zeller MH, Inge T, Crimmins N. “Bariatric surgery for severe obesity in two Endocrinology Clinic Visits: 6,136 bone disorders including metabolic bone disease such as presently, there are more than 500 patients on growth adolescents with type 1 diabetes.” Pediatrics. Vol. 132, No.4. (2013): e1031 – 4. Westerville Endocrinology Clinic Visits: 1,955 osteoporosis, disorders of sexual development including hormone treatment. Counts DR, Silverman LA, Geffner ME, Rajicic N, Hey-Hadavi J, Thornton PS, Lima Endocrinology Clinic Visits: 73 “ambiguous genitalia,” and a gender clinic to meet the Wajnrajch MP; ISS Study Group. “A four-year, open-label, multi-center, randomized, The section collaborates with other divisions at two-arm study of Genotropin® in patients with idiopathic short stature: comparison of Prader-Willi Clinic Visits: 94 endocrine and psychosocial needs of transgender youth. Nationwide Children’s to offer several specialty an individualized, target-driven treatment regimen to standard dosing of Genotropin® - Springfield Endocrinology Clinic Visits: 17 The section also evaluates and treats a wide variety analysis of two-year data.” Hormone Research in Paediatrics. Vol. 80, No.4 (2013): 242 – 51. clinics. A Metabolic Bone Disease Clinic is offered in Turner’s Syndrome Clinic Visits: 2 of syndromes that involve disorders of growth and/ Glaser NS, Ghetti S, Casper TC, Dean JM, Kuppermann N; Pediatric Emergency Care collaboration with the Section of Nephrology, a Cystic Total Endo Clinic Visits: 11,882 or the endocrine system, from Prader-Willi syndrome Applied Research Network (PECARN) DKA FLUID Study Group. Fibrosis Clinic is offered in collaboration with the “Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial.” Pediatric Diabetes. Vol. 14 (2013):435-46.
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