Puberty: timing is everything.

When evaluating delayed puberty, it is essential to determine the underlying cause. This can be done with history and physical exam as well as basal gonadotropin levels, bone age, and further testing as indicated. When the cause is hypogonadism, an underlying condition should be treated if present; otherwise lifelong hormonal therapy is necessary. When constitutional delay is present, each case must be handled individually. Most patients can be reassured while some may require transient hormonal treatment for psychosocial reasons. Patients receiving hormonal therapy may require assistance from an endocrinologist and close monitoring.

The multiple indications for growth hormone treatment of pediatric patients.

GH has many approved uses in pediatric patients including GH deficiency, CRF, Turner syndrome, Prader-Willi syndrome, SGA, and ISS. The child should have an appropriate evaluation for poor growth and endocrine consultation as dictated by clinical and investigative findings. Treatment of the child with GH deficiency is universally accepted. Treatment of children with Turner syndrome is dependent on the child's growth and stature with early diagnosis and treatment offering the most favorable outcome. Prescription of GH for PWS patients should be done cautiously given the possible association between GH use and sudden death; further studies are needed to fully delineate such a relationship. If a child has a history of SGA and is below the 3rd percentile at age 2, endocrine referral should be considered. Adult heights within the normal range may be attained in SGA patients treated with GH. An individualized approach to children with ISS should be practiced. The clinician should take into consideration factors such as psychosocial concerns and must exclude alternative etiologies of poor growth prior to consideration of therapy with GH. For all etiologies, greater height gains generally have been shown to be associated with younger age at time of diagnosis and treatment. There are ethical, economic and psychosocial issues surrounding GH use in children such that sound clinical practice should include an individualized approach to any patient who may be a potential candidate for GH treatment.

Type 2 diabetes mellitus in youth.

In the United States, the incidence of type 2 diabetes mellitus (DM) in children and adolescents has been increasing at an alarming rate. Early recognition and intervention can delay the onset of type 2 DM and prevent the long-term complications. School nurses have an essential role in implementing the American Diabetes Association (ADA) recommended screening guidelines to identify youth at high risk for type 2 DM and in implementing student health programs that focus positively on the importance of physical activity and healthy eating habits. The purpose of this article is to present an overview of the epidemiology, pathophysiology, complications, diagnosis, and treatment, as well as the recommended screening guidelines for type 2 DM in the pediatric age group. The information provided will enhance awareness, promote screening, and empower the school nurse to more effectively promote healthy lifestyle education.

Type 2 diabetes mellitus in adolescents.

While diabetes mellitus types 1 and 2 used to be distinguished largely by age at onset, in the past decade there has been an increase in the number of children presenting with diabetes that can be controlled with oral medications. This has lead to these children being diagnosed with type 2 diabetes mellitus despite their young age. This chapter offers an overview of presenting features, pathophysiology, treatment and prognosis of this disorder in the adolescent patient. Additionally, it offers information regarding the relationship between increasing childhood obesity and a rise in the reported cases of diabetes in children. Appropriate screening and laboratory tests and their results are explained, and the pros and cons of both pharmacologic and non-pharmacologic therapies are discussed. Some complications of diabetes in the developing adolescent differ from those adults will face, and the well-known complications of diabetes (hyperlipidemia, hypertension) must be addressed in a population that is not normally screened for these health concerns. It is hoped that by educating physicians to the potential for this disorder in their adolescent patients, long-term complications can be reduced and advanced sequelae of vascular and neurologic problems can possibly be avoided altogether.