Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment.

: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation.

Resilience matters: Student perceptions of the impact of COVID-19 on medical education.

Introduction: We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students' ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted.

Methods: A multidisciplinary team of educators created and distributed a survey to medical students.

Differential effects of hydrocortisone, prednisone, and dexamethasone on hormonal and pharmacokinetic profiles: a pilot study in children with congenital adrenal hyperplasia.

Background: Little is known about the comparative effects of different glucocorticoids on the adrenal and growth hormone (GH) axes in children with congenital adrenal hyperplasia (CAH). We sought to compare the effects of hydrocortisone (HC), prednisone (PDN), and dexamethasone (DEX) in children with classic CAH and to investigate a potential role of pharmacogenetics.

Methods: Subjects were randomly assigned to three sequential 6-week courses of HC, PDN, and DEX, each followed by evaluation of adrenal hormones, IGF-1, GH, and body mass index (BMI).

A competency-based approach to recruiting, developing, and giving feedback to department chairs.

Academic health centers (AHCs) are under unprecedented pressure, making strong leadership during these challenging times critical. Department chairs have tremendous influence in their AHCs, yet data indicate that--despite outstanding academic credentials--they are often underprepared to take on these important leadership roles. The authors sought to improve the approach to recruiting, developing, and giving feedback to department chairs at their institution, the Indiana University School of Medicine (IUSM), by reorganizing these processes around six key leadership competencies: leadership and team development, performance and talent management, vision and strategic planning, emotional intelligence, communication skills, and commitment to the tripartite mission.

Whole exome sequencing to identify genetic causes of short stature.

Background/aims: Short stature is a common reason for presentation to pediatric endocrinology clinics. However, for most patients, no cause for the short stature can be identified. As genetics plays a strong role in height, we sought to identify known and novel genetic causes of short stature.

Long-term glycemic control as a result of initial education for children with new onset type 1 diabetes: does the setting matter?

Purpose: The purpose of this study was to examine the role of initial diabetes education delivery at an academic medical center (AMC) versus non-AMCs on long-term glycemic control.

Methods: We performed a retrospective study of children with type 1 diabetes referred to an AMC after being educated at non-AMCs. These children were matched to a group of children diagnosed and educated as inpatients at an AMC.

The role of homeodomain transcription factors in heritable pituitary disease.

The anterior pituitary gland secretes hormones that regulate developmental and physiological processes, including growth, the stress response, metabolic status, reproduction and lactation. During embryogenesis, cellular determination and differentiation events establish specialized hormone-secreting cell types within the anterior pituitary gland. These developmental decisions are mediated in part by the actions of a cascade of transcription factors, many of which belong to the homeodomain class of DNA-binding proteins.

The timing of puberty: is it changing? Does it matter?

Whether the secular trend of a decreasing age of puberty has continued over the past 50 years remains controversial. Data that had been classically used to address this issue are reviewed and large epidemiologic studies, which had not previously been included, are now considered to challenge the conclusions of prior debates of this topic. The effect and timing of excessive weight gain are discussed in detail and recent observations about the opposing effects of obesity on the pubertal timing of girls versus boys are considered.

Sex steroid replacement for induction of puberty in multiple pituitary hormone deficiency.

Hypopituitarism results from the inability of the pituitary gland to make sufficient levels of more than one of the following hormones: adrenocorticotrophic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, and growth hormone (GH). While growth retardation is a symptom of GH deficiency in children, hypogonadism usually presents with the complete lack of puberty or a delayed onset with incomplete pubertal development. Although the goal of therapy is to simulate normal pubertal development as closely as possible, multiple approaches have been used to attain this goal.

Inhaled growth hormone (GH) compared with subcutaneous GH in children with GH deficiency: pharmacokinetics, pharmacodynamics, and safety.

Background: Delivery of GH via inhalation is a potential alternative to injection. Previous studies of inhaled GH in adults have demonstrated safety and tolerability.

Objective: We sought to assess safety and tolerability of inhaled GH in children and to estimate relative bioavailability and biopotency between inhaled GH and sc GH.

Roles of the LHX3 and LHX4 LIM-homeodomain factors in pituitary development.

The LHX3 and LHX4 LIM-homeodomain transcription factors play essential roles in pituitary gland and nervous system development. Mutations in the genes encoding these regulatory proteins are associated with combined hormone deficiency diseases in humans and animal models. Patients with these diseases have complex syndromes involving short stature, and reproductive and metabolic disorders.

Clinical case seminar: a novel LHX3 mutation presenting as combined pituitary hormonal deficiency.

Context: LHX3 encodes LIM homeodomain class transcription factors with important roles in pituitary and nervous system development. The only previous report of LHX3 mutations described patients with two types of recessive mutations displaying combined pituitary hormone deficiency coupled with neck rigidity.

Objective: We report a patient presenting a unique phenotype associated with a novel mutation in the LHX3 gene.

Adrenal ganglioneuromas in children with multiple endocrine neoplasia type 2: a report of two cases.

Context: Pheochromocytomas of the adrenal gland are a common component of the multiple endocrine neoplasia type 2 (MEN2) syndromes. However, pure adrenal ganglioneuromas, an extremely rare pediatric tumor of neural crest origin composed of mature ganglion cells, have never been reported in association with MEN2 in humans. MEN2A is comprised of medullary thyroid carcinoma (MTC), pheochromocytoma, and parathyroid hyperplasia.

Prevalence of adrenocorticotropin deficiency in children with idiopathic growth hormone deficiency.

We sought to determine the prevalence of ACTH deficiency in children with GH deficiency (GHD) of unknown etiology with and without TSH deficiency and to correlate the structural characteristics of the hypothalamic-pituitary region on magnetic resonance imaging (MRI) with TSH and ACTH status. The electronic medical records system of a children's hospital was used to identify all patients less than 18 yr of age with GHD. TSH and ACTH deficiency were defined as being present if the patient was prescribed replacement hormone therapy.

Severe short stature and endogenous growth hormone resistance in twin brothers without growth hormone gene mutations.

Growth failure in children with high growth hormone (GH) levels, low insulin-like growth factor 1 (IGF-1) levels, and accelerated linear growth in response to exogenous GH is presumed to result from biologically inactive GH. A molecular diagnosis has only been made in two such patients. We analyzed the presentations and the GH-1 genes of twin Egyptian brothers with this phenotype.

Low hemoglobin levels in children with in idiopathic growth hormone deficiency.

Multiple lines of evidence have implicated the growth hormone (GH) axis in the regulation of erythropoiesis. To test the hypothesis that GH deficiency is associated with hematologic abnormalities, we analyzed pretreatment hemoglobin levels in 100 children with GH deficiency. Hemoglobin levels were decreased in children with GH deficiency compared with age-corrected norms.