Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

Abstract

Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up. Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center. Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as “urgent” (<7 days), 35% as “deferrable” (<30 days), and 51% as “planned” (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit. Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.

Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics

“…Regarding the tests investigating GH secretion, we detected a striking reduction (− 35%) in tests performed in 2020, compared to 2019. This was sharply in contrast with a steady increase in referrals for growth issues that we reported from 2014 to 2018 in a previous study [ 1 ], even though the criteria – according to the Italian Medicines Agency (AIFA) – to perform stimulation tests were the same (i.e., height ≤ − 3 SD; or height ≤ − 2 SD + growth velocity per year ≤ − 1 DS for age and sex evaluated for at least 6 months or a reduction of height of 0.5 SD per year in children > 2 years of age; or height ≤ − 1.5 SD compared to target height and growth velocity per year ≤ − 2 SD or ≤ − 1.5 SD for two consecutive years; or growth velocity per year ≤ − 2 SD or ≤ − 1.5 SD after two consecutive years, even without short stature and after exclusion of other causes of failure to thrive; or malformations/lesions of hypothalamus/pituitary demonstrated at brain MRI) [ 13 ]. Although this is the first study reporting a decrease of referrals for suspected GHD during 2020 lockdowns, our results align with previous reports addressing a delay of hospital care admissions and a reduction of 30–40% in visits during the COVID-19 pandemic [ 9 , 10 ].…”

“…The two most frequent referral reasons in pediatric endocrinology are issues regarding growth and puberty, which constitutes almost half of the referrals for pediatric endocrinologists [ 1 ]. To detect growth hormone deficiency (GHD) or central precocious puberty (CPP), among other endocrine diseases, the determination of basal hormones is of limited diagnostic value, and stimulation tests – which require hospital admission – are needed.…”

Should Pediatric Endocrinologists Consider More Carefully When to Perform a Stimulation Test?

“…Children and young people referred to pediatric endocrinology services present with a wide range of illnesses and disorders varying from minor to life-threatening conditions ( 1 ). Diagnosis rely greatly on laboratory testing: while for some disorders a single blood sample is sufficient (e.g.…”

Definition and prevalence of familial short stature

“…Short stature (SS) – defined as a height ≤ − 2 standard deviation score (SDS) – is the most common referral reason in pediatric endocrinology [ 1 ].…”