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Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital
An important, timely question regards determining which co-existing conditions increase the severity of COVID-19 in youth. In adults, for example, obesity, metabolic syndrome, and type 2 diabetes are endocrine conditions that increase the risk of severe COVID-19. By contrast, it appears that diabetes in the young does not increase the risk of severe COVID-19 infection, as noted in our other blog post (link). In fact, most most pediatric endocrine conditions are not thought to induce immunosuppression. However, disorders of glucocorticoid secretion bear closer scrutiny. Excess glucocorticoid secretion, otherwise known as endogenous Cushing Syndrome, induces immunosuppression and may increase risk of severe COVID-19 (link). Thankfully, endogenous forms of Cushing Syndrome are very rare in children. However, deficiencies of glucocorticoid secretion (otherwise known as adrenal insufficiency) are not as rare and affect scores of youth in our region. The American Association of Clinical Endocrinologists (AACE) has published a position piece (link) warning that persons with adrenal insufficiency appear to be at higher risk of death from a wide swath of respiratory infections, and that there is no reason to suspect that this risk does not extend to COVID-19. Indeed, multiple large cohort / population studies have shown that persons with adrenal insufficiency have increased susceptibility to a wide swath of infections (example publications: 2020 JCEM ; 2013 JCEM ; 2016 JCEM ; 2006 JCEM ; 2017 EuJEndo ). It is important to note that there are at least two limitations to this “best available” evidence. (1) It has not involved youth with adrenal insufficiency. (2) Despite these studies being very large, they are largely retrospective. On the other hand, the observation is biologically plausible, since cortisol is a powerful immune modulating hormone that can not be replaced in a perfectly physiological manner. Thus, the related recommendations of the AACE appear important: briefly that persons with adrenal insufficiency should maintain precautions to avoid COVID-19 exposure, to maintain their adrenal replacement therapies, and to give stress dose steroids as instructed. The AACE recommendations can be found here. As always, our pediatric endocrinology team remains available 24/7 to support youth with adrenal disorders.
We are pleased to announce that Dr. Eirene Alexandrou is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from Indiana University School of Medicine, completed a residency in pediatrics at the Medical College of Georgia, and just completed a fellowship in pediatric endocrinology at the prestigious Cincinnati Children’s Hospital. She has published expertise in the areas of growth research (link) and Turner Syndrome. In clinic, her initial practice will include general pediatric endocrinology and diabetes, as well as outreach services in Cedar Rapids and Dubuque.
We are pleased to announce that Dr. Akhila Ramakrishna is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from the Armed Forces Medical College, then completed a residency in pediatrics at Case Western Reserve, and just completed a fellowship in pediatric endocrinology at the prestigious Mayo Clinic. She has published expertise in the area of thyroid dysfunction (link) and has studied rodent models of obesity as a fellow as well. In clinic, her practice will include general pediatric endocrinology and diabetes, as well as gender-related endocrine care, obesity-related endocrine care especially regarding bariatric surgery in adolescents, and outreach pediatric endocrine services in Cedar Falls.
We are pleased to announce that Dr. Catherina “Cat” Pinnaro is starting as a new pediatric endocrinologist in our division. Her position will be on the tenure-track, meaning that she will be expected to be productive as a research physician. Dr. Pinnaro received her Medical Degree from New York Medical College where she successfully competed for a Doris Duke research year, which she spent at the University of Iowa. She then completed a residency in pediatrics at the University of Iowa, just completed a fellowship in pediatric endocrinology here as well, and is on track to earn a Master’s in Translational Biomedicine in late 2020. While a fellow, she has created several productive research projects, having already published on the genetics of 22q syndrome (link) and diabetes care simulation (link). Her research will focus on the etiology of diabetes in specific disease contexts, applying her genetics expertise. In clinic, her practice will include general pediatric endocrinology and diabetes.
Today we are thrilled to announce that Dr. Alex Tuttle has joined our division as a pediatric endocrine fellow. He will serve three years in this role, after which he will be a full fledged board eligible pediatric endocrinologist. Dr. Tuttle received his Medical Degree from Indiana University. He then completed a pediatric residency at the University of Iowa Children’s Hospital. While a resident he demonstrated an aptitude for and interest in pediatric endocrinology, and was highly involved in diabetes camp (see picture below) at Camp Herkto Hollow and helped report an unusual pediatric endocrine case related to thyroid eye disease (link). Welcome Dr. Tuttle!!
We are extremely proud of Dr. Catherina “Cat” Pinnaro. For the past 3 years, Dr. Pinnaro has been a pediatric endocrinology fellow. Today she finishes this training, and will officially become a “board eligible” pediatric endocrinologist. During these three years, Dr. Pinnaro has been an exemplary fellow, providing outstanding clinical care, highly commended clinical teaching, and published research. She won several national awards as a fellow, including the Rising Star award from the Pediatric Endocrine Society, and the Leona Cuttler Quality Assurance Award from the American Academy of Pediatrics. We will miss her energetic approach to everything a fellow does. Following fellowship, Dr. Pinnaro has accepted a tenure-track position at a major research university where she continue her pediatric endocrine research related to diabetes, and will also continue her clinical work in pediatric endocrinology — stay tuned…. Congratulations Dr. Pinnaro!
Today we are saddened to say goodbye to our colleague Dr. Beth Sandberg. She has been a stalwart colleague for the past year, providing compassionate and expert pediatric endocrine care. Dr. Sandberg joined our division last summer having just completed a fellowship in pediatric endocrinology at the University of North Carolina. While here, she provided general endocrine care, including outreach services in Cedar Falls, and gender-related endocrine care. The Pediatric Endocrine Society recognized her expertise and commitment by placing her as a national special interest group co-leader this year. After leaving Iowa, she will be taking a position in the Division of Pediatric Endocrinology at the University of Michigan / Mott’s Children’s Hospital. We send our best wishes to Dr. Sandberg for her move and new position.
We were graced today by a research talk from David Breault, MD PhD. Dr. Breault is an Associate Professor at Harvard Medical school and is the Associate Chief of the Division of Endocrinology at Boston Children’s Hospital. He spoke at our Frontiers in Pediatric Research seminar series manged by the Department of Pediatrics. Dr. Breault is an expert in the study of stem cells and lineage development, especially as relates to endocrine system. He received his MD and PhD from the University of Connecticut, completed pediatric residency at Yale, and a pediatric endocrinology fellowship at Boston Children’s Hospital. He is a physician scientist and directs a stem sell research laboratory funded by the NIH. His research has earned several prestigious awards including the election to the American Society for Clinical Investigation, and a Presidential Early Career Award for Scientists and Engineers receive at the White House. Dr. Breault spoke today on stem sell lineage development in the intestine and endocrine system.
“With the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions.” –Andrew Norris
Dr. Tansey and collaborators across the country have been studying brain function in children with and without type 1 diabetes. In a study published today (link) in the prestigious journal Diabetes, they report important differences between these two groups. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given memory tasks. Compared to children without diabetes, those with type 1 diabetes exhibited decreased memory performance relative to children without diabetes. Interestingly the children with type 1 diabetes showed greater increases in brain activation with harder tasks than those without diabetes, suggesting that their brains were working harder to compensate. More research is needed to understand how these effects of diabetes occur and how they might be modulated. With the recent advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions. Also involved in the study from our Division were Dr. Tsalikian, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.