Dr. Parra Villasmil Named a CAPER Pancreas Scholar

Dr. Parra Villasmil

Children with recurrent pancreatitis are at risk to develop diabetes. However, current knowledge is insufficient to guide monitoring, screening, and therapy. Furthermore, there are no specific approaches to prevent diabetes from developing in those at risk. Additionally, there are very few pediatric endocrinologists with pancreatitis-specific expertise. To address these gaps, the Collaborative Alliance for Pancreatic Education and Research (CAPER) has created a program to identify rising physician specialists who can receive training to provide clinical care to these patients and to drive future research to better treat and even prevent endocrine complications from pancreatitis. We are pleased to broadcast that one of our Pediatric Endocrine Fellows, Dr. Parra Villasmil, has been selected as a CAPER Pancreas Scholar 2023-35. Dr. Parra Villasmil will receive mentorship from Dr. Melena Bellin who is a pancreas expert pediatric endocrinologist at the University of Minnesota. In this context, Dr. Parra Villasmil will develop a research project and participate in related national meetings. Congratulations to Dr. Parra Villasmil! We are not surprised that CAPER has recognized your talents and we look forward to her contributions to the field!

Using a Scribe to Improve Outpatient Physician Care.

Endocrine conditions are generally treated at home. Treatment can be complicated. A major purpose of appointments with the endocrinologist is to learn more about treatment. Often, a personalized plan is needed, depending on one’s daily schedules and activities. As a result, visits to the endocrinologist often involve numerous suggestions and details. Recording all of these details into the medical record can be difficult and time consuming. Two physicians in our Division participated in a pilot project whereby a scribe accompanied the physician during outpatient visits with the purpose of documenting the discussions and details. The results from this pilot project have now been published. The findings indicate that scribes have variable impact on visit times and physician charting burden, with improvements seen in one sub-specialty (developmental-behavioral pediatrics) but not another (pediatric endocrinology) . Patient satisfaction was equally high (>95%) with or without scribes. Two physicians from our Division, Dr. Kanner and Dr. Pesce contributed to the project and published manuscript. The paper is entitled “The Value of Adding Scribe Services to Two Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record” and is being published in the journal Clinical Pediatrics. The manuscript’s abstract can be found at Pubmed (link).

Iowa Well Represented at National Pediatric Endocrine Society Meeting

The Pediatric Endocrine Society (PES) is a professional organization of over 1,600 endocrinologists with the purpose of advancing treatment of youth with endocrine disorders. The PES held its annual meeting May 5-8 in San Diego. Several of our division faculty attended the meeting. Dr. Pesce presented at one of the symposium session on Endocrinology in the Neonatal Intensive Care Unit. Dr. Parra Villasmil presenter her research, conducted under the mentorship of Dr. Pinnaro, on Screening for Turner Syndrome-associated Hyperglycemia. Dr. Parra Villasmil’s work was selected as one of the top-ranking abstracts, receiving a PES Presidential Poster award. In addition, our future fellow, Dr. Kyle Baum, currently a pediatric resident at Sanford School of Medicine, also had an abstract selected for a PES Presidential Poster award.

Dr. Pesce presenting at PES 2023
Dr. Parra Villasmil at PES 2023

Dr. Pesce Recognized for her Outstanding Clinical Teaching

Dr. Pesce

Dr. Liuska Pesce is being recognized by the Carver College of Medicine for outstanding teaching. Today she is receiving the Collegiate Teaching Award. This award is given to recognize teaching that demonstrates unusually significant and meritorious achievement. The Award includes a plaque and monetary bonus. Those who have trained under her have many laudatory statements, including the following anonymous comment: “Dr. Pesce is the Mary-Poppins of physicians, ‘practically perfect in every way.’ She is an excellent teacher with clear explanations behind her thought processes which are always guided by best practices. She is very professional and thorough in all of her patient interactions and examinations. She provides excellent and timely feedback on presentations, physical exam findings, and clinical notes. She goes out of her way to ensure learners get the feedback they need.” Dr. Pesce is also involved in educational efforts at the national level, for example having just contributed as an author to this educational material “Pediatric ESAP 2023-2024: Pediatric Endocrine Self-Assessment Program. Washington, DC: Endocrine Society; 2023.”

Expert Advice on Providing Estrogen Replacement Therapy for those with Turner Syndrome

Dr. Eirene Alexandrou

The majority of women with Turner syndrome experience primary ovarian failure, meaning that their ovaries never produce estrogen in normal quantities. For this reason, normal puberty does not occur. Estrogen production is not only important for a feminizing puberty to occur but also is important for overall health and wellness. Dr. Eirene Alexandrou heads the Turner syndrome clinic (clinic homepage link) at the University of Iowa Stead Family Children’s Hospital. She is a published expert in Turner syndrome care. Recently, on April 4, Dr. Alexandrou gave an invited webinar entitled “Estrogen Replacement Therapy in Turner Syndrome” (announcement link) for the Turner Syndrome Foundation. She reviewed the prevalence of primary ovarian failure in Turner syndrome, the benefits of estrogen replacement therapy, and the timing of such replacement including initiation.

Advancing Reproductive Health of Youth

The North American Society for Pediatric and Adolescent Gynecology (NASPAG) is a non-profit association dedicated to advancing gynecologic care for youth. NASPAG held its 37th annual clinical & research meeting March 24-26 this year in Nashville. Dr. Kanner from our division was one of the Planning Committee members directing the meeting. Fellow Dr. Parra Villasmil from our division also attending the meeting and presented a Roundtable lecture. We thank them for their efforts to improve health.

Dr. Parra Villasmil leading a Roundtable at NASPAG 2023.
Dr. Kanner speaking at NASPAG 2023.

Impact of Highly Effective Modulator Therapy for Cystic Fibrosis on Body Composition

Dr. Larson Ode

The triple combination therapy consisting of elexacaftor/tezacaftor/ivacaftor (ETI) has made a tremendous impact for the health of persons with one of the most serious and most common genetic forms of cystic fibrosis. This medication dramatically improves lung health and helps persons with CF live a longer and healthier life. These medications also help persons with CF regain weight, which is important for health because being underweight in those with CF is associated with a higher risk of worsening lung disease and mortality. However, what is not yet known is whether the weight gain with ETI therapy is healthy weight gain such as muscle mass or less health gain such as excess adipose tissue. To address this knowledge gap, Dr. Katie Larson Ode from our division teamed with a group of investigators at several other hospitals across the country to study this in persons on ETI therapy. They found, perhaps concerningly, that the weight gain occurred mainly as increased fat mass and that the changes were associated with reduced insulin sensitivity. These results indicate a need to closely monitor and further study the metabolic impact of ETI therapy. Their study has been published in the journal Pediatric Pulmonology and is titled “The Impact of elexacaftor/tezacaftor/ivacaftor on Body Composition in a Small Cohort of Youth with Cystic Fibrosis”. It can be found at this pubmed link.

Finding Modifier Genes in Turner Syndrome

Dr. Pinnaro

Turner syndrome (TS) is a karyotype disorder in which the sex chromosomes consist of an intact X chromosome and partial-to-complete loss of the other sex chromosome. TS includes a number of phenotypic features, including many that have variable expression. The degree of second sex chromosome loss explains the risk of some but not all TS features. Modifier genes are one possible explanation for TS features whose risk is not explained by karyotype. In this case, the modifier genes would be polymorphisms on autosomal chromosomes. This postulate served as the basis for a recent research study by Dr. Cat Pinnaro. Specifically, she sought to determine whether autosomal genes might influence the risk of cardiovascular malformations in TS. She focused on genes involved in pathways already known to impact cardiac development. The identified that specific variants in the CRELD1 gene were associated with risk of having a bicuspid aortic valve in TS. This study serves as proof-of-concept that modifier genes impact TS phenotype, and paves the way for future studies searching for additional modifier genes that might impact other aspects of phenotype in TS and other karyotype disorders. The work is published in the journal Human Genetics (pubmed link here).

Dr. Tuttle Receives International Interest for His New Approach to Teach Physicians How to Manage Diabetes in Hospitalized Patients

The 11th International Meeting of Pediatric Endocrinology was held March 4-7 2023 in Buenos Aires, Argentina. This meeting allows pediatric endocrinology physicians from around the world opportunity to share their experiences, advances and best practices. This year the meeting was attended by over 1200 pediatric endocrinologists. Dr. Tuttle, a 3rd year pediatric endocrinology fellow in our division, presented his fellowship scholarly project at the meeting. He has created an interactive e-Book designed to more effectively teach pediatric resident physicians how to manage diabetes in hospitalized patients. Diabetes is difficult to manage, especially during illness and hospitalization. Mismanagement can lead to excessive hyperglycemia, elevated ketones, and/or hypoglycemia. Efficiently and effectively teaching learning physicians the complexities of management is challenging. Dr. Tuttle has met this challenge by creating new teaching approaches and materials and is currently working to optimize these new tools. An abstract of his poster presentation can be found here (linknote: this content may not be freely available at this external website).

Dr. Tuttle attends his poster at the 2023 International Meeting of Pediatric Endocrinology in Buenos Aires, Argentina .

Diabetes in Turner Syndrome

Although it has long been known that persons with Turner syndrome have increased risk of developing diabetes, the reasons are not well understood. Relatedly, there are no known preventative strategies and no directed therapies. Dr. Pinnaro and Dr. Alexandrou from our Division have teamed up to review published knowledge in this area and map out critical gaps in understanding. Their review, entitled “Hyperglycemia in Turner syndrome: Impact, mechanisms, and areas for future research” has just been published in the peer reviewed literature. Also contributing to the manuscript were student Cameron Mitsch and division member Dr. Norris. The paper appears in the journal Frontiers in Endocrinology and can be found here (doi: link or pubmed link ). Dr. Pinnaro is leading a team working to find the root causes of diabetes linked to Turner syndrome. It remains important for persons with Turner syndrome to receive expert endocrine care, such as can be obtained from Dr. Alexandrou; see this link for contact information for her Turner syndrome clinic .