ESPE Abstracts

Pediatric severe obesity is a major threat to health and longevity. Around 7% of children worldwide have early onset severe obesity before the age of 7. Pediatric obesity is caused by an interplay of multiple factors: lifestyle, environmental, sociocultural, psychological, biological and genetic factors. Endocrine, monogenetic or syndromal causes are rare, but currently underdiagnosed and important to identify for the need of specific treatment. Cardiovascular risk factors and...

Introduction: The current standard of care (SOC) for adrenal insufficiency (AI) is suboptimal due to fluctuating cortisol plasma concentrations. The sub- and supraphysiological cortisol levels, combined with the multi-day tablet intake, are associated with negative health outcomes and a poor quality of life. Furthermore, there is a high interindividual difference in the cortisol need, demanding a personalized approach. Pharmaceutical 3D printing (3DP) allows f...

Introduction: Following the onset of the COVID-19 pandemic in spring 2020, the European Registries For Rare Endocrine Conditions (EuRRECa), which is a collaboration between Endo-ERN, ESPE and ESE provided the possibility for registration of cases. Obesity is a risk factor for severe COVID-19 disease course in adults. In children and adolescents, COVID-19 disease course is much milder, but has also been identified as risk factor. As rare genetic obesity disorde...

Background: Biallelic loss of function (LoF) mutations in the leptin receptor gene (LEPR) cause a striking phenotype of early-onset severe obesity and hyperphagia. Additionally, hypogonadotropic hypogonadism, growth hormone deficiency, and/or hypothyroidism are often present. Currently, 19 European patients (all aged <30 years) are described in literature. As clinical trials investigating MC4R-agonist treatment are performed throughout Europe, ide...

Background: Inhalation corticosteroids (ICS) as treatment for asthma can interfere with the hypothalamic-pituitary-adrenal axis and could lead to hypocortisolism. The frequency of this systemic side effect and the correlation to ICS usage is still unclear. Given that the cortisol excretion is pulsatile and determined by acute stress and circadian rhythms, the usefulness of tests based on momentary measures, such as saliva or serum are therefore limited. Cortisol levels measure...

Background: Peak stimulated growth hormone (GH) levels are known to decrease with increasing BMI, possibly leading to overdiagnosis of GH deficiency (GHD) in children with overweight and obesity. However, current guidelines do not provide guidance how to interpret peak GH values of these children. The aim of this systematic review and meta-analysis was to study the effect of BMI standard deviation score (SDS) on stimulated peak GH values in children, to identi...

Introduction: The gold standard for the diagnosis of adrenal insufficiency (AI) is the ACTH stimulation test. According to the guidelines approved by the European Endocrine Society, the ACTH stimulation test should be performed with the administration of the standard dose of i.v. Synachten® 250 µg for adults and children aged ≥ 2 years (infants should receive 15 µg/kg, children ≤ 2 years 125 µg). In many clinical settings a Syna...

Leptin receptor deficiency is a rare genetic disorder that affects the body’s ability to regulate appetite and weight. For patients and their families, the disorder seriously disrupts daily life, however, little is published about this impact. We here report the experiences of a 10.5-year-old girl with leptin receptor deficiency and her family. The diagnosis of this rare genetic obesity had a deep impact on the life of the child and her family. It led to a better underst...

Background: Wernicke Encephalopathy (WE) is an acute life-threatening neuropsychiatric disorder caused by vitamin B1 (thiamine) deficiency. Although commonly associated with alcohol abuse in adults, it can also arise from non-alcoholic causes. WE is rarer in children. To our knowledge, WE has never been described in patients with extreme insatiable hunger due to genetic obesity, which seems paradoxical. We present a case of WE due to acute avoidance, restricti...

Background: Underlying causes of obesity are thought to be rare even in specialized paediatric endocrinology clinics. However, evidence is limited. The Endocrine Society (ES) guideline for paediatric obesity makes the following diagnostic recommendations: endocrine evaluation in presence of reduced growth velocity, evaluation of cerebral obesity in presence of CNS injury, re-evaluation of drug choice in patients using antipsychotics. Genetic testing is recomme...