Guidelines address pediatric obesity, thyroid disease in pregnancy, and androgen therapy in women

June 3, 2007

Contact:
Charles E. Blue, Director, Media Relations
Phone: 301-941-0240; Cell: 202-236-6324
cblue@endo-society.org

Aaron Lohr, Manager, Media Relations
Phone: 240-482-1380
alohr@endo-society.org

Toronto, Canada—The Endocrine Society will host three clinical practice guideline sessions at ENDO 07, the 89th annual meeting of the Society, to provide an in-depth look at its most recent guidelines: “Prevention and Treatment of Pediatric Obesity,” “Management of Thyroid Dysfunction during Pregnancy and Postpartum,” and “Androgen Therapy in Women.”

These clinical practice guidelines give healthcare professionals the benefit of the most recent advances and new strategies in diagnosing and treating patients.

Pediatric Obesity

The prevalence of childhood obesity has increased four-fold since 1970 for children ages 6 to 11. Health concerns related to pediatric obesity include its association with diabetes, sleep apnea, and various cardiovascular risk factors.

Among the guideline’s recommendations are:

• Defining overweight as BMI (body mass index) ≥85th percentile but ≤ 95th percentile, and obesity as BMI ≥95th percentile
• Preventing obesity by breast feeding infants for at least 6 months
• Prescribing and supporting lifestyle (diet and physical activity) modification as the cornerstone of prevention of overweight and obesity and as a prerequisite for any other treatment for children with BMI ≥85th percentile for age and gender
• Advocating that schools provide for 60 minutes of moderate to vigorous daily exercise in all grades
• Avoiding routine laboratory evaluations for classic endocrine causes of obesity in obese children or early- to mid-pubertal adolescents unless the child’s growth rate is attenuated
• Prescribing pharmacotherapy in combination with lifestyle modification for obese and overweight children with co-morbidities only after a formal 6-month program of lifestyle change has failed

The guideline also discusses indications and evaluation for bariatric surgery in youth.

“Pediatric obesity has reached epidemic levels,” said Gilbert August, MD, chair of the expert panel that developed the guidelines. “These guidelines reinforce the notion that lifestyle changes regarding exercise and diet are paramount.”

This clinical practice guideline session will take place on Sunday, June 3 at 8:30–9:15 a.m. in room 102 at the Metro Toronto Convention Centre.

Thyroid Disease in Pregnancy

Management of thyroid diseases during pregnancy requires special considerations since pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on the pregnancy and the fetus.

Clinical practice guidelines are critical as proper care requires coordination among several health care professionals including obstetricians, nurse midwives, family practitioners, endocrinologists, and/or internists.

Among the guideline’s recommendations are:

• Avoiding maternal (and fetal) hypothyroidism because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery
• Fine needle aspiration cytology be performed for dominant thyroid nodules discovered in pregnancy
• Radioactive isotopes must be avoided during pregnancy and lactation
• Universal screening of pregnant women for thyroid disease is not yet supported by adequate studies, but case finding targeted to specific groups of patients who are at increased risk is strongly supported.

“In the last 15 years, we have seen a rapid expansion of knowledge regarding thyroid disease and pregnancy,” said Leslie DeGroot, MD, professor of medicine at Brown University and chair of the expert panel that developed the guidelines. “These guidelines take into account the rapidity of advances in this field, and puts forth evidence-based recommendations for optimal detection and management of thyroid disease in the pregnant woman.”

This clinical practice guideline session will take place on Monday, June 4 at 8:30–9:15 a.m. in room 102 at the Metro Toronto Convention Centre.

Androgen Therapy in Women

The Society’s clinical practice guideline on androgen therapy in women recommends against making a diagnosis of androgen deficiency in women.

“We lack a well defined clinical syndrome and normative data on total or free testosterone levels across the lifespan,” says Margaret Wierman, MD, professor in medicine at the University of Colorado at Denver and Health Sciences Center and chair of the expert panel that developed the guidelines. “Without this information, we cannot accurately define this disorder.”

Although there is evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women, the guideline recommends against the generalized use of testosterone by women because the indications are inadequate and evidence of safety in long-term studies is lacking. A review of the data currently available is presented, and areas of future research are outlined in the guideline.

This clinical practice guideline session will take place on Tuesday, June 5 at 8:30–9:15 a.m. in room 102 at the Metro Toronto Convention Centre.

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Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.