U.S. News & World Report 2011-2012 edition of "Best Children's Hospitals" ranks the Diabetes programs at Nemours/Alfred I. duPont Hospital for Children, and at our pediatric partner Wolfson Children's Hospital, among the best in the country.
Patient Story
Endocrinology: Aaron
When 15-month-old Aaron developed an ear infection, his mother, noticed a strangely sweet odor about him. A registered nurse, Sheri immediately recognized it as ketones, a sign of type I diabetes. She...
Nemours Ranks Among the Nation's Best for Treating Kids With Diabetes & Endocrine Disorders
Hormones and Growth (Endocrinology)
The caregivers and staff of the Nemours Division of Endocrinology pride ourselves in providing top-quality care for babies, kids, and teens with all kinds of hormone problems (including diabetes, growth disorders, abnormal thyroid function, disorders of puberty, and many more).
Hidden deep within the body, the endocrine glands produce hormones – chemical substances that circulate in the bloodstream and act as signals from one type of cell to another. Manufactured by glands (like the pancreas, thyroid, adrenal, and pituitary), hormones control growth, puberty, reproduction, metabolism, and many other bodily functions.
Pediatric endocrinology is a subspecialty dealing with both common and very rare disorders. Type 1 diabetes is probably the most recognized condition seen by pediatric endocrinologists (doctors who specialize in treating children with hormone and growth problems). Disorders of growth are also high on the list.
By combining outstanding care, research, and patient and professional education, we’re able to give the children we see at our many Nemours locations the latest and best diagnostic evaluations and treatments. In addition to offering personalized, top-level care in our clinical settings, we’re also at the forefront of research and education of the next generation of pediatric endocrinologists.
In everything we do, we cater to you – making sure that you can feel confident entrusting your child’s care to Nemours.
Our commitment to improving the health of the whole child
We offer our patients and families a “total care experience” – we don’t just treat your child’s condition, we treat the “whole child.” That’s why our programs include these many comprehensive services for both the kids we care for and their families:
- diabetes-specific services
- convenient blood sugar reporting (by e-mail, fax, or phone) for diabetes patients
- inpatient and outpatient diagnostic and therapeutic services
- 24-hour, on-call emergency support for patients and families
- after-hours support groups for kids and families (available at some locations)
- nutrition and weight management services
Our efforts to keep you involved and informed
We may know your child’s endocrine problem and how to treat it, but you know your child best. That means we want you to be an active participant in the decision-making and health management process. And that’s why we take the time to: explain the diagnosis and treatment in understandable terms, present information about all of the options, and give you the training and educational materials you need to take charge of your child’s care at home. In diabetes, for example, our team members – including our certified diabetes educators (CDEs) – make sure that you understand what’s going on, what to expect, and how to manage your child’s diabetes and create lifestyle habits that will hopefully last a lifetime.
Our care throughout the communities
From our convenient locations in the North to our many clinics in the South we make it easy for you to get Nemours’ optimal endocrinology care. No matter where we’re located, at Nemours our mission is to give your child not just quality treatment, but the education and support you and your family need where and when it’s convenient for you. You can usually see not just your doctor, but multiple members of our endocrinology care teams all on the same day, at the same place – saving you precious time and money.
Our caring, experienced, skilled endocrinology care teams usually include:
- board-certified endocrinologists
- certified diabetes educators (CDE)
- registered dieticians/nutritionists
- nurses and nurse practitioners
Our patients we serve
At Nemours our experts in hormones, growth, and development are committed to providing care, treatment, education, and supportive services for children with diseases of (and related to) the endocrine system, which include (but aren’t limited to):
- type 1 and type 2 diabetes, maturity onset diabetes of youth, and insulin resistance disorders
- hypoglycemic disorders (such as neonatal hyperinsulinism)
- childhood obesity
- puberty disorders (such as premature/precocious puberty and delayed puberty)
- growth disorders (such as short stature and growth hormone deficiency)
- pituitary disorders (diabetes insipidus, hypopituitarism, septo-optic dysplasia, brain tumors affecting pituitary function)
- thyroid diseases (such as Hashimoto’s thyroiditis, Graves disease and thyroid cancer)
- adrenal disorders (such as Addison’s disease, congenital adrenal hyperplasia, and Cushing’s syndrome)
- polycystic ovary syndrome and other menstrual disorders
- genetic disorders that affect growth and fertility (such as Turner syndrome and Klinefelter syndrome)
- bone diseases and disorders of calcium and vitamin D (such as rickets and osteoporosis)
- disorders of sexual differentiation
Our commitment to research
At Nemours we make research a high priority. Why? Because we know that what we learn in the lab and our clinics can be put to work by our endocrinology teams to make our patient care the very best it can be. Our extensive involvement in clinical research includes physiologic studies that help us understand the complex interactions of nutrients and hormones, as well as developing novel treatments both in original work and participating in multi-center trials of medications used to treat hormonal problems. Many of these trials provide opportunities for our patients to receive innovative treatments potentially not available elsewhere.
There are multiple research projects and clinical trials focused on diabetes and disorders of growth and puberty underway throughout Nemours Center for Endocrinology, Diabetes & Metabolism and within the Nemours Center for Pediatric Psychology Research. Nemours endocrinologists also collaborate with other researchers in Center’s throughout the organization.
The Biomedical Analysis Laboratory is currently providing technical support to several ongoing studies in the areas of growth and metabolism, protein and amino acid metabolism, nutrition, obesity and cardiovascular disease.
Research at Nemours Children's Clinic, Jacksonville
The investigative team at the Nemours Children’s Clinic, Jacksonville, Florida, is involved with multiple research projects funded by institutions such as the National Institutes of Health (NIH), Juvenile Diabetes Research Fund (JDRF), Genentech Foundation for Endocrine Research, and the Abbott Fund, among others.
1. Effects of therapeutic intervention on cardiovascular risk markers, insulin resistance, and intra-hepatic fat contents in obese children at risk for metabolic syndrome (syndrome X), funded by Thrasher Research Fund. Data from this study will provide novel insights into the role of inflammation and thrombosis as co-morbidities in the metabolic syndrome in children and adolescents and further explore the interactions of pro-inflammatory markers with markers of insulin sensitivity and pubertal hormones.
2. A randomized, double-blind, placebo-controlled multi-center trial to assess the safety and efficacy of anastrozole (Arimidex™) in increasing predicted adult height of adolescent males with growth hormone deficiency, funded by AstraZeneca. The results of these studies offer a new and important alternative treatment for boys with disordered growth, and were published in the Journal of Clinical Endocrinology and Metabolism in 2008.
3. Nutrients and hormones: effects in boys with disordered growth, funded by Genentech Center for Endocrinology Research. This study offers unique insight into the role of nutrition with the in vivo actions of growth hormone, particularly for constitutional delay of growth and maturation (CDGM)—one of the most common causes of short stature.
4. Amino-terminal propeptide of C-type natriuretic peptide levels in healthy children, funded by Quest Diagnostic Laboratory and Nemours. This study is measuring levels of NT-proCNP in a large group of healthy children to see if NT-proCNP correlates with growth velocity and to define its normal range. This study may contribute to an important new tool for the evaluation of growth and overall health in children.
5. Effect on stature of genetic variations in the C-type natriuretic peptide receptor, funded by Genentech Center for Endocrinology Research. Recent data have shown that CNP, acting through its receptor natriuretic peptide receptor-B (NPR-B, gene NPR2), plays an important role in linear growth and may play a role in IGF-I regulation. Researchers have recently shown in a large kindred that segregates and inactivating mutation of NPR2, heterozygous carriers are significantly shorter than non-carriers. The prevalence of NPR2 mutations in the general population suggests these might be a significant cause of “idiopathic” short stature. This study is testing that hypothesis by determining the prevalence of NPR2 abnormalities in people with idiopathic short stature by sequencing NPR2 in 100 people with idiopathic short stature.
6. C-Type natriuretic peptide and Marfan syndrome: a pilot study, funded by Nemours. Marfan syndrome is a common genetic syndrome that affects the bones, heart, lung and eyes. The skeletal features include tall stature and are primarily due to bone overgrowth. Currently, there are no blood tests for the diagnosis of Marfan syndrome. This study is measuring a fragment of CNP in the blood of people and mice with Marfan syndrome to see if it is elevated. The CNP fragment may prove to be such a blood test. This blood test may also be useful in evaluating a new drug designed to treat Marfan syndrome.
7. C-type natriuretic peptide and skeletal growth: impact of thyroid dysfunction in prepubertal children, funded by Pfizer, Inc. Another study of blood levels of CNP and its related protein NTproCNP in children with abnormal rates of growth, researchers hope to determine the relationship between these blood levels and growth rates in children with thyroid disorders following treatment. This study will help to further clarify the important role of CNP in skeletal growth.
8. The artificial pancreas project, a multi-center trial funded by Juvenile Diabetes Research Foundation (JDRF). Children and adolescents with type 1 diabetes were recruited and randomized to (either) conventional insulin therapy or insulin therapy plus a continuous glucose sensor (CGS) to determine effectiveness of the combination of these therapies and tools in treatment.
9. Continuous glucose sensors and oxidative stress, funded by JDRF. Recruited patients have blood drawn to measure a series of parameters that reflect the oxidative damage in the body and whether those measures of oxidative damage correlate with the variability of glucose measurements obtained by the continuous glucose sensor. This will help determine whether the “bounciness” of blood sugars can affect oxidative stress in children with diabetes.
10. Regulation of glutathione homeostasis in adolescents with type 1 diabetes, funded by JDRF. This study expands on earlier studies that improve the understanding of the regulation of blood glutathione, an antioxidant, in adolescents with type 1 diabetes.
11. Clinical Use of Continuous Glucose Monitor (CGM) in Adolescents with Inadequate Diabetic Control, funded by National Institutes of Health. A randomized trial of this new technology with adolescents who have not been achieving targeted levels of glycemic control.
12. Hypoglycemia in children and adolescents with type 1 diabetes: mechanisms and prevention, funded by National Institutes of Health (NIH)
13. Development and initial use of the diabetes support in school scale, a survey conducted among parents in the diabetes clinic designed to learn about the in-school support available and needed for diabetes self-management.
14. A pilot study of the effect of continuous subcutaneous insulin infusion in adolescents with newly-diagnosed type 1 diabetes on insulin resistance, beta-cell function and the honeymoon period, funded by Nemours. This study evaluates how insulin pump therapy (CSII) compares with multiple daily injections (MDI) in affecting the time of onset and duration of the honeymoon period, and whether differences are related to changes in insulin sensitivity and beta-cell function. The data generated in these studies will offer a unique insight into the role of modern insulin delivery systems on beta-cell functions in adolescents who start using pumps at diagnosis.
Research at Nemours Children's Clinic, Pensacola
At Nemours Children’s Clinic, Pensacola, Florida, the Endocrinology Department has actively been recruiting for five observational research studies from patients who are currently on growth hormone therapy. Nemours patients benefit from these studies, as they are an effective method to track potentially serious side effects that any patient on the same medication may experience.
The following is a summary of the current studies underway in Pensacola:
| Trial Name |
Sponsor |
Drug |
| GeNeSIS |
Eli Lily |
Humatrope |
| KIGS |
Pfizer |
Genotropin |
| NCGS |
Genentech |
Nutropin (AQ) |
| Norditropin |
Novo Nordisk |
Norditropin |
| Increlex |
Tercica |
Increlex |
Other research studies underway in Pensacola, include:
1. Leuprolide Acetate 3 month formulation for patients diagnosed with central precocious puberty, sponsored by Abbott Endocrine, Inc.
2. Estrogen dosing in Turner Syndrome. This study is to evaluate the pharmacological and metabolic dosages of estrogen in girls with Turner Syndrome.
3. TrialNet Natural History Study, sponsored by National Institutes of Health (NIH) with the University of South Florida serving as coordinating center and the University of Florida serving as the regional site. During the first phase of this study, both first- and second-degree relatives of patients with type 1 diabetes are screened to determine if they are at risk of developing the disease. If an individual is identified as positive or at risk for developing type 1 diabetes, they move into phase two of the study to further examine the level of risk, assessing insulin response in an oral glucose tolerance test.By identifying individuals at high risk for developing type 1 diabetes, the TrialNet research group hopes to gain further information about the disease in order to implement methods to prevent it or slow its progression.
Resources from Nemours KidsHealth.org
Diabetes
- Diabetes Center (for Parents)
- Diabetes Center (for Teens)
- Kids’ Diabetes Center (for Kids)
- Nick Jonas and Diabetes: Call Me Mr. Positive (for Kids)
Other Diabetes Resources
- Helping the Student with Diabetes Succeed (for school personnel)
National Diabetes Education Program - Children with Diabetes
- Barbara Davis Center for Childhood diabetes
- National Diabetes Education Program (English & 18 other languages)
- American Diabetes Association
- Juvenile Diabetes Research Foundation
- Trial Net- Diabetes Research
- Becoming a diabetes advocate in the schools
- American Diabetes Association
- Children with Diabetes
- Diabetes Life
- National Diabetes Information Clearinghouse (English & Spanish)
- National Institute of Diabetes & Kidney Disease National Clearinghouse
- Centers for Disease Control
- American Heart Association
- International Diabetes Federation
Growth
- Growth Disorders (for Kids)
- Growth Problems (for Teens)
- Turner Syndrome (for Parents)
- Turner Syndrome (for Teens)
- What Is a Growth Disorder? (for Parents)
- Your Child’s Growth
Delayed/Precocious Puberty
General Endocrine/Anatomy
Thyroid Conditions
Parent Support Services
Quick Links
Trusted Resources
- American Diabetes Association (ADA)
- American Dietetic Association (ADA)
- ClinicalTrials.gov
- The Hormone Foundation
- The Human Growth Foundation
- Juvenile Diabetes Research Foundation International (JDRF)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- National Institute of Child Health and Human Development
- Turner Syndrome Society of the United States
Nemours News
Pilot Study for Diabetics
Constantly worrying whether your child's blood sugar is spiking or plummeting. Waking them up in the middle of the night every two hours to prick thei...
Childhood Obesity Increases Early Signs Of Cardiovascular Disease
At a press conference held today at The Endocrine Society’s 91st Annual Meeting in Washington, D.C., Nelly Mauras, M.D., Division Chief of Endocrinolo...