Choosing Wisely: 5 Pediatric Endocrinology Tests to Avoid

According to Ricki Lewis from Medscape (October 5, 2017):

“The American Academy of Pediatrics (AAP) Section on Endocrinology has added five tests commonly ordered for children and teens showing signs of early puberty, short height, or other hormone-related concerns to the 15 tests already making up their Choosing Wisely campaign.”

“The lists aim to alert parents and physicians to discuss tests that might be overused, especially among otherwise healthy individuals.”

“Past Choosing Wisely recommendations have included perinatal issues, the inappropriateness of prescribing antibiotics for viral respiratory illnesses in children, and not to order computed tomography or magnetic resonance imaging scans for simple febrile seizures”.

“Choosing Wisely is an initiative of the ABIM Foundation, in conjunction with Consumer Reports. The complete list and the five new entries are both available on the Choosing Wisely website.”

The new additions to the Choosing Wisely campaign issued by the endocrinology section of the American Academy of Pediatrics include:

The endocrinology section of the American Academy of Pediatrics has issued a list of five tests clinicians should avoid as part of the Choosing Wisely campaign.  These include:

  • Hormone tests (luteinizing hormone, follicle-stimulating hormone, and estradiol or testosterone) in children with pubic hair or body odor but without other signs of puberty
  • Screening tests for chronic illness or endocrine conditions in healthy children growing at or above the third percentile for height (at a normal growth rate) and with appropriate weight gain. Even in children who are below the 3rd percentile for height with a normal history and physical exam, the incidence of newly diagnosed pathology was found to be only about 1%. In patients who have significant short stature (e.g. ≤-2.5 SD) or who are well below their genetic potential based on parental heights, tiered or sequential screening may be considered.
  • Routine measurement of serum vitamin D in healthy children, including those who are overweight or obese.  This may have some relevance for autism, given the ongoing controversy of Vitamin D in this condtion. According to the American Academy of Pediatrics, although a 25-hydroxyvitamin D concentration, reflecting both vitamin D synthesis and intake, is the correct screening lab to monitor for vitamin D deficiency, current evidence is not sufficient to suggest that screening in otherwise healthy including children who are overweight or obese is necessary or safe. Global consensus recommendations caution against population-based screening for vitamin D deficiency. The US Preventive Services Task Force also has noted that variability of current assays and unclear cutoffs for deficiency may lead to “misclassification” of persons as having vitamin D deficiency, and that this misclassification “could outweigh any benefits if there are harms”. The American Academy of Pediatrics report on Optimizing Bone Health in Children and Adolescents advises screening for vitamin D deficiency only in patients with disorders associated with low bone mass such as rickets and/or a history of recurrent, low-trauma fractures. It has been shown that children who are overweight or obese have a greater likelihood of having low vitamin D levels. If the history suggests an obese child has insufficient dietary intake of vitamin D (e.g., little milk intake), a vitamin D supplement should be recommended, which is more cost-effective than 25-hydroxyvitamin D measurements for both screening and monitoring therapy.
  • Measurement of thyroid function or insulin levels in obese children
  • Routine ultrasound of the thyroid in children with simple goiters or autoimmune thyroiditis

 

 

 

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