Mark R. Palmert, MD, PhD, Editor

Denis Daneman, MBBCh, FRCPC, DSc (Med), Editor

Some topics were obvious as they represent the “frontiers” in pediatric endocrinology, namely, childhood obesity and its myriad consequences, and the child with repeated fractures. The vast majority of these children will remain in the care of generalists. Knowing who to investigate and who and when to refer for subspecialty opinion is important both in providing their care and in planning for specialized services.

Preventing diabetic ketoacidosis (DKA) is feasible and the only sure way to prevent the sometimes dire complications of DKA. The remaining three articles in the diabetes section explore, first, the use of technology in achieving goals: the use of pumps and sensors is steadily increasing and, when used optimally, can greatly improve outcomes, but rigorous assessment of cost-effectiveness is still needed. A second article highlights success as current approaches to therapy in type 1 diabetes have begun to show major reductions in the classical diabetes-related complications. The final article highlights that the brain ought to be added to the list of organs needing protection.

We chose to highlight two common reasons for referral to pediatric endocrinologists, namely, minor abnormalities in thyroid function or structure and menstrual irregularities, because most represent normal variations and can be easily separated into the majority that do not require referral from the minority that do. The article on height enhancement provides reason for pause in the ever-increasing use of growth hormones.

The articles on disorders of sexual differentiation (DSD) and gender dysphoria were included to highlight changing philosophies in these fields: in the indications and timing of surgery for the management of common and uncommon DSDs, and in the approach to and management of gender nonconforming youth. Our patients have taught us enormously in the past 10 years or so.

Finally, the articles on hyperinsulinemic hypoglycemia of infancy and early-onset diabetes (neonatal to about 6 months) highlight the need for molecular genetic diagnosis and the value of next-generation sequencing in informing not only diagnosis but also, perhaps even more importantly, management of these rare conditions.

Much has been left out of this issue, work to do for the next guest editors in pediatric endocrinology and diabetes. We are indebted to an international group of authors and coauthors for their excellent contributions. They all very willingly agreed to participate in this issue of Pediatric Clinics of North America .