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Re: [IPp] physicals for girls

> Do any of your children's endos. do a full physical (checking for
> "development" above and below) exams with your quarterly
> appointments?  My 12 yo is getting tired of being looked at and I
> don't see why it is necessary.  Our endo. says it is necessary to
> track normal development in this way.

I passed your question along to a panel of ped-endos and this is a 
selection of their responses -- all basically saying the same thing.
email @ redacted
... This is particularly important during the
adolescent growth spurt, about Tanner stage 2 (8-12
years) in girls.  The insulin dose often increases by
50% or more at this time in girls.  This increase
occurs later in boys, both at a later age and at a
later stage of puberty.  If puberty is not
progressing, or if control is difficult,
hypothyroidism may be occuring, but I usually check
thyroid function tests yearly.  If the patient
objects, I can and do skip this part of the exam, but
I try to find out why there is an objection.  If the
child is developing late or slowly, there is even more
reason to examine the development.  I would also
wonder if this child may be sexually abused, teased by
classmates about early or late development, or has
some other problem with developing sexuality. 
Checking "development" is particularly important in
new patients, poorly controlled patients, and very
tall or short patients.  If this child has not started
periods yet, it would be important to know if she has
no development, or if she is beginning to develop.  I
would usually order an LH and FSH in a 12 year old
girl with no menses and no signs of puberty.    
Daniel Postellon MD
Puberty has a major effect on diabetes control; therefore, it is
important to do puberty staging at most visits, especially those
around the time that puberty starts.  Also, poor diabetes control can
slow onset of puberty, and therefore, it isn't a good idea to assume
puberty has started without actually looking.  Both boys and girls are
shy about this exam, and if they are especially bothered by it, I have
let them self-stage by looking at pictures and telling me which
picture is closest to where they are.  For boys I let them do the
comparison with the ochidometer (the testicular volume models)
themselves and report it to me.  Of course, it's not as good as
looking firsthand, but when they are especially shy, it does provide
an approximation. Stephen F. Kemp, MD
 A complete exam including sexual maturity rating (Tanner Staging) is
appropriate at least twice yearly.  The impact of diabetes on sexual
maturation is well documented and vice-versa puberty and its hormonal
changes affect diabetes and blood sugar control. 
Sincerely, Reuben Rohn, MD
When blood sugars go up unexpectedly ina pre-teen, it is important to
check to confirm puberty has started because that helps a patient and
his/her parent get over preconceived notions about their insulin doses
and how to adjust them.  When puberty occurs,  a person may have to
change their doses by 50% in a relatively short period of time.
Without this advice from the endocrinolofgist,  the patient's blood
sugars generally remain high for a while.  Once puberty is confirmed,
it really isn't that important to check any more (unless periods
appear to be unduly delayed or there is a vaginal compalint such as
itching). Alan Cortez,MD
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