Beata Sawicka

ESPE Position Statement for Paediatric Endocrinology Subspecialty

Paediatric Endocrinology, under the leaderships of Lawson Wilkins in the US and of Andrea Prader in Europe, started to take shape as a subspecialty in the 1960s. Since that time, paediatric endocrinology has developed at a tremendous speed, especially during the last 30 years, in line with increasing knowledge in the field of genetics and other basic sciences, as well as improved medications and technical facilities. Endocrine conditions encountered in childhood are diverse and show a wide spectrum that is in many aspects substantially different from endocrine diseases in adults and the elderly. Children are simply not little adults. Handling of paediatric endocrine disorders requires the special attention of medical specialists with significant background training in paediatrics, to understand all aspects of human growth and development, along with specialised training in paediatric endocrinology. Developmental issues, including sex differentiation, body growth, skeletal development, pubertal maturation, and neuropsychological development from the intrauterine period to adolescence and young adulthood, are specific paediatric issues that cannot be fully understood and managed without paediatric training as the basic medical background. Recognising, classifying, diagnosing, and managing disorders of growth and development are specific tasks for fully trained paediatric endocrinologists. At the European Academy of Paediatrics (EAP), a subsection of the European Union of Medical Specialists (UEMS; formerly CESP), each paediatric subspecialty is represented by a liaison officer within the Tertiary Care Working Group (TCWG). The EAP has its own legislation/constitution (Belgian/ EU law) representing the central unifying platform for paediatric training in Europe. One of the major goals of the liaison officers is to update the current syllabus and accreditation procedures for their subspecialty, aiming at harmonisation of paediatric training throughout Europe. ESPE has recently, in 2014, revised its training program and this was approved by the General AsPublished online: July 6, 2016 HORMONE RESEARCH IN PÆDIATRICS

Practical Application of Elastography in the Diagnosis of Thyroid Nodules in Children and Adolescents

Background: Ultrasound elastography is a noninvasive method of imaging based on the estimation of the mechanical properties of tissue. Data in adults indicate that decreased flexibility in comparison to the surrounding healthy tissue is characteristic of malignancy (in most thyroid carcinomas, except for follicular thyroid carcinoma). The purpose of our study was to assess the deformation of thyroid nodules and to evaluate the usefulness of elastography in predicting malignant thyroid nodules in adolescent patients. Methods: We examined 47 children with 62 thyroid nodules. All patients underwent elastography and fine needle aspiration cytology (FNAC). Results: Thirty-seven girls (79%) and 10 boys (21%) were included in the study. A strain ratio <2 was observed in 17 nodules (27% of the study group), a strain ratio between 2 and 4.9 in 34 nodules (55%) and a strain ratio >5 in 11 nodules (18%). According to cytological examination, 3 nodules (4.8% of the study group) were malignant. Two of them were hard (strain ratio ≥5), and 1 nodule had a strain ratio of 2. Conclusions: Our results suggest that elastography can be complementary to conventional ultrasonography and useful while making a decision about FNAC. At the same time, it should not replace the cytological assessment of thyroid nodules in children and adolescents.