Continuous glucose monitoring (CGM) is being increasingly utilized in inpatient pediatric diabetes care; however, data on its real-world accuracy remain limited. We retrospectively assessed the clinical accuracy of factory-calibrated Dexcom G6 and G7 CGM systems in 69 pediatric patients with type 1 diabetes at a Korean tertiary hospital between 2019 and 2025. A total of 1838 CGM readings were temporally paired with point-of-care (POC) capillary glucose measurements. Accuracy was evaluated using the mean absolute relative difference (MARD), mean absolute difference (MAD), Bland-Altman analysis, and Clarke error grid classification. Subgroup analyses were performed according to the sensor day, glucose range, care setting, and CGM type. The overall MARD was 10.6±10.1% and MAD was 15.4±16.2 mg/dL. Accuracy improved over time, with MARD declining from 13.8% (G6) and 11.0% (G7) on Day 1 to <10% on Days 6 and 4, respectively. Bland-Altman limits narrowed from ±60 to ±39 mg/dL. During Days 6-11, 86% of CGM-POC pairs were within Clarke Zone A and 97% in Zones A+B. The MAD increased with higher glucose levels, whereas the MARD was highest during hypoglycemia (15.2%) and lowest during hyperglycemia (8.5%). ICU admission significantly increased the MAD (p=0.001) without affecting the MARD. G7 demonstrated superior accuracy to G6 (pooled MARD: 9.8% vs. 11.2%, p=0.003). Mixed-effects modeling confirmed that sensor day was an independent predictor of accuracy improvement (-0.34% MARD/d, p<0.001). The Dexcom G6 and G7 CGMs met the ISO 15197:2013 and FDA integrated-CGM criteria after a short inpatient stabilization period.

Purpose This study aimed to evaluate national trends in central precocious puberty (CPP) incidence in Korean children and to examine the association between early childhood obesity and CPP using linked population-based datasets.Methods Data were obtained from the National Health Insurance Service (NHIS, 2012–2020) and the Infant/Toddler Health Check-up Program (2013–2016). CPP was defined operationally as having an International Classification of Diseases, 10th Revision code for precocious puberty, NHIS registration for CPP, and at least one year of gonadotropin-releasing hormone agonist treatment initiated before age 8 in girls and 9 in boys. Children with at least 3 health screenings before 6 years of age were included for body mass index (BMI) analysis. Multivariable logistic regression was used to estimate odds ratios (ORs) for CPP across BMI categories.Results A total of 195,892 CPP cases were identified. The incidence of CPP increased steadily from 2012 to 2020 in both sexes. In BMI analysis (n=35,766), CPP risk was significantly higher in the overweight (85th–94th percentile) and obese (≥95th percentile) groups compared to the normal-weight group (5th–84th percentile). The association was strongest in obese boys (OR, 2.573; 95% confidence interval, 2.417–2.739). Underweight status (<5th percentile) was associated with reduced CPP risk.Conclusions CPP incidence in Korea has increased in recent years. Early childhood obesity is a strong, independent risk factor for CPP, particularly in boys. Early weight management strategies may help reduce CPP risk.a

Purpose Metabolic syndrome (MetS) is increasingly prevalent among adolescents, and thyroid-stimulating hormone (TSH) levels influence metabolic health. This study investigates whether TSH levels are associated with MetS and its components in euthyroid adolescents.Methods We used data from the Korean National Health and Nutrition Examination Survey between 2013 and 2015. The study included 940 euthyroid adolescents aged 10–18 years, who were divided into 2 groups: high-normal TSH group (top 25% of euthyroid TSH levels) and nonhigh TSH group (remaining 75%). We analyzed the association between high-normal TSH levels and MetS and its components.Results TSH quartiles were related to MetS (P for trend=0.006). The prevalence of MetS was 3.5% in the high-normal TSH group and 1.9% in the nonhigh group (P=0.1929). Abdominal obesity was more prevalent in the high-normal TSH than in the nonhigh TSH group (16.2% vs. 9.6%, P=0.0153). Other MetS components were more prevalent in the high-normal TSH group, but the difference was not significant. High-normal TSH was significantly associated with abdominal obesity (adjusted odds ratio, 1.975; 95% confidence interval, 1.104–3.531, P=0.0218).Conclusions In euthyroid adolescents, a significant trend was observed between TSH quartile and MetS. Specifically, high-normal TSH levels showed a significant association with abdominal obesity, a key component of MetS.

To the editor, Congenital hyperinsulinism (CHI) is a rare disease, but most frequent of persistent hypoglycemia in infants and children.CHI is caused by unregulated insulin secretion by the pancreatic cells.In these patients, recurrent episodes of hyperinsulinemic hypoglycemia lead to significant risk of permanent brain damage [1].Usually, CHI is clinically diagnosed when plasma insulin levels exceeded 2 U/ mL, despite a blood glucose concentration of <50 mg/dL, free fatty acids (FFA) <1.7 mmol/L, -hydroxybutyrate <1.8 mmol/L, and a glycemic response to glucagon >30 mg/dL [2].Transient hyperinsulinemic hypoglycemia usually resolves on its own within a few days or months [3,4].A prompt diagnosis of CHI and immediate management of glucose levels is critical to prevent complications such as epilepsy, cerebral palsy and neurodevelopmental deficits [1,3,4].Disease-causing variants in 16 different genes have been reported to cause isolated CHI.Recently, advances in genetic analysis technology have made improved accessibility to genetic diagnosis, as a result, more new genes causing CHI are continuously being identified.According to recent studies, FOXA2, CACNA1D and EIF2S3 gene mutations have been considered as a cause of CHI [4].These can be classified into defects in genes encoding the pancreatic ATP sensitive potassium channels (ABCC8 and KCNJ11) and other channels/transporter proteins (KCNQ1, CACNA1D and SLC16A1), enzymatic gene defects (GLUD1, GCK, HADH, UCP2, HK1, PMM2 and PGM1) and defects in genes encoding the transcription factors (HNF1A, HNF4A, FOXA2 and EIF2S3) [4].Herein, we report a case of CHI with a novel heterozygous variant in NEUROD1 detected by next-generation sequencing (NGS) panels associated with CHI.A 3-day-old girl presented with hypoglycemia for 4 days.She was delivered via cesarean section at a gestational age of 39 +2 weeks and had a birth weight of 3.0 kg (30.2 percentile).Her mother had no gestational diabetes.She was diagnosed with transient tachypnea of the newborn immediately after birth and received high-flow nasal cannula therapy.On the third day post-birth, hypoglycemia developed, and intravenous fluids were administered with a glucose infusion rate of 13.3 mg/kg/ min.Laboratory findings during the hypoglycemic episode (44 mg/dL) revealed plasma insulin of 3.5 U/mL, FFA levels of 0.198 mmol/L, and negative ketones, fulfilling the diagnostic criteria for CHI.Diazoxide therapy was initiated at a dose of 10 mg/kg/day for 2 days, followed by a reduction to 6.75 mg/kg/day, which resulted in effective blood glucose control.The medication was discontinued after 70 days without any side effects except for mild hirsutism, with sustained euglycemia observed postdiscontinuation.NGS panel test was conducted in the patient at the diagnosis of CHI, resulting in the NEUROD1 gene variant,c.79C>T,p.Leu27Phe (NM_002500.4).This variant was initially classified into variant of uncertain significance.Minor allele frequency of the variant is estimated to be 0.0008% (gnomAD).In silico analysis predicted the p.Leu27Phe is disease-causing variant

Current guidelines recommend immediate treatment after diagnosis of congenital hypothyroidism and reassessment of the hypothalamic-pituitary-thyroid axis at 3 years of age. As the known incidence of transient congenital hypothyroidism (TCH) has increased, experts have suggested the possibility of early drug discontinuation. Distinguishing TCH from permanent congenital hypothyroidism (PCH) is important to avoid prolonged treatment. We aimed to investigate the factors associated with TCH and to identify markers that indicate patients suitable for early treatment discontinuation. Participants were 167 children with congenital hypothyroidism. Subjects attempting to discontinue levothyroxine before 2 years of age were defined as the "early-off group." Cox proportional hazards models were used to identify factors associated with TCH and to determine factors predicting early drug discontinuation. Totals of 96 (57%) and 71 children (43%) were classified as having TCH and PCH, respectively. In the Cox multivariate analysis, gestational age (GA) and low levothyroxine dose at 24 months of age were statistically associated with TCH. Based on receiver operating characteristic (ROC) curve analysis, an optimal cutoff dose for levothyroxine of 3.03 µg/kg/day at 18 months of age can predict early treatment discontinuation (P<0.001; sensitivity, 75.0%; specificity, 72.9%; area under the curve, 0.778). Our study showed that lower GA and lower levothyroxine doses during treatment were highly suggestive of TCH. Those requiring lower levothyroxine levels at 18 months of age could be candidates to cease medication prior to 3 years of age.

Purpose To assess disparities in children referred for short stature evaluation and to evaluate the effectiveness of physician interventions on referral rates.Methods Retrospective chart review was conducted on children referred to a pediatric endocrinology center for short stature evaluation between 1/1/2022 and 12/31/2023. Interventions for participating physicians included an educational lecture and electronic medical record alert. Six-month pre- and postintervention referral rates for short stature from a general pediatrics practice were assessed.Results There were 747 children (68% males) with a predominance of non-Hispanic White (NHW) children (64%). Females presented at a younger age (P<0.001), lower height (P<0.001), and a greater height deficit (P=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all P<0.05). In those with heights <-2 standard deviations (SDs) (n=192) from the mean, there were no significant sex differences; however, Hispanic children continued to have greater height deficit than NHW and NHB children (all P<0.02). There was no sex difference in those who underwent growth hormone stimulation testing (GHST); however, NHW children comprised the largest racial group. After implementing the interventions in the general pediatrics practice, short stature referral rates improved (15 of 118 referrals [13%] to 25 of 81 referrals [31%], P=0.002).Conclusions Disparities in overall short stature referrals were less evident in the subset of children with heights <-2 SD from mean. There was no significant sex bias in GHST, but racial/ethnic disparities remained. Improvement in referring and evaluating females and children from minority groups is still crucial as they remain under referred.

the editor, Thank you for bringing this important point to our attention.In spite that some studies reported significantly increase incidence of gynecomastia among individuals who were marijuana smokers compared to both control patients and tobaccoonly smokers, other studies reported that marijuana use is not infrequently associated with gynecomastia [1,2].More researches are needed to clarify the relation between marijuana smoking and development of gynecomastia.

Long-acting growth hormones (LAGHs) represent a significant advancement in the treatment of pediatric GH deficiency, offering an alternative to daily recombinant human GH (rhGH) therapy. Traditional rhGH treatments, although effective, require daily injections, often leading to poor adherence due to the frequency of dosing, injection pain, and difficulties with storage and travel. In contrast, LAGHs, such as somatrogon, somapacitan, and lonapegsomatropin, are designed for once-weekly administration, improving patient compliance and quality of life. LAGHs have demonstrated non-inferiority to daily rhGHs in phase 3 clinical trials, showing similar efficacy in terms of growth velocity and safety profiles. Despite these advantages, concerns remain regarding the altered pharmacodynamics of LAGHs such as the lack of pulsatile secretion and potential for antibody formation. Although the overall safety of LAGHs has been confirmed, side effects, such as lipoatrophy at the injection site, may occur, especially with PEGylated formulations. Guidelines for prescribing LAGHs are currently evolving. LAGHs are not yet approved for other conditions traditionally treated with rhGHs, such as Turner or Noonan syndrome. Pediatric endocrinologists should carefully consider which patient groups would benefit most from this therapy, particularly individuals at risk of poor adherence to daily injections such as patients undergoing multidrug therapy, patients with needle phobia or behavioral disorders, very young children, adolescents, patients with separated parents, families that travel frequently, or children involved in activities such as scouting. LAGHs present an opportunity to enhance therapeutic outcomes and adherence, but careful patient selection remains critical to maximize their potential benefits.