Meet the Professor Continues to Please

Bright and early at ENDO2013 and the Meet the Professor series started things off well with a session on pediatric lipid disorders. Unfortunately because of the gas leak, other meet the professor sessions were missed today. I have to say that I was pleased to sit through a talk in which I did not get up saying, wow that was really interesting, but none of the potential therapeutics can help the children that I see in clinic. Dr. Morrison did a wonderful job simplifying a potentially confusing topic. In my training experience, I have found a lot of uncomfortability in pediatric lipid disorders. This probably largely stems from it being mostly viewed as an adult problem and there being a great deal of time since the previous NHLBI guideline (23 years). We now have additional medications and diagnostic tools available to us to treat lipid disorders. Unfortunately, the rise of childhood obesity has made a once rare problem increasingly more common. 

The talk started with the new recommendations as far as treatment strategies and lipid cutoff values. We were all reminded that a non-fasting non HDL level should be obtained on all children from age 9-11. Also, we were reminded that screening can begin as early as 1 year of age for those children at the highest risk (e.g. family history of premature coronary artery disease). Important secondary causes of hyperlipidemia were reviewed as well, such as hypothyroidism and liver disease. Now, the most interesting part of the talk was discussing management strategies. Clearly diet and exercise are a cornerstone of treatment. Even a "perfect diet", however, will often not lower LDL to goals in patient with familial hyperlipidemia which stresses the importance of follow up. A goal of restriction to less than 7% of calories from saturated fat and cholesterol less than 200 mg/day. There is also evidence that plant sterol/stanol esters can result in more LDL reduction. A therapy discussion cannot be complete without a discussion about statins. They are recommended for patients greater than 10 years of age with familial hypercholesterolemia (LDL>190 with no risk factors or >160 with risk factors) after 6 months of diet interventions. One must also be careful to counsel female patient about its teratogenicity. The talk touched on hypertrigyceridemia treatment with niacin, fibrates, and omega 3s.  It closed with a couple of cases for discussion of management of children with abnormal lipid profiles.

I certainly left with a better practical understanding of the subject and hope to bring this knowledge into our endocrine clinic. If you were not able to catch the second lecture because of the evacuation, check your case management book for a well-written summary. 

Time to rest up for day 3...