Saba, Leslie

Abstract Purpose Sellar and parasellar lesions in children have heterogeneous clinical presentations and variable endocrine morbidity. Population-based data describing endocrine outcomes across lesion types and management strategies remain limited. Methods We conducted a retrospective, population-based cohort study of patients aged 18 years or younger who were diagnosed with sellar or parasellar lesions between 1976 and 2021 in a multicounty region. Clinical presentation, lesion characteristics, management, and endocrine outcomes were abstracted from medical records. Associations were evaluated by lesion type, lesion size (< 10 mm vs. ≥10 mm), and management approach. Results Among 104 patients, endocrine abnormalities at diagnosis differed by lesion type (p = 0.0004) and were most frequent among patients with pituitary adenomas. Endocrine dysfunction at presentation was more common with lesions ≥ 10 mm than with lesions < 10 mm (74.2% vs. 49.2%; p = 0.0217). Post-treatment endocrine abnormalities were also more common with lesions ≥ 10 mm (64.5% vs. 13.1%; p < 0.0001). Surgical treatment was associated with a higher prevalence of post-treatment endocrinopathy, although this association may reflect lesion size, diagnosis, and treatment selection. Conclusions Endocrine morbidity was common in this population-based pediatric cohort and was associated with lesion type and size. Clinically relevant endocrine abnormalities also occurred in smaller lesions, supporting endocrine evaluation regardless of lesion size and the need for longitudinal surveillance in patients with sellar and parasellar disease.

Pediatric obesity is an increasingly prevalent, chronic, and multifactorial disease. Achieving successful and sustained weight reduction with current interventions remains challenging due to significant heterogeneity in treatment response. This review summarizes current evidence describing variability in outcomes across lifestyle, pharmacologic, and metabolic/bariatric surgery interventions in children and adolescents, and examines key biological, metabolic, behavioral, environmental, and psychosocial factors that influence response. In adults, recent findings on energy balance obesity phenotypes (characterized by abnormal satiation, abnormal postprandial satiety, abnormal hedonic eating, and reduced energy expenditure) have demonstrated promise in predicting weight loss outcomes and guiding tailored interventions. However, data on obesity phenotyping within children and adolescents remain limited. Addressing this gap is essential for advancing precision medicine approaches in pediatric obesity, with the potential to improve treatment selection, enhance effectiveness, and optimize long-term clinical outcomes.

ABSTRACT Melanocortin‐4 receptor (MC4R) deficiency is the most common cause of monogenic obesity; yet treatment options for children with MC4R mutations are limited. We describe significant improvement in weight in three patients with pathogenic or likely pathogenic MC4R mutations; two adolescents treated with semaglutide, and a younger child treated with metformin and topiramate. These findings indicate GLP‐1 receptor agonists, topiramate and metformin can be helpful in managing obesity associated with MC4R deficiency.

Abstract Disclosure: L. Saba: None. K. Leopold: None. A.N. Lteif: None. A. Al Nofal: None. Objectives: Glucagon-like peptide-1 receptor (GLP-1R) agonists are currently approved for the treatment of type 2 diabetes and obesity in patients aged ≥10 and ≥12 years, respectively. While studies in adults with type 1 diabetes mellitus (T1DM) suggest potential glycemic benefits of GLP-1R agonists, data on their role in pediatric patients with T1DM and concomitant obesity remains limited. This case series evaluates the safety and efficacy of GLP-1R agonists as an adjunct to insulin therapy in pediatric patients with T1DM and obesity. Methods: A single-center retrospective review examined pediatric patients with T1DM and obesity who initiated GLP-1R agonists at &lt;18 years of age. Data were collected from chart review and analyzed from 120 days prior to GLP-1R agonist initiation until medication discontinuation, transfer of care, or January 1, 2025. Results: 5 patients (aged 12-17 years, 4 female) with T1DM and obesity all received the GLP-1R agonist semaglutide at a mean of 5.2 years post-T1DM diagnosis. 3 patients had ≥2 positive T1DM autoantibodies, 1 had positive ZnT8 antibodies only, and 1 lacked autoantibody testing. All patients were receiving insulin therapy; 4 were utilizing insulin pumps. The overall treatment duration ranged from 194-437 days (mean: 9 months), with 3 patients experiencing interruptions (42-187 days) due to insurance or supply issues. Pre- and during-treatment data were compared with a mean interval of 140 days between GLP-1R agonist start date and comparison time point (range: 69-226 days). All patients showed reductions in glucose management indicator or hemoglobin A1c by an average of 1.2%. 3 of 4 patients with available data had decreased weight-adjusted total daily insulin requirements by 30-33% (absolute dose reduction of 0.1-0.3 units/kg/day), while 1 patient had no change. Time in range increased in all 5 patients by an average of 14.2%. The average BMI change was -9%. Adverse effects included nausea, vomiting, and abdominal pain in patient 1 leading to GLP-1R agonist discontinuation; this patient also experienced 4 episodes of diabetic ketoacidosis during treatment. Increased hypoglycemia frequency was observed in patients 2, 3, and 4, however, none required glucagon administration. To mitigate hypoglycemia risk, pump settings were proactively adjusted in patients 1 and 4. Conclusions: Beyond promoting weight loss, GLP-1R agonists show promise as an adjunctive therapy in pediatric patients with T1DM and obesity by improving glycemic control and reducing insulin requirements. The observed reduction in insulin requirements per body weight suggests an underlying degree of insulin resistance in these patients. Preemptive decrease in insulin doses with each increase in GLP-1R agonist dose should be considered to mitigate hypoglycemia risk. Larger studies are needed to assess long-term safety and efficacy in the pediatric population with T1DM and obesity. Presentation: Saturday, July 12, 2025

Purpose of review Hyponatremia and hypernatremia are commonly encountered electrolyte abnormalities that require timely and careful intervention, as they can be associated with significant morbidity and mortality. Recent findings This review article addresses the etiology, presentation, diagnosis, and management of both hyponatremia and hypernatremia, emphasizing the latest advancements and emerging trends in pediatric care. Summary A methodical approach is needed to accurately assess and treat hyponatremia and hypernatremia. Both conditions continue to rely on serum and urine testing, however newer tests such as copeptin and stimulated testing may hold promise to further refine testing in the future.