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Welcome to The Differential, our weekly pediatrics briefing. Created by physicians for physicians, The Differential is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in right here). Today’s Differential is edited by Dr. Cherilyn Cecchini, a pediatrician entering hematology/oncology fellowship at St. Jude Children’s Research Hospital.

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Single-Sentence Summaries

  1. Gilenya, Novartis’s MS drug, has been approved for pediatric use.  Reuters, May 2018.
  2. Low-dose Vitamin D supplements during pregnancy improve infant growth. JAMA Pediatrics, May 2018
  3. When delivering a dismal prognosis to parents, you can express hope even without optimism, as in “I hope your child will survive, but I am not optimistic.” JAMA Pediatrics, Apr 2018
  4. Long-acting reversible contraceptives like IUDs should be recommended to adolescent girls before any other method, according to the Canadian Paediatric Society. CPS position statement, May 2018
  5. Children with mild penicillin allergy symptoms should be retested, as they usually tolerate the challenge — and this greatly reduces costs. Pediatrics, May 2018.

Clinical Quiz

A 9-year-old girl is brought to a new pediatrician by her mother for concerns regarding her weight. The patient has a history of developmental delay, and her mother mentions that she is noticeably shorter than her peers. She is noted to have a round face and bilaterally shortened fourth metacarpals on examination. She is in the 96th percentile for weight and below the 3rd percentile for height for her age. Laboratory testing reveals hypocalcemia. Which additional laboratory findings are associated with this patient’s most likely diagnosis?

A. Low parathyroid hormone and phosphate levels
B. Normal parathyroid hormone and elevated phosphate levels
C. Normal parathyroid hormone and low phosphate levels
D. Elevated parathyroid hormone and phosphate levels

Answer at the bottom of this post, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

Allergy season has arrived and with it comes many misdiagnosed kids! If you are seeing a patient with watery, itchy ocular discharge make sure to inquire about a history of low grade fever and swollen preauricular node on exam — to diagnose adenovirus!  This is consistent with viral conjunctivitis and does not require antibiotics.


Clinical Quiz Answer:
D. Elevated parathyroid hormone and phosphate levels.

This patient’s findings are suggestive of Type 1a pseudohypoparathyroidism (PHP), an autosomal dominant disease that is characterized by renal resistance to parathyroid hormone (PTH). Patients with Type 1a PHP have hypocalcemia, hyperphosphatemia, and elevated PTH concentrations. The condition is associated with Albright hereditary osteodystrophy (AHO), a constellation of clinical features including round facies, short stature, obesity, developmental delay, and shortened fourth metacarpal bones. While features of AHO are also present in patients with pseudo-pseudohypoparathyroidism, those patients will have normal levels of calcium, phosphate, and PTH.

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