- Pediatric Endocrinology
- Diabetes Mellitus
Clinical Assistant Professor, Pediatrics - Endocrinology and Diabetes
Boards, Advisory Committees, Professional Organizations
Member, American Academy of Pediatrics (2001 - Present)
Member, Endocrine Society (2004 - Present)
Member, Pediatric Endocrine Society (2007 - Present)
Member, American Society of Reproductive Medicine (2009 - Present)
Board Certification: American Board of Pediatrics, Pediatric Endocrinology (2017)
Board Certification: American Board of Pediatrics, Pediatrics (2017)
Fellowship: Stanford University Medical Center (2007) CA
Residency: Stanford University Medical Center (2004) CA
Internship: Stanford University Medical Center (2002) CA
Medical Education: Stanford University School of Medicine (2001) CA
MD, Stanford Medical School, Medicine (2001)
Review of implant gonadotrophin-releasing hormone agonist use: experience in a single academic center
HORMONE RESEARCH IN PAEDIATRICS
Gonadotrophin-releasing hormone agonists (GnRHa) are used for puberty suppression in central precocious puberty (CPP) and gender dysphoria (GD). Guidelines on biochemical monitoring are not defined.To evaluate the utility of biochemical monitoring of GnRHa therapy in patients with CPP or GD.Retrospective chart review of patients 18 years or younger who received GnRHa therapy from 1/1/2018 to 3/2/2021.103 patients were evaluated, 43 with CPP and 60 with GD. Using thresholds of basal luteinizing hormone (LH) <2 IU/L and stimulated LH <4 IU/L, biochemical pubertal suppression occurred in all but two patients. Basal LH frequently remained above prepubertal range.Laboratory assessment for puberty suppression on GnRHa therapy may be unnecessary in CPP and GD patients monitored with physical exams.
View details for DOI 10.1159/000529733
View details for Web of Science ID 000937266800001
View details for PubMedID 36791687
Pharmacodynamics of Aqueous Leuprolide Acetate Stimulation Testing in Girls: Correlation between Clinical Diagnosis and Time of Peak Luteinizing Hormone Level
JOURNAL OF PEDIATRICS
2012; 161 (4): 757-?
We assessed the pharmacodynamics of a 3-hour leuprolide stimulation test in 11 girls with precocious puberty to determine an optimal single sampling time. Luteinizing hormone level following leuprolide stimulation was near maximum by 30 minutes in girls with central precocious puberty, whereas it continued to rise slowly in girls with nonprogressive puberty.
View details for DOI 10.1016/j.jpeds.2012.06.015
View details for Web of Science ID 000309516400039
View details for PubMedID 22809662
A Randomized Trial of 1-and 3-Month Depot Leuprolide Doses in the Treatment of Central Precocious Puberty
JOURNAL OF PEDIATRICS
2011; 159 (6): 982-U148
To compare 1-month and 3-month depot formulations of leuprolide acetate (DL), a gonadotropin-releasing hormone analog, in the treatment of central precocious puberty (CPP).Subjects with CPP naïve to therapy were randomized to 7.5 mg of 1-month DL, 11.25 mg of 3-month DL, or 22.5 mg of 3-month DL. Stimulated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and estradiol levels, growth velocity, and bone age progression were examined in a 2-year period.Forty-nine female and 5 male subjects with CPP were randomized. Mean stimulated LH and FSH levels during treatment were higher in the low-dose 11.25-mg 3-month DL group, and more LH levels >4 IU/L were observed, in comparison with the other two dose groups. Mean LH and FSH levels in the 22.5-mg 3-month group were not different from the monthly DL. No differences in estradiol levels, growth velocity, or bone age progression were observed in dosing groups.All DL doses resulted in prompt and effective suppression of puberty, but higher LH and FSH levels were seen with the 11.25-mg 3-month DL dose. Multi-monthly DL is effective in treating CPP, but higher dosing may be required in some circumstances.
View details for DOI 10.1016/j.jpeds.2011.05.036
View details for Web of Science ID 000296849400021
View details for PubMedID 21798557
Definition of metabolic syndrome in preadolescent girls
JOURNAL OF PEDIATRICS
2006; 148 (6): 788-792
To compare and contrast proposed definitions of metabolic syndrome in pediatrics, and to determine prevalence of metabolic syndrome in preadolescent females when applying different criteria.A literature review on definitions of metabolic syndrome and cardiovascular "risk factor clustering" in children and adolescents published in the past decade. Pediatric definitions of metabolic syndrome were then applied to a community-based study of 261 black preadolescent females (Girls Health Enrichment MultiSite studies [GEMS]) and a school-based, cross-sectional study of 240 ethnically-diverse preadolescent females (Girls Activity, Movement and Environmental Strategy [GAMES]) who had a baseline physical examination and fasting morning blood sample.Agreement among pediatric definitions of metabolic syndrome was poor. The prevalence of MS and cardiovascular risk factor clustering ranged from 0.4% to 23.0% for GEMS and 2.0% to 24.6% for GAMES with definitions adapted from the National Cholesterol Education Program Adult Treatment Panel III, and 0% to 15.3% for GEMS and 0.4% to 15.8% for GAMES using modified criteria from the World Health Organization.The prevalence of metabolic syndrome in preadolescent girls varies widely because of disagreement among proposed definitions of metabolic syndrome in pediatrics. Further investigation is needed to determine which metabolic factors and their respective cut points should be used to identify children at risk for development of clinical disease.
View details for DOI 10.1016/j.jpeds.2006.01.048
View details for PubMedID 16769388
Sequential comparisons of one-month and three-month depot leuprolide regimens in central precocious puberty
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
2006; 91 (5): 1862-1867
Dosing of monthly depot leuprolide (DL) in central precocious puberty (CPP) varies considerably. U.S. practitioners use 7.5-15 mg, in contrast with the international standard of 3.75 mg. Pubertal suppression using the newer 3-month DL also has been reported from Europe. To date there have been no direct comparisons of these different DL doses.In an open 12-month protocol, we tested the efficacy of three DL doses (7.5 mg- and 3.75 mg-1 month and 11.25 mg-3 month) given sequentially to subjects treated for CPP. Primary outcome measures were stimulated gonadotropin (Gn) levels at 12-wk intervals. The null hypothesis was no difference among doses.Both existing and new patients with CPP received our standard therapy (DL 7.5 mg every 4 wk) for a minimum of 24 wk. In subjects with DL-stimulated LH 2 IU/liter or less, the dose was changed to 3.75 mg every 4 wk and evaluated 12 wk later. Subjects who met LH criteria (<4.5 IU/liter) on 3.75 mg then received a single dose of 11.25 mg-3 month and were reevaluated 12 wk later. Serum LH/FSH and sex steroids were obtained 40 min after DL injection.Thirty subjects were enrolled (20 naive; 24 girls, 6 boys), and 21 were evaluated on all three DL doses. DL-stimulated LH levels (mean +/- sd) were 1.30 +/- 0.74, 1.73 +/- 0.99, and 2.13 +/- 1.41 on 7.5 mg, 3.75 mg, and 11.25 mg-3 month, respectively (7.5 vs. 3.75 mg, P = 0.019; 7.5 mg vs. 11.25 mg-3 month, P = 0.004, Wilcoxon ranked sign test). Mean FSH levels were 2.86 +/- 1.91, 3.91 +/- 1.98, and 3.96 +/- 1.34, respectively (7.5 vs. 3.75 mg, P = 0.017; 7.5 mg vs. 11.25 mg-3 month, P = 0.020). No differences were detected in mean sex steroid levels.Stimulated LH and FSH levels were significantly higher during therapy with both the 3.75 mg and 11.25 mg-3 month depot leuprolide doses, compared with 7.5 mg, contradicting the null hypothesis of no difference. These data suggest that low-dose 1- and 3-month DL preparations are associated with persistently greater gonadal stimulation in most CPP patients, but the LH/FSH results were not corroborated by differences in sex steroid levels. Whether various DL doses lead to long-term therapeutic differences remains to be determined.
View details for DOI 10.1210/jc.2005-1500
View details for PubMedID 16449344