Division of Pediatric Endocrinology

Prior to your child’s appointment with the Division of Pediatric Endocrinology, please fill out the patient information form, which can be found here.

We also request that you obtain the following relevant medical information from the referring provider and have this faxed to 877-680-5507 prior to your scheduled appointment.

• Growth charts (height, weight, BMI)

• Laboratory testing, X-rays

• Most recent office visit notes

• Referral if required by insurance

On the day of your appointment, please plan to arrive at least 15 minutes prior to your scheduled appointment time to allow time for traffic, parking, and check-in. Late arrivals may not be able to be seen. At the time of check-in, our front desk staff will request a copy of your child’s insurance card and a valid form of identification.

To cancel or reschedule your appointment, please contact our scheduling team at 202-295-0547 at least 24 hours in advance.

Your pediatric endocrinologist is going to test your child for growth hormone deficiency (GHD). Part of this testing involves a growth hormone (GH) stimulation procedure called a “Growth Hormone Provocative Test.”

GH is secreted in several bursts throughout the day; thus, a random blood test might miss the burst. To determine if your child is GH deficient, a standard GH provocative test or stimulation (“stim”) test is necessary. In a standard stim test, two selected medications will be given to measure how well the pituitary gland secretes GH in response to stimulation; in other words, the “peak” of your child’s growth hormone production will be measured.

Our office utilizes the “L-Dopa” and “Arginine” growth hormone study. L-Dopa and Arginine are two among many standard medications used to stimulate the release of GH from the pituitary gland. The stim test involves delivering a controlled dose of each of these medications and then measuring blood levels of GH in 30-minute intervals for 2 hours after administration of the medications. An intravenous catheter (IV) will be placed to give the Arginine and to draw the blood samples, so your child will not be poked to obtain each blood sample. You will pick up one of these medications (L-Dopa) from your pharmacy prior to the test. This medication is a liquid and will be administered by the nurse when you are here in clinic. It must be refrigerated when you pick it up at the pharmacy. Please bring it to our office for the test.

The GH stimulation test with Arginine and L-dopa is a safe and standard test that has been used throughout the world for many years to assess pituitary GH production. Side effects and adverse reactions from these medications are rare, especially when used in the low doses used in this test. If they do occur, possible side effects are as follows:

• L-dopa: nausea, vomiting, and temporary low blood pressure when changing positions
• Arginine: feeling warm or red, dizziness, nausea or vomiting

During the procedure, your child’s blood pressure and heart rate will closely be monitored. They will receive IV fluids during the test. We make sure that your child’s vital signs are normal before we send them home. IV placement may cause discomfort at the site of the needle stick. The amount of blood required for each blood test may vary, but we will ensure that the amount of blood taken for testing is an amount that your child can easily recover from.

A stimulated peak growth hormone level less than 10 ng/dL may indicate growth hormone deficiency. This means that the pituitary gland is not producing enough growth hormone and may be contributing to your child’s poor growth.

• The night before the test, your child is not allowed to have anything to eat or drink after midnight except water. Please have your child drink plenty of water in the days leading up to the test.

• If your child is receiving any medications, ask your doctor what to do about the doses that might be required between midnight and the test appointment time. We generally recommend that most medications are held until after the test so as to minimize influences on test results.

• Your child should wear comfortable clothing- something with short sleeves that can be easily pulled up is best.

• Bring a quick energy, high protein snack for after the test — like peanut butter crackers or a granola bar, with Gatorade or juice.

• The test takes up to three hours to complete. Bring a book, crossword puzzle, or a tablet/phone with headphones for your child to use, as they may need to wait for the test to start or sit quietly or lie down during the test. We have a TV with a DVD player in the room where the test is completed.  Feel free to bring DVDs for your child to watch during the test.

• Explain what will happen to your child in words that they will understand.

• The test will take place in the outpatient pediatric clinic in Tenleytown on the 4th The address is 4200 Wisconsin Avenue NW, Washington, D.C. Access to the paid parking garage is available on Van Ness Street across from the McDonalds. The parking garage is located underneath the building.

• Please call us if your child is sick, as the test will need to be rescheduled. 

After the test is complete, your child can have a snack and/or beverage. He or she may feel tired and want to rest after the test is done. Stay with your child if possible or have someone available to supervise them for the rest of the day. Depending on the labs ordered, it may take up to 10 business days for your doctor to have all the test results back. You should contact the endocrinology office and ask for your doctor to discuss the results with you if you do not hear back in that timeframe. Based on the test results, additional follow-up visits, testing, and/or treatment may be required.

At any time, if you have any questions feel free to contact your doctor at: 202-243-3560. For after-hours or urgent questions, you should contact the hospital page operator system at 202-444-7243 and ask for the “on call pediatric endocrinologist” to be paged.

Your pediatric endocrinologist will be testing your child for puberty disorders, including delayed (too late) or precocious (too early) puberty. Part of this testing involves a gonadotropin releasing hormone (GnRH) stimulation procedure, also known as a “Leuprolide Stimulation Test.”

GnRH is a hormone normally produced from the hypothalamus that then triggers the pituitary to release luteinizing hormone (LH) and follicle stimulating hormone (FSH). These are often referred to as “the puberty hormones” or the “sex hormones.” This process occurs in a pulsatile fashion with several bursts throughout the day, so a random blood test may miss these bursts. By giving the body a stimulating dose of a GnRH medication, we can measure the LH and FSH response in a standardized way. This test evaluates pituitary function by measuring the pituitary gland’s secretion of LH and FSH after stimulation. The results can tell us more about early or late puberty.

Your child will be given a medication called leuprolide, which is a medication that acts like GnRH in the body. This medication will be administered subcutaneously (beneath the skin). An intravenous catheter (IV) will be placed to give fluids. Blood will be drawn through the IV at specific time intervals after the medication is given to measure the body’s response of LH and FSH. Your child’s blood pressure and heart rate will be monitored throughout the test.

The GnRH stimulation test is a safe, standardized procedure that is generally very well tolerated without side effects. Rarely, your child may experience nausea, headache, abdominal pain, or menstrual bleeding. IV placement may cause discomfort at the site of the needle stick. The amount of blood required for each blood test may vary, but we will ensure that the amount of blood taken for testing is an amount that your child can easily recover from.

The stimulated responses of LH and FSH after administration of leuprolide can tell us whether your child is biochemically in puberty. If your child has had early puberty signs, this test can help us to determine if these signs are due to central, progressive puberty (puberty starting in the brain). If your child has delayed puberty, this test can tell us if the pituitary is responding appropriately to signals to start puberty.

• The night before the test, your child is not allowed to have anything to eat or drink after midnight except water. Please have your child drink plenty of water in the days leading up to the test.

• If your child is receiving any medications, ask your doctor what to do about the doses that might be required between midnight and the test appointment time.

• Your child should wear comfortable clothing- something with short sleeves that can be easily pulled up is best.

• Bring a quick energy, high protein snack for after the test — like peanut butter crackers or a granola bar, with Gatorade or juice.

• Bring a book, quiet game, or a tablet/phone with headphones for your child to use, as they may need to wait for the test to start or sit quietly or lie down during the test. We have a TV with a DVD player in the room where the test is completed.  Feel free to bring DVDs for your child to watch during the test.

• Explain what will happen to your child in words that they will understand.

• The test will take place in the outpatient pediatric clinic in Tenleytown on the 4th The address is 4200 Wisconsin Avenue NW, Washington, D.C. Access to the paid parking garage is available on Van Ness Street across from the McDonalds. The parking garage is located underneath the building.

• Please call us if your child is sick, as the test will need to be rescheduled.

After the test is complete, your child can have a snack and/or beverage. He or she may feel tired and want to rest after the test is done. Stay with your child if possible or have someone available to supervise them for the rest of the day. Depending on the labs ordered, it may take up to 10 business days for your doctor to have all the test results back. You should contact the endocrinology office and ask for your doctor to discuss the results with you if you do not hear back in that timeframe. Based on the test results, additional follow-up visits, testing, and/or treatment may be required.

At any time, if you have any questions feel free to contact your doctor at: 202-243-3560. For after-hours or urgent questions, you should contact the hospital page operator system at 202-444-7243 and ask for the “on call pediatric endocrinologist” to be paged.

Your pediatric endocrinologist will be conducting a test to measure your body’s hormone response from the adrenal glands. The adrenal glands are structures that sit on top of the kidneys and are responsible for the production of several hormones that play a critical role in puberty, water balance, metabolism, and recovery from illness or stress.

The adrenocorticotropin hormone (ACTH) stimulation test is used to determine if your adrenal glands are producing enough stress hormone, and to rule out excess adrenal hormone levels. Sometimes we need to do this test to investigate causes of early puberty or bone age advancement.

Your child will be given a medication called cosyntropin, which stimulates the adrenal glands to produce the stress hormone, cortisol. An intravenous catheter (IV) will be placed to administer the medication and give fluids. Blood will be drawn through the IV at specific time intervals after the medication is given to measure the body’s response of cortisol. Your child’s blood pressure and heart rate will be monitored throughout the test. The test will last approximately 60-90 minutes.

Cosyntropin is generally well tolerated, but in rare instances may lead to elevated heart rate, increased blood pressure, facial flushing, anxiety, nausea, or dizziness. Your child will be monitored for these side effects while they are in clinic. IV placement may cause discomfort at the site of the needle stick. The amount of blood required for each blood test may vary, but we will ensure that the amount of blood taken for testing is an amount that your child can easily recover from.

An elevated cortisol level after stimulation indicates that the adrenal glands are responding appropriately to the medication and are functioning properly. A low cortisol level indicates that the adrenal glands may be suppressed, or not functioning normally. If your child is being evaluated for androgen excess, levels of several different adrenal hormones will also be measured. We will interpret the ratios of these hormone levels. If these levels are elevated, this may indicate an enzyme deficiency and/or a diagnosis of adrenal hyperplasia.

• The night before the test, your child is not allowed to have anything to eat or drink after midnight except water. Please have your child drink plenty of water in the days leading up to the test.

• If your child is receiving any medications, ask your doctor what to do about the doses that might be required between midnight and the test appointment time.

• Your child should wear comfortable clothing- something with short sleeves that can be easily pulled up is best.

• Bring a quick energy, high protein snack for after the test — like peanut butter crackers or a granola bar, with Gatorade or juice.

• Bring a book, quiet game, or a tablet/phone with headphones for your child to use, as they may need to wait for the test to start or sit quietly or lie down during the test. We have a TV with a DVD player in the room where the test is completed.  Feel free to bring DVDs for your child to watch during the test.

• Explain what will happen to your child in words that they will understand.

• The test will take place in the outpatient pediatric clinic in Tenleytown on the 4th The address is 4200 Wisconsin Avenue NW, Washington, D.C. Access to the paid parking garage is available on Van Ness Street across from the McDonalds. The parking garage is located underneath the building.

• Please call us if your child is sick, as the test will need to be rescheduled.

After the test is complete, your child can have a snack and/or beverage. He or she may feel tired and want to rest after the test is done. Stay with your child if possible or have someone available to supervise them for the rest of the day. Depending on the labs ordered, it may take up to 10 business days for your doctor to have all the test results back. You should contact the endocrinology office and ask for your doctor to discuss the results with you if you do not hear back in that timeframe. Based on the test results, additional follow-up visits, testing, and/or treatment may be required.

At any time, if you have any questions feel free to contact your doctor at: 202-243-3560. For after-hours or urgent questions, you should contact the hospital page operator system at 202-444-7243 and ask for the “on call pediatric endocrinologist” to be paged.

We recommend that all families register for the MyMedStar patient portal. This is a secure messaging that can be used to contact each provider directly, with the confidence that your correspondence is documented in your child’s medical record. To register, you must obtain a PIN from the front desk in person at the Tenleytown office. You will then receive an email with instructions to activate your account on the MyMedStar patient portal. Once you have set up your account, you will be able to send messages to individual providers and see limited information from your child’s medical record.

To reach our department by phone, please refer to the following important numbers:

Scheduling Line: 202-295-0547

Administrative Assistant and Endocrine Nurse: 202-243-3560

Endocrine Fax: 877-680-5507

New Patient Intake Form

Maryland Diabetes School Form

Virginia Diabetes School Form

DC Diabetes School Form

Diabetes Email List Request Form

Blood Sugar Log

Insulin to Carb Ratios and Correction Factors

Please refer to this handout from the Academy of Nutrition and Dietetics for an in-depth instruction sheet on how to calculate insulin doses. This teaches you how to use your child’s blood sugar and planned carbohydrate intake to calculate a recommended mealtime insulin dose.

We recommend the following guidelines for diabetes care during times of illness, when your child is eating less than usual or vomiting.

• Check blood sugar at least every 3 hours

• Check urine ketones with every void

• Continue taking insulin every 3 hours. Do not skip insulin even when you are not eating. If blood glucose is low, ingest carb containing fluids to increase blood glucose.

• Watch for signs of diabetic ketoacidosis (DKA). These include lethargy, sweet smelling breath, heavy breathing, confusion, vomiting, abdominal pain.

• Ensure your child is obtaining some form of carbohydrate intake by mouth. Some examples if they are having difficulty keeping food down include:

1. Sports drinks

2. Jell-O

3. Popsicle

4. Broth-based soups

5. Applesauce

6. Saltines

7. Bananas

8. Toast

9. Graham crackers

We recommend checking urine ketones whenever the blood sugar is >250 and/or every 3 hours in times of illness.

Ketones are usually a sign that the body does not have enough insulin on board to move energy into the cells. In many cases, additional insulin is required when ketones are present.

You should ask your provider for specific instructions on how to give additional insulin to your child if they have ketones.