Saint Louis University's Division of Endocrinology in the Department of Pediatrics
is dedicated to improving the health of children through clinical care, teaching and
Our division faculty is comprised of five pediatric endocrinologists and a pediatric
nurse practitioner, who is also a Certified Diabetes Educator. Two clinical nurses
perform specialized endocrine function testing and provide education in endocrine
disorders. Four clinical nurses and one APN clinical nurse specialist, three of whom
are Certified Diabetes Educators, provide in- and outpatient diabetes education, instruct
patients in intensive insulin regimens including CSII and CGM, and maintain a high
level of inpatient diabetic care through education of the hospital nursing staff.
In addition, two dietitians, a social worker and a child psychologist are available
to offer nutritional guidance and psychosocial evaluation and advice.
Pediatric Endocrinology Training
Our teaching programs are closely intertwined with both the Department of Pediatrics
and the Division of Endocrinology in the Department of Internal Medicine. In addition
to departmental conferences, division faculty give lectures in the Academic Half Day
lecture series for residents and a series of lectures for third-year medical students.
Popular electives are offered to residents and fourth-year medical students, and third-
and fourth-year medical students are supervised in the outpatient clinics. Finally,
the division assists in the training of fellows from the Division of Endocrinology
in Internal Medicine by its supervision of fellows in a one-month rotation and its
participation in a combined case conference.
The division offers clinical care for infants, children, and adolescents with growth
disorders, complex endocrine system disorders, diabetes, and metabolic bone disease
is comprehensive and state-of-the-art. Division members participate in several multi-disciplinary
clinics, including the Lipid Disorders, Turner Syndrome, and Prader-Willi Syndrome
clinics. We have also recently developed a highly successful program to transition
adolescents with diabetes to adult care. One faculty member is responsible for patient
care on the inpatient service. Most newly-diagnosed diabetic children are hospitalized
for a brief period to initiate therapy and education. Consultations to assess and
assist in the management of complex inpatients are also provided, as requested by
Saint Louis University was one of 15 sites in the NIH-funded, multi-center TODAY (Treatment
Options for type 2 Diabetes in Adolescents and Youth) Study (Sherida E. Tollefsen,
PI) and is participating in TODAYPhase 2. Division members are participating in ELLIPSE,
a Novo Nordisk trial to compare the safety and efficacy of liraglutide with metformin
vs metformin monotherapy on glycemic control in children and adolescents with type
2 diabetes, and in a Zafgen-funded phase 3 trial of subcutaneous beloranib in obese
subjects with Prader-Willi syndrome.
The research protocol was designed to evaluate the efficacy of three treatment regimens
(metformin alone, metformin plus rosiglitazone, and metformin plus intensive lifestyle
intervention) on time to treatment failure based on glycemic control. Nationwide,
699 subjects were randomized into one of the treatment regimens and were treated for
at least two years.
At the SLU site, 39 subjects were randomized, and 35 subjects have been retained to
date. Of the 699 randomly-assigned participants (mean duration of diagnosed type 2
diabetes, 7.8 months), 319 (45.6 percent) reached the primary outcome over an average
follow-up of 3.86 years. Rates of failure were 51.7 percent, 38.6 percent, and 46.6
percent for metformin alone, metformin plus rosiglitazone, and metformin plus lifestyle
intervention, respectively. Metformin plus rosiglitazone was superior to metformin
alone (P = 0.006); metformin plus lifestyle intervention was intermediate but not
significantly different from metformin alone or metformin plus rosiglitazone. Pre-specified
analyses according to sex and race or ethnic group showed differences in sustained
effectiveness, with metformin alone least effective in non-Hispanic black participants
and metformin plus rosiglitazone most effective in girls.
Serious adverse events were reported in 19.2 percent of participants. Long-term observation
of these participants is ongoing in two phases - phase 1 from 3/1/11 through 2/28/14
and phase 2 [RFA-DK-14-502 - Limited Competition: Continuation of Treatment Options
for type 2 Diabetes in Adolescents and Youth], which is funded through 4/30/21.
Susan E. Myers, M.D., in the Division of Pediatric Endocrinology and her collaborator,
Barbara Whitman, Ph.D., continue to contribute significantly to our understanding
of children and adults with Prader-Willi syndrome (PWS). They participated in a randomized,
double-blind, placebo-controlled, phase 3 trial of ZGN-440 (subcutaneous beloranib
in suspension) in obese subjects with PWS.
An abstract showing statistically and clinically significant weight loss and improvement
in hyperphagia in patients with PWS has been presented by the study group; in addition,
a second abstract showed that ~90% of weight loss with beloranib was due to loss of
body fat, indicating preferential loss of fat with minimal change in lean mass. The
majority of adverse events (AEs) were consistent with patient population characteristics
and AEs observed in prior beloranib clinical trials.
Margaret Siska, M.D., is the principal investigator for a Novo Nordisk trial entitled
ELLIPSE (efficacy and safety of liraglutide with metformin versus metformin monotherapy
on glycemic control in children and adolescents with type 2 diabetes), and one patient
has completed and other patients are being screened for this study. Drs. Tollefsen
and Siska have also joined the Pediatric Diabetes Consortium, a consortium of academic
institutions participating in clinical research for type 2 diabetes treatment options
in pediatric patients.
Novo Nordisk MK Siska, PI, NN2211-3659 - Efficacy and Safety of Liraglutide in Combination with
Metformin versus Metformin Monotherapy on Glycemic Control in Children and Adolescents
with Type 2 Diabetes (ELLIPSE)
National Institutes of Health (NIDDK) SE Tollefsen, PI, Saint Louis University site
Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) TODAY, TODAY ARRA, T2P1, T2P2
Kapadia CR, Nebesio TD, Myers SE, Willi S, Miller BS, Allen DB, Jacobson-Dickman E.
Endocrine effects of inhaled corticosteroids in children. JAMA Pediatrics 2015; 170(2):163-170.
McCandles SE, Yanovski JA, Miller J, Fu C, Bird LM, Salehi P, Chan CL, Stafford D,
Abuzzahab MJ, Viskochill D, Barlow SE, Anglo M, Myers SE, Whitman BY, Styne D, Roof
E, Dykens EM, Scheimann AO, Malloy J, Zhuang D, Taylor K, Hughes T, Kim DD, Butler
MG. Effects fo MetAP2 inhibition on hyerphagia and body weight in Prader-Willi syndrome:
A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2017;1-11
As members of the TODAY Study Group, SE Tollefsen and DP Dempsher were cited in the
Levers-Landis CE, Walders-Abramson N, Amodei N, Drews KL, Kaplan J, Levitt Katz LE,
Lavietes S, Saletsky R, Seidman D, Yasuda P for the TODAY Study Group. Longitudinal
correlates of health risk behaviors in children and adolescents with type 2 diabetes.
Journal of Pediatrics 2015; 166(5):1258-1264.
Larkin ME, Walders-Abramson N, Hirst K, Keady J, Ievers-Landis CE, Venditti EM, Yasuda
PM. Effects of comorbid conditions on health related quality of life in youth with
type 2 diabetes: the TODAY clinical trial. Diabetes Management 2015; 5(6):431-439.
Zeitler P, Hirst K, Copeland KC, El ghormli L, Katz LL, Levitsky LL, Linder B, McGuigan
P, White NH, Wilfley D for the TODAY Study Group. HbA1c after a short period of monotherapy
with metformin identifies durable glycemic control among adolescents with type 2 diabetes.
Diabetes Care 2015; 38:2285-2292.
Tryggestad JB, Willi SM. Complications and comorbidities of T2DM in adolescents: findings
from the TODAY clinical trial. Journal of Diabetes and Its Complications 2015; 29(2):307-312.
Walders-Abramson N, Anderson B, Larkin ME, Chang N, Venditti E, Bzdick S, Tryggestad
JB, Tan K, Geffner ME, Hirst K. Benefits and barriers to participating in longitudinal
research of youth-onset type 2 diabetes: results from the TODAY retention survey.
Clinical Trials 2016; 13(2):240-243.
Chernausek SD, Arslanian S, Caprio S, Copeland KC, El ghormli L, Kelsey MM, Koontz
MB, Orsi CM, Wilfley D. Relationship between parental diabetes and presentation of
metabolic and glycemic function in youth with type 2 diabetes: baseline findings from
the TODAY trial. Diabetes Care 2016; 39(1):110-117.
Klingensmith GJ, Pyle L, Nadeau KJ, Barbour LA, Goland RS, Willi SM, Linder B, White
NH for the TODAY Study Group. Pregnancy outcomes in youth with type 2 diabetes: the
TODAY study experience. Diabetes Care 2016; 39:122-129.
Kelsey MM, Geffner ME, Guandalini C, Pyle L, Tamborlane WV, Zeitler PS, White NH for
the TODAY Study Group. Presentation and effectiveness of early treatment of type 2
diabetes in youth: lessons from the TODAY study. Pediatric Diabetes 2016; 17(3):212-221.
Dempsher, DP: "Hyperinsulinism" Division of Neonatology noon conference, SSM Cardinal
Glennon Children's Hospital. St. Louis, MO, 8/3/15.
Dempsher, DP: "Diabetic Ketoacidosis" PL1 Introductory Lectures, Department of Pediatrics,
SSM Cardinal Glennon Children's Hospital. St. Louis, MO, 8/12/15.
Eddy, MC: "A Curious Case of a Newborn Metabolic Screen" Pediatric Science Days, Department
of Pediatrics, SSM Cardinal Glennon Children's Hospital. St. Louis, MO, 4/21/16.
Myers, SE: "Perioperative Management of Children with Endocrine Disorders" Pediatric
Surgery Grand Rounds, SSM Cardinal Glennon Children's Hospital. St. Louis, MO, 3/16/16.
Yanovski JA, Myers S, et al.: "Improvement in Hyperphagia and Weight Loss in Adolescent
Patients: Results from bestPWS, a Phase 3, Randomized, Placebo-Controlled, Clinical
Trial of Beloranib in Prader-Willi Syndrome" 2016 Pediatric Academic Societies meeting.
Baltimore, MD, 5/1/16.
Butler MG, Myers S, et al.: "Weight Loss and Improvement in Body Composition: Results
from bestPWS, a Phase 3, Randomized, Placebo-Controlled, Clinical Trial of Beloranib
in Prader-Willi Syndrome" 2016 Endocrine Society meeting. Boston, MA, 4/3/16.
In addition to monthly resident PL1 and Core Curriculum lectures and the second- and
third-year medical student lectures, Division faculty members have given the following
presentations at the combined case conference with the Division of Endocrinology in
the Department of Internal Medicine:
Dempsher, DP Disorders of Puberty (7/25/17)
Myers, SE Growth Disorders (8/29/17)
Dempsher, DP A Case of Congenital Hypothyroidism from Iodine deficiency (9/26/17)
Siska, MK Premature Ovarian Failure in a 15yr old girl 10/31/17
12yr old boy with hypocalcemia 11/28/17
17 alpha-hydroxylase deficiency CAH 1/30/18
Myers, SE Hypothalmic Obesity 2/27/18
Dempsher, DP 15 year old w/acute testicular swelling 3/27/18
Siska, MK A Case of 46,XY DSD 4/24/18
Eddy, MC Empty Sella Wyndrome
Administrative and Academic Office Phone: 314-577-5648 Fax: 314-268-6448