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The Future of Pediatric and Adolescent Endocrinology

Traditionally, pediatric and adolescent endocrinology has encompassed the study of growth and development, including psychosexual differentiation and maturation, and of diseases of the endocrine system that occur during the “dynamic” periods of childhood and adolescence. The latter period, which was indistinguishable from that of puberty in earlier societies, is clearly distinct fiom it in the modern world. This is reflected in the use of the word “hebe” as synonymous to both “puberty” and “adolescence” in classic Greek. Literally speaking, the latin roots of “puberty” and “adolescence” are, respectively, the words “pubis-esce,” meaning development of pubic hair and, hence, sexual maturation, and “adult-esce” or becoming a grown-up and, hence, a self-sustaining, financially and psychologically independent member of the adult society, who can raise and support his or her own family.’ Whereas the duration of puberty, that is, the process of complete sexual maturation, is 4 or 5 years, the duration of adolescence in today’s developed societies has been extended by an additional 5 to 10 years. Thus, the periods of puberty and adolescence, which include endocrine, somatic, psychological, and socioeconomic changes and are under the purview of pediatric endocrinology, are now characterized by a major disengagement, which is bound to interfere with the psychological and physical health of our youth. The last 50 years have seen profound progress in pediatric and adolescent endocrinology. We have dramatically enhanced our understanding of the physiology and pathophysiology of the developing endocrine system; we have markedly improved our diagnostic capacity; and, we have immensely increased our therapeutic efficacy? Also, during the past two decades, we have seen an enlargement of the scope of our field. This has been aided by the realization that there are “critical” periods within childhood and puberty/adolescence, during which psychological and physical vulnerabilities develop; several classic hormones appear to participate in this phenomenon. Also, the same period is characterized by the onset of life-long medicaVpsychologica1 problems, which have a strong genetic predisposition; these include obesity, addictive behaviors, depression, eating disorders, insulin-dependent diabetes mellitus type I, and the severe forms of schizophrenia, referred to as hebephrenia from the above mentioned root hebe.’ Finally, the vicious cycle of teenage pregnancy-poverty and unhappiness/development of vulnerabilities, which plagues a significant proportion of some modern societies, takes place in the population of patients that pediatricians and pediatric endocrinologists serve.