Esin KARAKILIÇ ÖZTURAN, Aslı Derya KARDELEN, Ayşe Pınar ÖZTÜRK, Ayşe Kubat ÜZÜM, Mustafa ÖZÇETİN, Firdevs BAŞ, Şükran POYRAZOĞLU, İlhan SATMAN, Feyza DARENDELİLER

Endokrin Hastalıklarda Çocukluktan Erişkine Geçiş Deneyimi

Amaç: Kronik hastalığı olan çocuklar ve aileleri için erişkin polikliniklerine geçiş endişe verici olabilmektedir. Çalışmamızın amacı, çocukluk döneminden erişkin döneme geçiş sürecinde uyguladığımız yöntemlerin sunulmasıdır. Gereç ve Yöntem: 2001-2017 yılları arasında, iki farklı geçiş modeliyle erişkin endokrinolojiye devredilen hastalar değerlendirildi. Birinci modelde Model 1 çocuk ve erişkin endokrinologlarla beraber yapılan tek toplantıda hasta ve/veya yakınlarının katılımıyla veya katılımı olmaksızın yalnızca epikriz ile geçiş yapılmıştır. İkinci modelde Model 2 ise hastalar Çocuk ve Erişkin Endokrinoloji dernekleri tarafından ortak olarak geçiş hastaları için hazırlanan formlar kullanılarak “Hasta Geçiş Polikliniği”nde en az 4-6 ay ara ile görülüp değerlendirildikten sonra erişkin endokrinolojiye devredilmiş ve hastaların 4-6 ay arayla 1 yıl ortak poliklinik takibi gerçekleşmiştir. Ayrıca hasta ve yakınlarının geçişle ilgili değerlendirmelerini almak için Psikiyatri Kliniğinin hazırladığı hasta memnuniyet ölçeği kullanılmıştır. Bulgular: Model 1 ile devredilen 373 hastanın 312 kız, 161 erkek, 18-31 yaş , %26’sı tiroid hastalıkları, %25’i DM diyabet , %9’u konjenital adrenal hiperplazi KAH , %5’i çoğul hipofiz hormon eksikliği ÇHHE , %3’ü büyüme hormonu eksikliği BHE , %2’si Turner sendromu TS , %2’si cinsiyet gelişim bozukluğu CGB , %3’ü obezite-hiperinsülinemi, %4’ü puberte bozuklukları/ergen sağlığı sorunları, %7’si kalsiyum-kemik metabolizması bozuklukları, %6’sı boy kısalığı, %3’ü diğer grubundaydı. Bu hastaların %8’inin erişkin endokrinolojiye en az 1 poliklinik başvurusu mevcuttu. Yirmi yedi hasta ise Model 2 ile 19 kız, 6 erkek, 19-22 yaş devredilmiştir. Mevcut tanıların %48’si DM, %19’u ÇHHE, %11’i BHE, %11’i tiroid hastalıkları, %22’si KAH, %4’ü CGB, %4’ü hipogonadizm olup, bu hastaların tümünün takibi devam etmektedir.Sonuç: Hastaların çocuk ve erişkin endokrinologlar tarafından bir süre beraber değerlendirip takip edilerek devredilmesinin hastaların geçiş sürecindeki endişelerinin ve sürecin olumsuz yönlerinin azaltılmasında yararlı olacağı düşünülmüştür

Anahtar Kelimeler:

Çocukluk çağı, erişkin dönem, geçiş, kronik hastalık, endokrinoloji

Endokrin Hastalıklarda Çocukluktan Erişkine Geçiş Deneyimi

Objective: As transition to admission to adult polyclinics can be stressful both for children with chronic diseases and their families, our study aims to present the methods we used during this transition period.Material and Method: The patients who were transferred to adult endocrinology polyclinic with two different transition models between 2001-2017 were evaluated in the study. In the first model Model 1 , transition was conducted in a single meeting with pediatric and adult endocrinologists, whereas patients and/or their relatives had either participated or not by the help of patient records . And in the second model Model 2 , patients were transferred to the adult endocrinology polyclinic , after being seen and evaluated at the “Transition Outpatient Clinic” for at least 4-6 months intervals by using the forms prepared by the Associations of Pediatric and Adult Endocrinology; and a mutual clinic follow-up was carried out for a year, with 4-6 month-intervals. In addition, the patient satisfaction scale prepared by the Psychiatric Clinic was used to evaluate the opinions of patients and their relatives, regarding the transition.Results: Among 373 patients 312 females, 161 males,18-31 years transferred with Model 1; 26% had thyroid diseases, 25% had diabetes DM , 9% had congenital adrenal hyperplasia CAH , 5% had multiple pituitary hormone deficiency MPHD , 3% had growth hormone deficiency GHD , 2% had Turner syndrome TS , 2% had disorders of sex development DSD , 3% had obesity-hyperinsulinemia, 4% had adolescent health problems, 7% had calcium/bone metabolism disorders, 6% had idiopathic short stature and 3% was in the “others” group. 8% of these patients had at least 1 outpatient application to adult endocrinology. Among 27 patients transferred with Model 2 19 female, 6 male, 19-22 years ; 48% of the diagnoses had DM, 19% had MPHD, 11% had GHD, 11% had thyroid diseases, 22% had CAH, 4% had DSD, and 4% had hypogonadism; and all these patients have follow-ups going on.Conclusion: A transition conducted by the mutual evaluation and follow-up of pediatric and adult endocrinologists for a while is thought to be effective on reducing the patients’ anxiety and the negative effects observed during the transition periods

Keywords:

Childhood, adulthood, transition, chronic disease, endocrinology,

PDF

___

Blum RW. Transition to adult health care: setting the stage. J Adolesc Health. 1995;17:3-5.
https://doi.org/10.1016/1054-139X(95)00073-2
Mazur A, Dembinski L, Schrier L, Hadjipanayis A, Michaud PA. European Academy of Paediatric consen- sus statement on successful transition from paediatric to adult care for adolescents with chronic conditions. Acta Paediatr. 2017 Aug;106(8):1354-7.
https://doi.org/10.1111/apa.13901
Cook DM, Rose SR. A review of guidelines for use of growth hormone in pediatric and transition patients. Pituitary. 2012 Sep;15(3):301-10.
https://doi.org/10.1007/s11102-011-0372-6
McDonagh, JE, Viner RM. Lost in transition? Between paediatric and adult health services. It’s time to impro- ve the transition of adolescents from paediatric to adult services. BMJ 2006;332:435-6.
https://doi.org/10.1136/bmj.332.7539.435
Kennedy A, Sloman F, Douglass JA, Sawyer SM. Young people with chronic illness: the approach to transition. Intern Med J. 2007 Aug;37(8):555-60.
https://doi.org/10.1111/j.1445-5994.2007.01440.x
Kipps S, Bahu T, Ong K, Ackland FM, Brown RS, Foxt CT, et al. Current methods of transfer of young people with type 1 diabetes to adult services. Diabet Med. 2002;19:649-54.
https://doi.org/10.1046/j.1464-5491.2002.00757.x
Kruse B, Riepe FG, Krone N, Bosinski HA, Kloehn S, Partsch CJ, Sippell, et al. Congenital adrenal hyperpla- sia - How to improve the transition from adolescence to adult life. Exp Clin Endocrinol Diabetes. 2004 Jul;112(7):343-55.
https://doi.org/10.1055/s-2004-821013
Tauber M, Moulin P, Pienkowski C, Jouret B, Rochiccioli P. Growth hormone (GH) retesting and auxological data in 131 GH-deficient patients after completion of treatment. J Clin Endocrinol Metab. 1997;82:352-6.
https://doi.org/10.1210/jcem.82.2.3726
Stanhope R. Transition from paediatric to adult endoc- rinology: hypopituitarism. Growth Horm IGF Res. 2004 Jun;14 Suppl A:S85-8.
Geffner ME. Growth Hormone Replacement Therapy: Transition from Adolescence to Adulthood. J Clin Res Pediatr Endocrinol. 2009 Sep;1(5):205-8.
https://doi.org/10.4274/jcrpe.v1i5.205
Hauffa BP, Touraine P, Urquhart-Kelly T, Koledova E. Managing transition in patients treated with growth hormone. Front Endocrinol (Lausanne). 2017 Dec 11;8:346.
https://doi.org/10.3389/fendo.2017.00346
Richmond E, Rogol AD. Treatment of growth hormone deficiency in children, adolescents and at the transitio- nal age. Best Pract Res Clin Endocrinol Metab. 2016 Dec;30(6):749-75.
https://doi.org/10.1016/j.beem.2016.11.005
Godbout A, Tejedor I, Malivoir S, Polak M, Touraine P. Transition from pediatric to adult healthcare: Assessment of specific needs of patients with chronic endocrine conditions. Horm Res Paediatr. 2012;78:247- 55.
https://doi.org/10.1159/000343818