By all accounts, the subspecialty of pediatric endocrinology was non-existent until the arrival of Dr. Russell Cunningham in 1964.  Up until then, children with diabetes and other endocrine disorders were managed by regional pediatricians and family physicians. Born in Bayou La Batre in coastal Alabama, Dr. Cunningham returned to the state upon completing his fellowship training at Boston Children’s. He was, befittingly, the first pediatric endocrinologist in the state.  In addition to manifold clinical and administrative responsibilities, such as ward attending in general pediatrics, he ushered in the concept of tailored, highly specialized, all-inclusive care for children with endocrine disorders. For the next 26 years, the endocrine service remained a one-person division until 1990, at which time Drs. Katrina Parker and Joycelyn Atchison, both fresh out of fellowship at the University of Pittsburg, joined the program. In 1999, Dr. Hussein Abdullatif was recruited to the faculty and, since then, perhaps to the exasperation of some, he has garnered nearly all the yearly medical student and resident teaching awards.

Of note, Dr. Cunningham retired in 1997, and after his passing in 2006, and in recognition of his pioneering endocrinology accomplishments at UAB and Children’s Hospital, a summertime Russel Cunningham Memorial Research Scholarship was established to fund medical students who aspire to academic careers.

In mid-2000, Dr. Kenneth McCormick was appointed as the second division director of the Division of Pediatric Endocrinology. While in Wisconsin, he had been director of the core laboratory for a seven year, state-wide, NIH-funded, non-interventional, longitudinal study of Type 1 diabetes sequelae. Approximately seven months thereafter, with the addition of Dr. Gail Mick, the division had expanded to five members, some of which were part time. Drs Mick and McCormick were collaborators on numerous clinical and laboratory-based research studies. See timeline of faculty appointments below.

 Note: this timeline excludes faculty with less than three years as a faculty member prior to their relocation. (Drs. Moreland, Martin and Colvin)

Conceived as an enterprise to coordinate and enhance diabetes research and care throughout the UAB campus, the Comprehensive Diabetes Center was established in 2018, involving more than 10 departments and 250 faculty members. Several pediatric endocrinology faculty members are center members, partaking in the disparate collaborative research opportunities available at the center.

Since 2001, the endocrine service has flourished as a clinical juggernaut, with a nearly six-fold increase in outpatient visits and inpatient admissions. Clinic census snowballed from 2,500 visits in 2001 to nearly 14,000 in 2018. Incontestably, the spike in endocrine referrals paralleled the surge in childhood obesity, especially rife in the Southeast, with its attendant co-morbidities such as type 2 diabetes, dyslipidemia, PCO syndrome, metabolic syndrome, early puberty and questionable hypothyroidism.

Quite unanticipated, however, was the upsurge of type 1 diabetes in Alabama, appearing in younger and younger children, sometimes in those less than 5 years of age. This trend started in the late 80’s or perhaps earlier. Alabama was not alone. Type 1 diabetes expansion was observed throughout the US, even world-wide. Based on a World Health Organization survey spanning 10 years to 2006, and upon examining 10 years of records from 57 countries, it was reported that the incidence of type 1 diabetes had increased an average of 5.3% per year in North America, 4% in Asia and 3.2% in Europe. Another study, which extracted data from US diabetes registries from 2002 to 2009, corroborated the growing incidence of this chronic disease, a relative increase of 2.7% each year. The worrisome and escalating incidence in type 1 diabetes remains to this day unexplained.

During this same time period, namely, 2001 to the present, several comprehensive, multi-specialty clinics were established at Children’s of Alabama. These clinics, bulleted below, involve physicians from other subspecialties (e.g., genetics, rehab medicine, cardiology, orthopedics, etc.), in addition to ancillary health care providers (nutritionists, child psychologists, social workers, pharmacists, etc.).

Distinct Comprehensive Clinics

List of comprehensive multi-disciplinary clinics, and their directors, inaugurated since 2001:

• Type II Diabetes Clinic- Dr. Mary Lauren Scott

• Lipid Disorders Clinic - Dr. Ambika Ashraf

• Metabolic Bone Disorders Clinic - Dr. Ambika Ashraf and Dr. Kenneth McCormick

• Newborn Screening (hypothyroidism and CAH) Program- Dr. Gail Mick

• Turner Syndrome Clinic - Giovanna Beauchamp

• Thyroid Cancer/Nodules Clinic - Dr. Pallavi Iyer

• Cystic Fibrosis Related Diabetes Clinic - Dr. Michael Stalvey

• Gender Clinic- Dr. Hussein Abdullatif

• Diabetes Insulin Pump Program- Dr. Joycelyn Atchison.

Fellowship Program

In 2001, the most pressing mission was to develop a fellowship program given the relentless decline in pediatric residents wishing to pursue a career in endocrinology which, alarmingly, paralleled the aforementioned nationwide rise in the incidence of both type I and II diabetes. With the proliferation of endocrine disorders and concomitant decline in the number of young endocrinologists, these antithetical trends did not bode well for endocrine care in Alabama. Fortuitously, and timely, funding for the three-year fellowship was ensured by an endowment from the Bruno Diabetes Foundation. Parenthetically, years before 2001, the largess of the Joseph Bruno family supported not only the endocrine fellowship but also multiple diabetes-related academic/clinical activities. Accreditation of the fellowship program was announced in 2002.

Endocrine fellows are listed in chronological order:        

• Ambika Ashraf 2003-2006

• Whitney Brown 2005-2008

• Amy Burton 2007-2010

• James Gardner 2008-2011

• Alison Lunsford 2010-2013

• Caroline Colvin 2011-2014

• Linnea Larson-Williams 2012-2015

• Alexandra Martin 2013-2015

• Shelly Mercer 2015-2018

• Heather Choat 2016-2019

• Bhuvana Sunil 2017-2020

• Jessica Schmitt 2017-2020           

• Jurhee Freese 2018-2021

• Erin Greenup 2018-2021

As of 2018, the division was comprised of nine board-certified endocrinologists, one instructor, nine nurse practitioners, 12 clinic nurses, six hormone stimulation testing nurses, 14 diabetes educators, five diabetes pump nurses, two nutritionists, two social workers, and one shared child family therapists. Note: many of the staff are part-time.

Featured Divisional Research

Since 2001, research conducted by pediatric endocrinology faculty encompassed cystic fibrosis-related bone health/growth, treatment and etiology of type 1 diabetes (T1DM), lipoprotein metabolism, Vitamin D deficiency, congenital hypothyroidism, endoplasmic reticulum luminal redox effect on cortisol production in isolated microsomes and β-cell apoptosis in cystic fibrosis (CF). 

Publications have appeared in several high-impact journals, including: J Peds, JAMA Pediatrics, Arch Internal Med, Journal of Biological Chemistry, Biochemical Journal, Journal of Steroid Biochemistry, Pediatrics, Journal of Clinical Endocrinology and Metabolism, PLOS ONE, Obesity, Journal of Clinical Lipidology, Endocrinology, Journal of Endocrinology and Biochim Biophysics Acta to name a few.

Ongoing research studies and clinical projects include such topics as:

• The biological defect in the CF transmembrane conductance regulator (CFTR) protein impact on both growth and bone health

• GABA intervention in new-onset Type1 diabetes to preserve β-cell function. This pioneering double-blind, placebo- controlled, project is the first clinical trial of oral gamma aminobutyric acid (GABA) to preserve or restore endogenous insulin secretion, reduce prandial glucagon secretion, improve metabolic/glycemic control, and modulate favorably the autoimmune milieu. This is an investigator initiated study funded through JDRF.

• Increased incidence of Type1 diabetes in African American youth, a cross-section investigation

• Anti-N-acetylglucosamine antibodies from B lymphocytes, their prevalence and their role in the etiology of Type1 diabetes

• Immunology of Type1 diabetes the first year post diagnosis

• Redox regulation of endoplasmic calcium ATPase and uptake in isolated hepatic microsomes

• Modulation of macronutrient composition for management of lipid disorders and non-alcoholic fatty liver disease.

• Natural history of Type1 diabetes (NIH multicenter study)

• 11-Ketotestosterone concentrations in children with CAH and other adrenal disorders

• Cystic fibrosis diabetes and β-cell apoptosis by assaying unmethylated insulin DNA(in collaboration with Pennington Biomedical Center)

• ECHO (Extension for Community Healthcare Outcomes) video-conferencing program covering Pediatric Diabetes and Obesity - Spring 2018

• Diagnostic value of a second newborn screening test for congenital hypothyroidism

• Vitamin D deficiency in pediatrics and its role in glucose homeostasis and vascular health

• Dyslipidemia, obesity, and pre-diabetes

• Participation in at least 10 pharmaceutical-sponsored investigative drug studies concerning Type2 diabetes, growth hormone deficiency, hypophosphatasia, FGF23 excess, Prader Willi syndrome