Issue 37 – Autumn 2017

In 2016, Marco Rivarola received ESPE’s International Outstanding Clinician Award, in recognition of his contribution to paediatric endocrinology in Argentina, Latin America, and internationally. Here, we trace the development of paediatric endocrinology in his South American homeland. We look at those who have influenced his life as a paediatric endocrinologist, and examine the role he has had in our field.

PAEDIATRIC ENDOCRINOLOGY DEvELOPED IN ARGENTINA in the late 1950s, in response to paediatric consultations at the two largest general paediatric hospitals in Buenos Aires. The Casa Cuna (now the Hospital General de Niños Pedro de Elizalde) had a service chaired by Salvador De Majo, while the service at the Hospital de Niños (now the Hospital de Niños Ricardo Gutiérrez) was chaired by Martin Cullen. Early inspiration Marco Rivarola graduated in medicine from the University of Buenos Aires in 1960. While there he met two Nobel laureates, Bernardo Houssay (1947 laureate for research into pituitary hormones and blood sugar regulation) and Luis Federico Leloir (1970 laureate for work on sugar nucleotides, carbohydrate metabolism and renal hypertension). Dr Houssay founded the national research council, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), to support scientific research in Argentina. After training in general paediatrics at the Children’s Hospital, Dr Rivarola applied to CONICET for a fellowship at the Hospital’s Endocrine Unit, under the mentorship of César Bergadá (1929–2005). Bergadá had recently returned from a 2-year visit to Lawson Wilkins’ (1894–1963) Pediatric Endocrine Clinic at the Johns Hopkins Hospital in Baltimore, MD, USA. Nowadays, training in paediatric endocrinology usually consists of a 3-year fellowship following a 3-year paediatrics residency. Dr Rivarola’s initial paediatric endocrine training under César Bergadá was for 2 years, when he developed a clinical research proposal including a strong component of laboratory work in steroids. In 1963, he received a 1-year CONICET overseas fellowship to the ex-Wilkins’ Clinic of the Johns Hopkins Hospital, mentored by Claude Migeon. However, his tenure in Baltimore actually lasted for 4 years, providing a potent boost to his scientific career. This was a productive time of learning, teaching, knowledge exchange and acquisition of a sense of teamwork. The Bergadá years In 1967, Dr Rivarola returned to the Endocrine Unit in Buenos Aires, supported by a Research Career Award from CONICET. The Unit developed to become, in 1973, the Centro de Investigaciones Endocrinológicas (CEDIE), a research centre led by César Bergadá. It gathered a large group of clinical and translational investigators, and is still very active. César Bergadá’s broad contribution to paediatric endocrinology included establishing a Centre for the Study of Pituitary Hormones, to collect human pituitaries to purify growth hormone, which was used to treat many patients (fortunately, no side effects from its use were reported in Argentina). He arranged the first national programme for early detection of hypothyroidism and phenylketonuria (later covering other congenital diseases). This earnt him the Spanish Government’s Reina Sofia Award. In 1986, he was central in the creation of the Sociedad Latinoamericana de Endocrinología Pediátrica (SLEP). Dr Rivarola’s research and teaching continued at CEDIE until 1987, with a significant contribution to developing translational paediatric endocrinology, and the personal direction of several young fellows, including biochemists (Ernesto Podesta, Selva Cigorraga, Stella Campo) and physicians (Titania Pasqualini, Alicia Belgorosky). New opportunities In 1987, a new large national paediatric hospital was inaugurated in Buenos Aires: the Hospital de Pediatría Garrahan. This is a tertiary reference paediatric institution for the whole country, encompassing all paediatric specialties. Dr Rivarola and Dr Belgorosky were invited to help organise teaching and research here and, shortly afterwards, to develop a new Endocrine Service, for which Dr Rivarola was appointed as Chair. Dr Belgorosky had a central role in developing the Service’s expertise in molecular biology, in particular establishing a laboratory during the late 1980s and early 1990s. The Service participates in a postdoctoral paediatric endocrinology residency, financed by the city of Buenos Aires and associated with the University of Buenos Aires School of Medicine. To keep up to date with scientific advances, many of the staff attend ESPE Annual Meetings. After Dr Rivarola’s retirement in 2007, Dr Belgorosky became the new Chair of the Endocrine Service. Dr Rivarola is Honorary Consultant, regularly attending his old office. Under Dr Belgorosky’s leadership, the Endocrine Service still seeks to continuously improve the clinical assistance, teaching and research within the group. After all these years, many ex-trainees now practise specialised clinical medicine across Latin America. They benefit from being able to discuss difficult cases with colleagues from their original teaching institution. Finally, at Dr Belgorosky’s suggestion, Dr Rivarola and Dr Belgorosky became co-editors of a free-to-access Spanish/English website, www.endopedonline.com.ar, which is now over 11 years old. It provides information on paediatric endocrinology for paediatricians, and it is updated five times annually. It attracts readers from around the world, with over 200 unique visitors accessing on average 1600 pages each day. Dr Rivarola’s role in the training of paediatric endocrinologists across Latin America has been accompanied by publication of over 180 papers in international peer-reviewed journals. His is proud to have supported colleagues in the expansion of our specialty. Alicia Belgorosky and Marco A Rivarola Hospital de Pediatría Garrahan, Buenos Aires, Argentina