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Dr. Grimberg investigates the growth hormone (GH)/insulin-like growth factor (IGF)-I axis and clinical issues related to child growth. Her recent research is focused on disparities in, and the decision-making related to, the medical management of children with short stature. She is fascinated by how differential societal pressures for tallness and the advent of an expensive therapeutic have transformed a fundamental aspect of pediatric healthcare.
Trained as a translational physician-scientist, Dr. Grimberg’s research is focused on the growth hormone (GH)/insulin-like growth factor (IGF)-I axis and clinical issues related to child growth.
She is the scientific director of the Diagnostic and Research Growth Center at CHOP, which follows more than 5,500 children per year for growth faltering and where more than 200 patients per year are started on GH treatment.
Intrigued by the report during her fellowship of the identification of IGF binding protein (IGFBP)-3 as a target of p53, arguably the most important human tumor suppressor, Dr. Grimberg wondered how a GH-dependent gene could also fall under transcriptional activation by p53, how did the two systems interact, and how was cell fate directed toward survival/proliferation or apoptosis? With support from a K08 award from the National Institute of Diabetes and Digestive and Kidney Diseases as well as several foundation, society and institutional grants, Dr. Grimberg studied the molecular biology of the GH/IGF axis and how it interacts with the p53 tumor suppressor pathway in cancer development. She acquired expertise in the modulation of IGF bioactivity in the context of intersecting cell signaling pathways that together determine cell fate. For example, as principal investigator, Dr. Grimberg discovered that IGF binding protein-2 is a novel target of p53 and also that it is regulated by protein kinase A.
While her current collaborative translational research includes investigations into novel genetic mechanisms of growth failure, Dr. Grimberg’s principal research focus shifted in response to observations from her clinical experience. What started with systematically collecting evidence supporting the existence of gender- and race/ethnicity-based disparities in the evaluation and treatment of children with short stature has evolved into a much richer area of inquiry. Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Dr. Grimberg has been studying the shared medical decision-making process through electronic health record-based studies of primary care provider clinical judgments, mixed qualitative-quantitative methods to explore parental attitudes and beliefs about short stature and its medical management, and mixed methods to discover the role the youth themselves play in the decision-making process.
Dr. Grimberg’s research on disparities in the evaluation and treatment of children with short stature created a new line of investigation and conversation in the world of pediatric growth disorders. Although growth faltering may be the first or only sign of an underlying health problem, which is equally important for all children, social pressures for tallness affect males more than females in our society. The influence of social pressures on clinical practice can lead to missed diagnosis of underlying health problems in girls and children of racial/ethnic minorities while promoting overzealous treatment of healthy, primarily white boys who want to be taller. Dr. Grimberg’s work has received coverage in multiple media venues in the United States and internationally, including the New York Times, and raised awareness of the pediatric and endocrine communities to this bias.
Throughout nearly 20 years on faculty in the Endocrine Division at CHOP, Dr. Grimberg has trained fellows in the clinical skills of endocrine practice, research skills from study design through to publication, and academic skills including giving public presentations, and writing case reports, review papers, and book chapters.
Additional notable career achievements include:
- Chair of the taskforce charged with drafting the new guidelines for GH and IGF-I use in children and adolescents for the Pediatric Endocrine Society (PES)
- Chief guest editor, 60 Years of Human Growth Hormone. Pediatric Endocrinology Reviews. 2018 Sept;16(Suppl 1).
- Co-chair of the PES Drug and Therapeutics Committee
- Elected Member, Council, The Growth Hormone Research Society
- Member, National Children’s Study Federal Advisory Committee, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
- Member, PREP Endocrinology Advisory Board, American Academy of Pediatrics
- International recognition of contributions to the field at the 8th International Congress of the Growth Hormone Research Society and IGF Society in Tel Aviv, Nov 2016:
- Invited presenter of an abstract on new data (“Barriers Perceived by Parents to Potentially Impede Medical Care for a Child's Short Stature”)
- Three papers on the topics of pediatric GH treatment and neoplasia risk, GH safety, and gender bias in U.S. pediatric GH treatment, were highlighted by Dr. Beverly Biller’s presentation of the most important GH publications of the past two years.
- One paper describing a GRP94 variant as a novel mechanism of IGF-I deficiency was highlighted by Dr. Briony Forbes’ presentation of the most important publications of the past two years in IGF research.
Education and Training
BS, Cornell University (Biology – Genetics and Development), 1989
MD, Cornell University Medical College, 1993
Certificate of Patient-Oriented Research, University of Pennsylvania Perelman School of Medicine, 2002
Introduction to Health Policy and Health Services Research, Perelman School of Medicine at the University of Pennsylvania, 2014
Titles and Academic Titles
Attending Physician, Division of Endocrinology and Diabetes
Scientific Director, Diagnostic and Research Growth Center
Professor of Pediatrics
Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania
The Endocrine Society, 1997-
Pediatric Endocrine Society (PES; formerly named in honor of Lawson Wilkins), 1999-
PES Drug and Therapeutics Committee, 2008-2012
PES Growth Hormone and Neoplasia Taskforce, 2010-2015
PES Program Committee, 2012-2015
PES Representative, First International Consensus Statement on Diagnosis and Management of Silver-Russell Syndrome, 2015-2016
PES Education Council (Clinical Update/Board Review Subcommittee), 2017-
Abramson Cancer Center, University of Pennsylvania, 2000-
Board member, The Philadelphia Endocrine Society, 2002-2009
University of Pennsylvania Institute for Diabetes, Obesity and Metabolism, 2003-
Institutional Review Board, Children’s Hospital of Philadelphia, 2004-2007
Associate Editor, Growth, Genetics and Hormones, 2004-2009
Fellow, American Academy of Pediatrics, 2004-
International Society for IGF Research, 2004-
Institute for Translational Medicine and Therapeutics, University of Pennsylvania, 2007-
The Growth Hormone Research Society, 2010-
Editorial Board, Pediatric Endocrinology Reviews, 2014-
Grant reviewer, German-Israeli Foundation for Scientific Research and Development, 2015
Steering Committee, Pfizer International Growth Study (KIGS) Database, 2015-
Intramural Program Site Visit team, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2016
Lilly Research Fellowship Grant, Lawson Wilkins Pediatric Endocrine Society (LWPES), 1998-1999
Genentech Clinical Scholar Award, LWPES, 2000-2002
Plenary Speaker, LWPES Annual Meeting, 2002
National Institutes of Health Loan Repayment Program Award (Pediatric Research), 2003-2005
Elected member, Society for Pediatric Research, 2007-
America’s Top Pediatricians, Consumers’ Research Council of America, 2009
Top Northeast Doctors (100 overall, 10 of whom were pediatricians), Arrive Magazine and Avvo.com, 2011
Plenary speaker, 2nd International Conference on Nutrition and Growth, Barcelona, Spain, 20014
Plenary speaker, 3rd International Conference on Nutrition and Growth, Vienna, Austria, 2016
The Leading Physicians of the World, International Association of Pediatricians, 2015
Castle Connolly Top Doctor in Pediatric Endocrinology, 2015-2019
America’s Most Honored Professionals, American Registry, 2016-2019
Castle Connolly Exceptional Women in Medicine, 2017-2019
Best original paper (2018) from North America, Hormone Research in Paediatrics, 2019