Pediatric ENDOCRINE DISORDERS
Pediatric ENDOCRINE DISORDERS
The endocrine system is made up of glands that make hormones. Hormones are the body’s chemical messengers. They carry information and instructions from one set of cells to another.
Endocrine System Function
Endocrine glands release hormones into the bloodstream. This lets the hormones travel to cells in other parts of the body.
The endocrine hormones help control mood, growth and development, the way our organs work, metabolism , and reproduction.
The endocrine system regulates how much of each hormone is released. This can depend on levels of hormones already in the blood, or on levels of other substances in the blood, like calcium. Many things affect hormone levels, such as stress, infection, and changes in the balance of fluid and minerals in blood.
Too much or too little of any hormone can harm the body. Medicines can treat many of these problems.
ENDOCRINE SYSTEM
GROWTH DISORDERS
DISORDERS OF SEXUAL MATURATION
DISORDERS OF PUBERTY (INCLUDING PRECOCIOUS PUBERTY AND DELAYED PUBERTY)
THYROID DISORDERS
DISORDERS AFFECTING THE PITUITARY GLAND
DIABETES MELLITUS, TYPES 1 AND 2
DISORDERS AFFECTING THE ADRENAL GLAND
DISORDERS
OF
ENDOCRINE FUNCTION
GROWTH DISORDERS
Growth disorders are problems that prevent children from developing normal height, weight, sexual maturity or other features.
Very slow or very fast growth can sometimes signal a gland problem or disease.
The pituitary gland makes growth hormone, which stimulates the growth of bone and other tissues.
Children who have too little of it may be very short. Treatment with growth hormone can stimulate growth.
People can also have too much growth hormone. Usually the cause is a pituitary gland tumor, which is not cancer. Too much growth hormone can cause gigantism in children, where their bones and their body grow too much. In adults, it can cause acromegaly, which makes the hands, feet and face larger than normal. Possible treatments include surgery to remove the tumor, medicines, and radiation therapy.
Short Stature
Gigantism
Puberty is an extremely important phase in the physical and psychosocial development of the adolescent.
Precocious puberty is pubertal onset before 8 years of age in girls and before 9 years of age in boys. Accelerated linear growth, breast development, penile enlargement, pubic hair
Usually idiopathic in girls; 30% of boys have CNS tumors
Delayed puberty is the absence of breast development in girls by 13 years of age and absence of testicular growth to at least 4 mL in volume or 2.5 cm in length in boys by 14 years of age
Early puberty and sexual development may be caused by tumors or growths of the ovaries, adrenal glands, pituitary gland, or brain.
A detailed history and physical examination are the first steps in the diagnostic evaluation of a normal variant or an abnormal puberty. Further evaluation includes:
Hormone levels.
Specific blood/urine studies for end products of abnormal metabolism.
Radiographic/imaging (bone age).
DIAGNOSIS OF ABNORMAL PUBERTY
Referral to pediatric endocrinologist
Hormonal replacement for hypogonadism.
Treatment Depends on underlying disorder, degree of advancement of bone age, can be effectively treated with medication.
PITUITARY GLAND DISORDERS
The pituitary gland is located in the brain and is known as the master gland because it produces hormones essential for daily functioning. These hormones stimulate the adrenal gland, the thyroid gland, the ovaries, and the testes.
In neonatal hypopituitarism (NH) an infant’s pituitary gland fails to develop properly.
Later in childhood, different types of tumors that may form in the pituitary gland, limiting its ability to function.
PITUITARY GLAND DISORDERS
SYMPTOMS
Infants with NH generally develop yellow skin or eyes (jaundice) and low blood sugar, and suffer from poor growth or lethargy.
Children and adolescents with pituitary tumors may suffer from poor growth, early or late puberty, over- or under-active thyroid or problems with their adrenal glands. In addition, they may experience excessive or decreased urination. Girls may discharge milk from the breasts without being pregnant.
Infants with NH can be treated with replacement pituitary hormones
Children and adolescents with pituitary tumors may be treated with microsurgery, radiation therapy, conventional surgery, drugs, or a combination of these approaches.
TREATMENT
ADRENAL GLAND DISORDERS
One adrenal gland lies above each kidney. These manufacture a number of hormones that are vital to many bodily functions. For example, they regulate the body’s response to stress, to cold, the heart rate and blood pressure, they manage blood sugar and sodium and potassium salt levels, and regulate sexual maturation during puberty.
When the adrenal glands produce too little or too much of one or more hormones significant health problems occur and these conditions are generally known as adrenal disorders.
CAUSES OF TOO LITTLE HORMONE
CAUSES OF TOO MUCH HORMONE
Autoimmune disease, infections, tumors, medications, genetic mutations or problems with other glands like the pituitary gland
Overproduction of hormones (like Cushing’s disease, hyperaldosteronism) may result from benign (non-cancerous) growths (adenomas) or cancerous tumors in the adrenal or pituitary glands.
ADRENAL GLAND DISORDERS CONT
SYMTOMS OF TOO LITTLE HORMONE
Fatigue, weight loss, decreased appetite, low blood pressure, nausea, vomiting, abdominal pain, and many other symptoms.
Obesity, a round or moon shaped face, slow growth, acne, bone and muscle weakness, exaggerated male characteristics (like excessive body hair, baldness, big muscles, faster growth, high blood pressure
SYMTOMS OF TOO MUCH HORMONE
MANAGEMENT
Hormone replacement/pediatric endocrinologist
Adrenal crisis is medical emergency
MANAGEMENT
Steroid doses if more than 7-10 days
Most common cause of preventable mental retardation
Untreated – irreversible brain damage, growth failure, deafness, neurological abnormalities
Newborn screening/thyroid replacement
The thyroid gland is in front of the neck and is shaped like a butterfly or bowtie.
The main job of the thyroid is to make thyroid hormones (T4 and T3).
Thyroid hormones help maintain normal metabolism, growth, and development.
A thyroid disorder may be present at birth (congenital) or might develop later in life.
The thyroid may make too little hormone (hypothyroidism) or too much (hyperthyroidism).
THYROID DISORDERS
HYPERTHYROIDISM SYMPTOMS
Weight loss, nervousness, tremors, excessive sweating, increased heart rate and blood pressure, protruding eyes, and a swelling in the neck from an enlarged thyroid gland (goiter)
Graves’ disease/autoimmune disease
Management
Antithyroid drugs, subtotal thyroidectomy, radioiodine.
HYPOTHYROIDISM SYMPTOMS
Fatigue, slow heart rate, dry skin In children: slower growth and delayed puberty
Hashimoto’s thyroiditis, which results from an autoimmune process that damages the thyroid and blocks thyroid hormone production, is the most common cause of hypothyroidism in kids.
Management
TBG deficiency – no treatment
Thyroid hormone replacement pills levothyroxine with frequent monitoring/more often in children <3 years.
THYROID DISORDERS
3rd most common chronic disease in childhood.
Occurs when the level of blood sugar is high (Darbre, 2018).
Glucose is the main source of energy
Insulin is responsible for maintaining blood sugar levels.
DIABETES
TYPE 1 DIABETES
Previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes
Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells.
This form of diabetes usually affects children and young adults
TYPE 2 DIABETES
Increased insulin resistance in tissues – hyperinsulinemia/hyperglycemia
Increased insulin demand – pancreas loses ability to secrete insulin effectively
Autoimmune destruction of beta cells does not occur
Growth hormone during puberty increases insulin resistance
Strong association with obesity, sedentary lifestyles, high-calorie, lipid-rich foods
Types of diabetes
The major types of diabetes involves type 1 and type 2 diabetes.
Type 1 diabetes is when the pancreases fails to produce enough insulin
Type 2 diabetes affects the way the body produces sugar
Gestation diabetes develops in pregnant women
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Diabetes symptoms
Polydipsia,
Polyphagia
Polyuria, nocturia
Blurred vision
Weight loss or poor weight gain
Fatigue, lethargy
Ketonuria – abdominal pain,
Fruity smell to your breath
Weakness from dehydration,
Mental confusion
Polydipsia
Polyphagia
Polyuria
Nocturia/bed-wetting
Blurred vision
Obesity
Hyperpigmented, velvet-like rash
Frequent/slow-healing infections
Fatigue
Premature adrenarche
Sleep apnea
Family history of type 2 diabetes
TYPE 1 DIABETES
TYPE 2 DIABETES
Prevention and treatment of diabetes
PREVENTION
Eating healthy
Being active
Avoiding being sedentary for longer periods
TREATMENT
Exercising regularly
Insulin therapy
Monitoring blood sugar level
Eating healthy- eat food lower in fats and calories with higher fiber. Eat majorly fruits, vegetables and whole grains
Being active-exercise often
Losing weight
Avoiding being sedentary for longer periods
Eating healthy- eating fewer calories, fewer refined carbs, fewer foods containing saturated fats and eating more vegetables, fruits and foods with fiber
Losing weight- loosing 5-10% of body weight makes an impact on blood sugar levels
Exercising regularly- having aerobic exercises.
Insulin therapy- medications such s metformin, sulfonylureas, meglitinides and thiazolidinediones
Monitoring blood sugar level
Bariatric surgery
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Obesity
BMI >95th percentile
Occurs due to excessive body fats
The condition increases the risks of other diseases such as diabetes, high blood pressure and heart diseases
Excessive calories intake results to the condition
Other causes may be genetic hormonal or behavioral
Refer to pediatric endocrinology if other endocrine disorders present
Prevention entails exercising regular, eating healthy, monitoring your weight regularly
Nutritional counseling
Lifestyle management
Weight maintenance, not loss
Conclusion
Endocrine system is responsible for production and release of hormones
The system affects metabolism growth and development, mood and sexual functions
Endocrine system disorders interfere normal body functions
Diabetes is the most common endocrine disorder
In concluding this presentation here is a recap of the main issues addressed
Endocrine system is responsible for production and release of hormones
The system affects metabolism growth and development, mood and sexual functions
Endocrine system disorders interfere normal body functions
Diabetes is the most common endocrine disorder
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References
Darbre, P. D. (2018). Overview of air pollution and endocrine disorders. International Journal of General Medicine, 11, 191–207. https://doi.org/10.2147/IJGM.S102230
Endocrine disorders | | Blogs | CDC. (n.d.). Retrieved October 20, 2020, from https://blogs.cdc.gov/publichealthmatters/tag/endocrine-disorders/
Kalra, S., Gupta, L., Khandelwal, D., Gupta, P., Dutta, D., & Aggarwal, S. (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of Postgraduate Medicine, 63(4), 242. https://doi.org/10.4103/jpgm.jpgm_16_17
Lause, M., Kamboj, A., & Fernandez Faith, E. (2017). Dermatologic manifestations of endocrine disorders. Translational Pediatrics, 6(4), 300–312. https://doi.org/10.21037/tp.2017.09.08
National Institute of Diabetes and Digestive and Kidney Diseases. (2019, December 18). Endocrine Diseases | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases
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