Scope of Paediatric Endocrinology

by Dr. Namratha Upadhya

Aster hospitals is a pioneer of excellence and achievements in the field of medical consultancy and treatments. The hospital runs paediatric endocrinology clinics in all its branches at Bangalore. Paediatric endocrinology services at Aster is one of its kind, in the comprehensive management of a wide spectrum of endocrine disorders in children. The team boasts to have dedicated, passionate and trustworthy doctors who work day in and day out with the strong support of devoted and vigilant management and assistant staff.

What is Paediatric endocrinology?

The endocrine system consists of various glands that secrete hormones. Hormones are chemical signals  which are poured by the glands into the blood and carried by it to different target organs where they perform regulatory functions of growth, puberty, metabolism of blood glucose, calcium and many more.

Paediatric endocrinology is a  subspecialty  of paediatrics that deals with the diagnosis and treatment of diseases related to the endocrine system in children such as diabetes, disorders of  growth, puberty, thyroid, adrenal glands, bone and calcium etc.

Common Paediatric Endocrinology disorders:

  1. Short stature and poor growth : Short stature is a condition in which a child's height is below the expected standards as compared to other children of their age and sex. When the pituitary gland of the endocrine system is not able to produce the right amount of growth hormone needed for normal growth of a child, it results in severe stunted growth.

  2. Early or delayed puberty: Puberty is the age of attaining reproductive maturity. Girls hit puberty at the age of 8 to 13 whereas boys hit puberty at the age 9 to14. There can be precocious or delayed puberty. Adolescents with delayed puberty  may have underdeveloped secondary sexual characteristics, e.g. underdeveloped breasts in girls.

  3. Obesity: Children who are overweight or obese have a BMI much higher than expected for the age and sex of the child. This could be due to an underlying endocrine disorder. Obesity in childhood & adolescence due to any cause can lead a spectrum of co-morbidities including Type-2 diabetes, high blood pressure, abnormal lipid profile, PCOS and many others.

  4. Type 1 diabetes: This is most common type of diabetes among children and adolescents in which the pancreas is not able to produce the hormone insulin, leading to high blood sugars, excess thirst, urination and when left untreated to a life -threatening condition called Diabetic ketoacidosis resulting from excessive accumulation of ketoacids in the body.

  5. Thyroid: Hypothyroidism occurs due to reduced secretion of thyroid hormones whereas hyperthyroidism occurs due to over secretion of hormones by thyroid glands. Hypothyroidism may present as a Goiter, with symptoms such as short stature, weight gain, delayed development, slow and reduced activity, etc.Hyperthyroidism manifests itself as symptoms like weight loss, excess swearing hand tremors, irregular heartbeats  and may also present with Goiter.

  6. Adrenal gland hypo and hyper secretion: Hyposecretion of adrenal glands causes Addison's disease which results in fatigue, weakness weight loss, dark skin and low blood pressure. Inborn problems like congenital adrenal hyperplasia (CAH) can present in newborn period with impaired function of adrenal glands and ambiguous genitalia. Hypersecretion of adrenal gland can cause features of Cushing syndrome which may be associated with Obesity, short stature, high Blood Pressure, etc.
  7. Calcium & Bone disorders- Hypocalcemia or low calcium in the body can occur due disorders with hormones such as Vitamin D & Parathyroid hormone (PTH). These children can have seizures, tetany, weakness, and sometimes deformities. They can also have bowlegs, knock knees or other deformities due to rickets. Children can have inborn or acquired disorders affecting bone formation which can lead to repeated fractures due to weak bones (osteoporosis)
  8. Endocrine problems due to other disorders- Certain diseases such as Thalassemia, cancers, chronic liver, kidney, lung diseases and their treatment can affect the endocrine glands leading to secondary endocrine disorders. If your child has any chronic disorder, your treating doctor may refer you to a paediatric endocrinologist to screen for endocrine problems.

Why has paediatric endocrinology become important?

The endocrine disorders that affect children are different from those seen in adults. The management of these disorders requires a depth of knowledge and expertise which is often beyond that can be attained by general practitioners in this specialty. Paediatric endocrinologists are specifically trained to have a better understanding of these disorders and their impact on different stages of growth and development of your child. They are also trained specifically to handle children and address the concerns of the families, making a timely diagnosis and initiation of treatment when indicated, and specific monitoring of certain disorders. The Paediatric endocrinology history is often detailed, in depth and followed by a thorough and complete examination of your child in order to put together a comprehensive assessment and best possible plan for your child.

How do we at Aster help you at our Pediatric Endocrinology Clinics ?

The paediatric endocrinology clinics of Aster Hospital provide services for the following conditions:

  • Growth disorders- including Growth hormone therapy for failure to gain height( when indicated)
  • Comprehensive management of type 1 diabetes - Nutritional counselling, diabetes education and technology driven care such as continuous glucose monitoring (CGM) and insulin pumps
  • Type- 2 diabetes in children & adolescents
  • Hypoglycemia ( Low blood sugars) in newborns and children
  • Obesity in children and adolescents
  • Early and delayed puborty
  • Thyroid, Adrenal gland, Calcium & Bone disorders in children
  • Endocrine complications in systemic disorders- such as Thalassemia, childhood cancer survivors
  • Genetic disorders affecting the Endocrine system- Turner , Prader Willi Syndrome, etc

Our diagnostic tools for comprehensive assessment:

  • Bone age assessments
  • Interpretation of hormonal assays
  • Stimulation tests such as
  • ACTH stimulation
  • Leuprolide stimulation
  • Growth hormone stimulation
  • Fasting challenge test for hypoglycemia disorders
  • Water deprivation test.
  • Genetic testing when indicated

Our embellishments:

The department has conducted a multidisciplinary clinic for children with Prader Willi Syndrome. Prader Willi Syndrome is a genetic disorder caused due to defect in 15th chromosome. This disrupts the normal functioning of Hypothalamus of the brain leading to issues with hunger, growth, mood ,sleep, body temperature and sexual development.