Pediatric Endocrinology

Pediatric Endocrinology

Overview

If your child has problems with growth, puberty, diabetes, or other disorders related to the hormones and the glands that produce them, a pediatric endocrinologist may treat your child.

Endocrinology is the science that studies glands and the effects of the hormones. Problems seen by pediatric endocrinologists are often quite different from those commonly seen by endocrinologists for adults.

Pediatric endocrinologists often require special training in pediatric conditions as they relate to growth and development.

What is Pediatric Endocrinology?

Pediatric endocrinologists deal with hormone disorders at all stages of childhood and the teen years. For example, hormones decide how a child grows and matures.

As growing individuals they have special needs related to growth and development. In addition, their psychological needs are different from those of adults.

Hormone problems affecting growth or sexual development can have significant effects on a child’s physical and emotional well-being. Pediatric endocrinologists are sensitive to these issues.

A pediatric endocrinologist cares for your child in a setting that is appropriate for children and teens.

Meet the Team

Dr Manu Agarwal
Dr Manu Agarwal
Pediatric & Adolescent Endocrinologist
child-health-educator
Suhani Grover
Child Health Educator
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Nupur Sah
Child Health Educator
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Sarita
Coordinator

Conditions Treated

  • Growth problems, such as short or excessive tall stature
  • Early or delayed puberty
  • Enlarged thyroid gland (goiter) and under or overactive thyroid gland
  • Problems with Vitamin D (rickets, hypocalcemia)
  • Ambiguous genitals/intersex
  • Dyselectrolytemia
  • Diabetes or low blood sugar
  • Obesity

Services provided

  • Growth hormone therapy
  • Growth hormone stimulation test
  • Thyroid ultrasound
  • Bone age assessment
  • Sexual maturity assessment
  • Adrenal insufficiency evaluation
  • Obesity weight management
  • Nutritional counselling

Treatment for Short Height in Children | Growth Hormone Therapy

A Glance at the disorders treated

A pediatric and adolescent endocrinologist treats many disorders ranging from growth problems to delayed or early puberty and conditions like thyroid in children. This is a glance at the disorders treated by them:

Short Stature:

Short stature is a condition where the child is lesser in height when compared to the familial or national expectations. This may result in low self-esteem and resultant concern in the child or the parent. It has to be diagnosed properly since it is easily treatable if identified early.

Precocious or delayed puberty:

Puberty is the time when your body grows from a child’s to an adult’s. You’ll know that you are going through puberty by the way that your body changes.

If you’re a girl, you’ll notice that your breasts develop and your pubic hair grows, that you have a growth spurt, and that you get your period (menstruation). The overall shape of your body will probably change, too — your hips will widen and your body will become curvier.

If you’re a guy, you’ll start growing pubic and facial hair, have a growth spurt, and your testicles and penis will get larger. Your body shape will also begin to change — your shoulders will widen and your body will become more muscular.

These changes are caused by the sex hormones (testosterone in guys and estrogen in girls) that your body begins producing in much larger amounts than before.

Puberty takes place over a number of years, and the age at which it starts and ends varies widely. It generally begins somewhere between the ages of 9 and 14 for girls, and somewhere between the ages of 10 and 16 for guys, although it can be earlier or later for some people. This wide range in age is normal, and it’s why you may develop several years earlier (or later) than most of your friends.

Sometimes, though, people pass this normal age range for puberty without showing any signs of body changes. This is called delayed puberty. It is characterized by the lack of onset of puberty within the normal range of ages. Precocious puberty have similar signs to normal puberty but they manifest earlier that is before the age of 8 in girls and 9 in boys.

Thyroid disorders:

The symptoms of thyroid problems depend on the type of problem, including whether it causes too much or too little thyroid hormone.

Children with too much thyroid hormone (overactive thyroid or hyperthyroidism) may be more nervous, agitated or emotional than usual, and they may have trouble sleeping.

They may lose weight even though they seem to be eating enough. They may sweat more than normal and have heart palpitations, high blood pressure and diarrhea. An overactive thyroid can make the thyroid enlarge (get bigger). An enlarged thyroid is called a goiter.

Children with too little thyroid hormone (underactive thyroid or hypothyroidism) tend to have the opposite symptoms. They may seem sluggish or have low energy. They may be depressed. They may start gaining weight even though they haven’t changed their eating or exercise. There may be no clear symptoms at first.

Thyroid nodules and thyroid cancer do not usually cause symptoms. Both conditions may cause a lump in the neck that you, your child or a health care provider can feel.

Sometimes thyroid cancer makes the thyroid and lymph nodes in the neck enlarge. It may also cause voice changes because the thyroid is near the voice box (larynx) and nerves to the vocal cords.

Overactive parathyroid glands can cause high levels of calcium in the blood. Symptoms can include feeling tired, weak and not well overall; having kidney stones; having headaches and being constipated.

Ambiguous genitals/intersex:

Sometimes at birth it is difficult to tell the sex of the child because the external genitals are not fully differentiated and it becomes extremely distressing for the parents.

After the detailed work up the underlying cause is identified, treated and the child is assigned a particular sex. The treatment is multidisciplinary involving other than pediatric endocrinologists, pediatric surgeon, psychologist, geneticist etc.

Diabetes:

Throughout the world, incidences of diabetes are on the rise, and consequently so is diabetes amongst children.

Most children are affected by type 1 diabetes in childhood. However, the number of children and young adults affected by type 2 diabetes.

Approximately 90% of young people with diabetes suffer from type 1 and the number of patients who are children varies from place to place.

A figure of 17 per 100,000 children developing diabetes each year has been reported. As a metabolic syndrome, obesity and bad diets spread, so too have the first incidences of type 2 diabetes, previously incredibly rare.

Obesity:

Body mass index (BMI) uses height and weight measurements to estimate a person’s body fat. But calculating BMI on your own can be complicated. An easier way is to use a BMI calculator.

Once your child’s BMI is known, it can be plotted on a standard BMI chart. Kids ages 2 to 19 fall into one of four categories :

  • Underweight: BMI below the 5th percentile
  • Normal weight: BMI at the 5th and less than the 85th percentile
  • Overweight: BMI at the 85th and below 95th percentiles
  • Obese: BMI at or above 95th percentile7.

Vitamin D Disorders:

Rickets and Bone Metabolic Disorder

Rickets is a condition where a child’s bones become soft and weak due to an extreme vitamin D deficiency. Vitamin D helps bones absorb calcium and phosphorus from food. In some cases, rickets can be genetic or hereditary.

Children between the ages of 6 months to 24 months are at the greatest risk for rickets because their bones are growing at a fast rate during this time.

Other factors for children diagnosed with rickets may include :
• Dark skin
• Limited exposure to sunlight
• Diet lacking in vitamin D, calcium or phosphorus
Symptoms of Rickets
Some of the symptoms of rickets may include :
• Stunted or delayed growth
• Larger than average forehead
• An abnormal curve in the spine or back
• Abnormalities in the breast and rib bones
• Wide joints at the elbow and wrist
• Abnormally shaped legs
• Wide ankles

Diagnosing Rickets

Your child’s doctor will conduct a physical examination and may ask about your child’s family health history and diet. If your doctor feels your child may have rickets, he or she may order the following testing :

  • Blood tests: Blood tests can determine if your child has the appropriate amount of vitamin D, Calcium, Phosphorus, Parathyroid hormone, magnesium.
  • X-rays: X-rays of your child’s arms or legs can reveal any bone abnormalities to determine if your child has rickets.

Treatments Offered for Rickets
Treatment varies depending upon the severity of the condition.

Generally treatment includes :
• Daily doses of calcium and vitamin D
• Yearly injections of vitamin D
• Increased foods with calcium

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