Endocrine Disorders in Children - Symptoms, Diagnosis, and Treatment

Introduction:

The endocrine system consists of glands such as the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid gland, parathyroid gland, hypothalamus, and adrenal glands. The endocrine system secrets hormones and releases them into the blood. These hormones help in many important functions like growth, metabolism, and reproduction. Growth and development among children are based on the proper functioning of the endocrine system. An imbalance in hormones may affect growth and development and may cause disorders that are life-threatening or may need surgery.

What Are Endocrine Disorders in Children?

The endocrine system controls the hormones that regulate many bodily functions such as temperature, mood, growth, etc. Problems related to growth, puberty, and sexual development have their roots in endocrine systems. Common endocrine disorders among children are related to the pancreas, pituitary, thyroid, or adrenal glands. These problems may be due to an imbalance of hormones or the presence of tumors.

Endocrine Disorders Include:

• Diabetes (type 1 or type 2).

• Thyroid disorders (Hyperthyroidism and hypothyroidism).

• Short stature due to growth hormone deficiency.

• Turner syndrome.

• Tumors.

• Adrenal glands disorder.

• Adrenoleukodystrophy.

• Bone and mineral disorder.

• Childhood obesity.

• Lipid disorders.

• Multiple endocrine neoplasia type 1 (MEN 1) and type 2 ( MEN 2).

• Pituitary disorders.

• Puberty disorders.

What Are the Symptoms Associated With Endocrine Disorders in Children?

Children show the following symptoms and they vary:

• Fatigue.

• Weakness.

• Headache.

• Irritability.

• Weight loss/gain without knowing.

• Failure to attain growth milestones.

What Are the Causes of Endocrines Disorders in Children?

Sometimes causes of endocrine disorders are unknown. Risk factors like genetics and obesity may increase a child’s chance of getting affected by endocrine disorders. The causes of endocrine disorders in children depend on the different conditions.

• Tumors: Tumors (noncancerous) of the adrenal and pituitary glands are the cause of acromegaly and Cushing’s syndrome (a syndrome caused due to excess cortisol hormone).

• Hormonal Imbalance: Some conditions like hypothyroidism and hyperthyroidism are due to an increase or decrease in thyroid hormones. High androgen levels in females lead to polycystic ovary syndrome.

• Autoimmune Condition: Some autoimmune conditions like diabetes type 1, and Grave’s disease are seen in hyperthyroidism.

Which Are the Endocrine Disorders in Children?

The following disorders are related to children:

• Growth Disorders: Children may show abnormal growth in height or size for their age and sex. Other reasons include; imbalances in growth hormone, thyroid, and Cushing’s disease. Genetics play a role in height of a child but endocrine disorders may affect a child’s growth. If a child is having a growth hormone deficiency, the child's growth is affected and they show short stature.

• Pubertal Disorders: Puberty occurs due to changes in hormone levels. An imbalance of hormones may lead to early or delayed puberty. If puberty starts before the age of eight years in girls and nine years in boys, it is called precocious puberty. In delayed puberty, due to a deficiency of hormones, signs of puberty may not be seen even at the age of 13 in girls and 14 in boys.

• Turner Syndrome: A rare genetic disease occurring only in girls. Girls showing this syndrome present short height and cardiac problems. As the symptoms are mild, girls will be in their teens when get diagnosed. They may also present with learning disabilities, lack of menstrual cycles, delayed puberty, and show infertility on growing up.

• Calcium Disorders: Calcium is an important mineral required by the human body. Hypercalcemia (increased levels of calcium) affects digestion, and the functioning of the heart, brain, kidneys (causing stones in the kidney), and bone (weaken bones). Hypocalcemia (decreased calcium levels) causes jitteriness, muscle twitches, and seizures. The child may not eat properly.

• Lipid Disorders: Hormones control pathways for fats and proteins and help in metabolism.

• Pituitary Disorders: These include acromegaly and Cushing’s syndrome, hypothyroidism, hypogonadism, etc.

• Multiple Endocrine Neoplasia Type 1 (MEN 1) and Type 2 ( MEN 2): In this type of disorder, tumors develop in hormone-secreting cells.

• Childhood Obesity: A serious medical condition resulting because of extra weight.

• Thyroid Disorders: Most common endocrine disorder in children. Hyperthyroidism and hypothyroidism are the two types. In hyperthyroidism, the child is presented with weight loss and feels nervous and sweaty. In the case of hypothyroidism, the child presents with fatigue, constipation, dry skin, and depression.

How Are Endocrinal Disorders Diagnosed?

Some of the endocrine diagnostic tests include;

• Annual Wellness Check-Ups: It is recommended if a child’s growth lags behind and not matching with a growth chart, which can be a symptom of a problem.

• Bone Age Assessment: It is done to know the maturity of a child’s skeletal system using an X-ray.

• Stimulation and Suppression Test: It is used to know the relationship between the adrenal cortex and anterior pituitary to know the primary cause of abnormal adrenocortical secretion.

• Blood Test: It helps to know the levels of hormones.

• Nutritional Assessment: It includes a history of diet intake, physical examination, anthropometrics (weight, height, stature, head circumference, triceps skinfold thickness), pubertal staging, skeletal maturity staging

• Imaging Tests: Magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound is done in case of endocrine-related tumors to know where is it situated and to what extent it has spread.

• Biopsy: Once the tumor is identified then small tissue is taken out to check under a microscope.

• Diabetic Tests: Blood tests are done to know random blood sugar, fasting, and average A1C blood levels. Autoantibodies are checked which are found in type 1.

• Dysmetabolic Endocrine Tests: Cluster of disorders which include blood pressure, obesity, impaired glucose tolerance (IGT), hypertension, fatty blood, and impaired fibrinolysis leading to blood clots. Tests for these are outside the endocrine. Blood tests are used to know lipid levels in children.

• Lipid Tests: Blood tests are used for checking lipid levels.

• Polycystic Ovary Syndrome (PCOS) Tests: A blood test to check for hormone levels especially androgen ( a male sex hormone) which is a hallmark of the disease. Ultrasound and other scans to check if any cysts are present in the ovaries.

How Do You Treat Endocrine Disorders in Children?

Treatments of endocrine disorders in children depend on the specific endocrine disorder.

• Hormonal therapy is the first line of defense for treating children with endocrine disorders.

• Depending on the cause and based on the child’s overall health, medicine, and lifestyle changes (exercise and diet) may be recommended.

• In PCOS, based on the condition of the child, a course of treatment that includes medications and surgery is recommended to remove cysts.

• In the case of tumors, treatment options can be planned for radiotherapy, chemotherapy, or surgery.

Conclusion:

Endocrine disorders are a complex web of diseases. They are challenging to identify because of the range of symptoms they show and the similarities present with other conditions. Especially in children identifying and treating is a big challenge to parents as well as doctors. Knowing about the conditions in detail helps one to seek help from a doctor at the earliest. Early diagnosis is always good to treat the disease well.