Paediatric endocrinology
Endocrinology is basically disorders of hormones which are responsible for homeostasis, disorders of the mechanisms of homeostasis and the disorders of the organs which produce these hormones. There are four main areas affected in paediatrics, with diabetes the most important:
Diabetes mellitus
This is a reasonably common disorder, that often presents in childhood, especially around puberty onset age (12/13). There are two main things you need to know.
- Read the disease profile on Diabetes mellitus type 1.
- Read about how to deal with Diabetic ketoacidosis, which is how 10% present.
Other Endocrine Problems
Thyroid disorders
Hypothyroidism
Babies have a low thyroid level at birth. The TSH jumps up, and this soon sorts out. However, in some babies there can be congenital causes of hypothyroidism. If treated, these can prevent development of learning difficulties. The main two causes are:
- Malformation of the thyroid gland - this is the commonest cause. It may never properly develop.
- Iodine deficiency - rare in the UK. Make sure mothers get enough iodine.
Other causes of hypothyroidism are the same as in adult medicine.
Hyperthyroidism
This is due to the same problems that adults get, such as Grave's disease. First line of treatment is medical, usually carbimazole, and second line is radioiodine treatment to kill off the thyroid gland.
Adrenal disorders
There are two key culprits here:
- Addison's disease - Not enough corticosteroids. Rare in children. Found in conjunction with other endocrine problems. They present with a salt losing crisis, with hyponatraemia and hyperkalaemia. Treatment is through acutely restoring balance of salts, and long term with replacement glucocorticoids and mineralocorticoids.
- Cushing's syndrome - Too many corticosteroids. Usually caused by long term steroid use, such as in severe asthma. The other causes tend to be from some kind of tumour. That is such a special field, just don't worry about it.
Parathyroid disorders
Parathyroid problems are rare in childhood (and pretty rare in adulthood). I can't be bothered - don't worry about them!