Pediatric Endocrinology and Diabetes Care

Type 1 diabetes mellitus (previously known as juvenile-onset diabetes) affects approximately 1 in 400 children, adolescent and young adults under the age of 20 years.  These individuals cannot produce enough insulin to maintain normal blood glucose due to antibody mediated destruction of pancreatic beta cells

Insulin is a critical hormone that is needed to regulate blood glucose and generate energy from the food we eat. There is a lot of research being done for future management with bionic pancreas and pancreatic transplants, but current management is still daily subcutaneous insulin delivery.

Early Symptoms:

• Increasing hunger
• Increasing thirst
• Increasing urination
• Fatigue
• Weight loss

Late Symptoms:

• Nausea
• Vomiting
• Lethargy
• Altered mental status
• Hyperventilation

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It is estimated that more than 25 million people in the US have Type 2 diabetes (previously known as adult-onset diabetes).  Although this is less commonly seen in children, the incidence is occurring more and more frequently, typically in overweight and obese children as young as age 10 years and in teenagers.

This is different from T1D in that the body produces excessive amounts of insulin but the hormone does not function adequately and the cells are unable to respond appropriately to the insulin leading to a phenomenon called insulin resistance.  Most of these individuals have a period of “prediabetes” prior to developing full blown type 2 diabetes.

Physical signs:

• Central obesity
• Acanthosis nigricans (dark velvety thickening on flexural surfaces of the skin)
• Hypertension

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Linear growth and appropriate weight gain in children and adolescents is an overall indication of health and optimal nutritional status. Pediatric growth disorders may be diagnosed if a child grows too slowly (resulting in short stature) or too rapidly (resulting in excessively tall stature). Height deviations seen on growth charts may be the first sign of a hormone disorder or other chronic disease.

Accurate height and weight measurements at EVERY pediatric visit are paramount for the evaluation of a growth disorder.

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Pubertal disorders refer to conditions that affect a child's ability to reach physical and sexual maturity. These fall into two broad categories: Delayed puberty and Precocious Puberty

Most commonly, late puberty does not indicate a health problem, however, sometimes it may be a sign of pathology.

For females, delayed puberty is defined as:

• Lack of breast development by age 13

• Lack of menstruation by age 16

• Lack of menstruation ≥ five years after initial breast development

For males, it is defined as:

• Lack of pubic hair by age 14

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Pubertal disorders refer to conditions that affect a child's ability to reach physical and sexual maturity.  These fall into two broad categories: Delayed puberty and Precocious Puberty

Precocious Puberty is defined as the onset of any secondary sexual characteristic.  It is important to evaluate the cause behind these early changes.

For females, precocious puberty is defined as:

• Breast buds before that age of 8

 For males, it is defined as:

• Testicular and/or penile enlargement before the age of 9

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The thyroid gland is a butterfly-shaped endocrine gland located in the lower front of the neck. Its job is to make thyroid hormones which are carried to every tissue in the body. These hormones regulate the rate of metabolism. In children, it plays a critical role in height gain and brain development.

Symptoms of hypothyroidism (underactive thyroid):

• Fatigue

• Weight gain

• Poor height gain

• Dry skin

• Constipation

• Sensitivity to cold

Symptoms of hyperthyroidism (overactive thyroid):

• Irritability

• Nervousness

• Weight loss

• Tremors

• Frequent bowel movements

• Heat sensitivity

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