Endocrinology is the branch of medicine that deals with issues and diseases related to hormones and the glands that secrete them in the body. Hormones are directly related to a child’s normal growth and development, with each hormone being secreted from its specific gland. If these glands fail to develop, are absent, work insufficiently, work excessively, or function irregularly, conditions called endocrine diseases emerge.

A Pediatric Endocrinology specialist primarily deals with hormonal disorders that arise during childhood and adolescence (0-18 years). They monitor the child’s healthy growth, the onset and progression of puberty at a normal age, and the safe transition into adulthood. Pediatric endocrinologists are responsible for the diagnosis and treatment of children and adolescents with hormonal disorders from birth up to the end of age 18.

What kind of medical training do Pediatric Endocrinology specialists undergo?

After completing six years of medical school, they complete a 4 or 5-year Pediatrics residency. Then, they undergo an additional three years of Pediatric Endocrinology fellowship training, gaining expertise in diagnosing, treating, and monitoring hormone-related diseases.

Common Endocrine Disorders and Conditions in Childhood and Adolescence

Short Stature

A child's growth can be influenced by both personal and environmental factors. For normal growth, one must be healthy, have a balanced diet, and maintain normal hormonal balance. Short stature may be familial, structural, due to hormonal deficiencies, or a reflection of another disease. Pediatric Endocrinology evaluates all potential causes of short stature and provides treatment. If short stature is due to a growth hormone deficiency, treatment should be administered without delay; time loss can lead to reduced height gain. Adolescents with closed growth plates may completely lose the opportunity for growth hormone treatment.

Precocious Puberty

Puberty is the transition period from childhood to adulthood. While there are individual differences, puberty generally begins around age 10 in girls and age 12 in boys in our country. It is considered abnormal if sexual development starts before age 8 in girls or age 9 in boys. Another important issue is potential short stature later on. Children who grow quickly due to the effects of sex hormones might experience early closure of growth plates, leading to early growth cessation and short adult height. A child who is the tallest in the class in elementary school may end up as the shortest in high school. If there is an underlying condition causing early puberty, it should be identified and treated.

If there are still no signs of puberty by age 13 in girls and age 14 in boys, it is considered delayed puberty, and underlying causes should be investigated.

Other problems occurring during adolescence often have hormonal origins. For this reason, issues like excessive hair growth, breast disorders, any menstrual issues in girls, and Polycystic Ovary Syndrome (up to age 18) are also addressed by Pediatric Endocrinologists.

Hypothyroidism/Hyperthyroidism

Thyroid hormones impact growth and development, oxygen usage, heat generation, nerve function, and the utilization of sugars, fats, proteins, and vitamins. Thyroid hormones are essential, especially in the first three years, for intellectual development. Disease symptoms emerge when hormone levels in the blood decrease or increase. Hypothyroidism is defined as the thyroid gland producing little or no hormone, while hyperthyroidism is the condition of the thyroid producing excessive hormone and releasing it into the bloodstream. Pediatric Endocrinologists are also trained to treat thyroid nodules, thyroid cancer, and enlarged thyroid tissue (goiter) and monitor children with family histories of thyroid or goiter issues.

Sex Differentiation Disorders

Sex is a term that defines us as male or female and encompasses our psychosocial and cultural development and preferences. Many factors determine our sex, including genetic structure [46, XX (female genetic structure) and 46, XY (male genetic structure)], our gonads [testes (male) or ovaries (female)], and hormones secreted by these gonads. Environmental factors can also influence this structure. Disorders of sex differentiation are developmental abnormalities in which a newborn’s sex is not clearly identified as male or female. These conditions are typically noticed by a Neonatologist or Pediatrician in the hospital, though they may be missed or become apparent later.

For boys, it’s important if the testes are not observed in the scrotum, urination does not occur from the tip of the penis, or the penis appears very small. For girls, very small urinary openings or small swellings in both groins should be evaluated by a Pediatric Endocrinologist before surgery.

Childhood Diabetes

Type 1 diabetes arises when the pancreas, an endocrine gland, fails to produce the hormone insulin. Insulin is injected several times a day to prevent high blood sugar (i.e., blood glucose) levels. Type 1 diabetes can occur at any age from the newborn period to young adulthood. Delayed treatment can lead to symptoms progressing to coma and even death. Treatment requires lifelong management with insulin alone. These children and adolescents should be treated and closely monitored by a Pediatric Endocrinologist until they reach young adulthood.

Due to the increase in childhood obesity, Type 2 diabetes is also increasingly seen in younger age groups. Insufficient or relatively deficient insulin activity leads to elevated blood sugar. Type 2 diabetes in children is treated and closely monitored by Pediatric Endocrinologists as well.

Obesity

Obesity is the excessive accumulation of fat in the body or an increase in the ratio of fat to body mass. Obesity is a significant health issue during childhood. Most obese children do not have any underlying hormonal disorders; their obesity often results from excessive food intake, known as "simple obesity" or "exogenous obesity." Even in childhood, excess or unspent energy is stored in the body, causing obesity. Although this energy surplus accounts for the majority of childhood obesity cases, hormonal disorders or genetic conditions involving multiple diseases may predispose a child to weight gain. A Pediatric Endocrinologist examines underlying causes, treats conditions requiring intervention, and monitors complications caused by obesity.

Rickets / Bone Health

Childhood and adolescence are critical years for forming a strong and healthy skeletal structure. A calcium-rich balanced diet and weight-bearing physical activities support healthy bone formation. Inadequate vitamin D intake or metabolic diseases affecting vitamin D from birth may lead to inadequate bone mineralization, resulting in rickets. Rickets, osteoporosis, and other bone metabolic diseases fall under the scope of Pediatric Endocrinology.

Hormones Secreted by the Adrenal Glands

The adrenal glands secrete cortisol (stress hormone), aldosterone (water and salt-retaining hormone), sex-related hormones, and adrenaline. Pediatric Endocrinologists deal with adrenal gland hormonal disorders that are congenital or acquired later in childhood.

Children are in a constant state of growth and development and have many physiological and psychological characteristics different from adults. Endocrine issues in early childhood, if not treated promptly, can lead to severe negative effects in later life. Endocrine and hormonal disorders in children must be followed and treated by a Pediatric Endocrinology specialist.