Pediatric Endocrinology is a bridge between pediatric and endocrinology, dealing with several specific problems from that category.
Auxology is dealing exclusively with growth disorders – predominantly with growth deficit.
The majority of cases from endocrine pediatrics are represented of children with small height/waist, sent by family or school doctors or, more commonly brought by their parents, concerned about stagnation or insufficient increase in height / weight.
Many of the children are of average or low height inherited from genitors – child’s height corresponds to the average height of the parents with +/- 8cm. But few children have hormonal disorders – growth hormone deficiency or thyroid, cortisol excess, etc. Therefore, every child with low height must be properly investigated and as idiopathic causes are excluded – eg. family, poor nutrition, rickets, hypovitaminosis, other chronic diseases – are launched detailed investigations – punch radiography, hormonal tests, CAT scans, etc.
Parents should monitor the speed of growth in height and weight of their children. A speed of 4-5 cm and 2-3 kg per year is considered normal even if the child is smaller than the children of the same age. We must consider the growing in leaps with weight stagnation or vice versa, keeping the hours of sleep – from 22 … until morning – the supervision of diet and playing sports.
In case it’s discovered a hormone deficiency – eg. GH deficiency – Growth hormone – the child will receive a free treatment with this synthetic hormone, obtained in a program of CNAS .
The treatment is injected daily, with or without needle devices, strictly followed by the endocrinologist. The child is retested periodically – at 6 months – and the treatment is continued until the growth cartilages are closed or from other reasons, from case to case. Side effects are few – following studies – GH doesn’t give leukemia or cancer than to children who already had undiagnosed disease. However, the parents are well trained and advised on possible side effects.
Another category of children who don’t grow by hormonal causes are those with thyroid hormone deficiency or excess of adrenal hormones. The characteristic of the clinical picture is the fact that these children are small and fatty. Further investigations indicate the cause and indicates the treatment that, properly applied, leads to improved growth rate.
I mentioned at large the main causes of auxological disorders.
There are genetic syndromes – TURNER, DOWN, PRADER WILLI and bone abnormalities – ex-achondroplasia, hipocondroplasia which represents disease border, of which many specialties are concerned – internal medicine, etc.
TAKE HOME MESSAGE – … a child who doesn’t grow 4 cm per year or no longer grow as he should, should be seen by an endocrinologist!
Dr. Antonela Burlacu, MD Endocrinologist, Medical Group Romgermed
Competencies in pediatric endocrinology and endocrine ultrasound