What is Pediatric Endocrinology?
Endocrine glands in the body undertake the task of secreting hormones. The system in which all endocrine glands are located is the endocrine system. Secreted hormones have various tasks such as growth, development, reproduction, and controlling external reactions. Endocrinology is the branch of the unit that deals with the diseases that occur due to the fact that the glands do not work correctly and properly. The unit that deals with the hormonal disorders of all children in the 0-18 age group and the diseases that occur in response to these disorders is pediatric endocrinology.
Any endocrine problem that may arise from hormones, which are especially important in the growth and development of children, should be treated with early diagnosis. Since children show continuous development, diseases that are not treated in this process can lead to permanent problems in the future. Therefore, pediatric endocrinology has a special importance.
Which Diseases Does the Pediatric Endocrinology Unit Treat?
The transition period from childhood to adolescence begins with the hormones secreted from the pituitary gland. In this process, other secreted sex hormones enable the development of sex-specific features. In adolescence, which manifests itself with breast enlargement in girls and testicular enlargement in boys, children change not only physically but also mentally.
The transition of girls to puberty occurs between the ages of 8-13 and boys between the ages of 9-14. If children show these symptoms before the age of 8 or 9, they are experiencing early puberty. Early puberty may be caused by hormones secreted, or it may have other reasons. If early puberty is not taken under control or the underlying disease is not treated, it can cause a premature cessation of growth in the child. For early puberty, which affects bone development and height, children should be checked by a pediatric endocrinologist.
The growth plates at the ends of the bones continue to function until the end of puberty. Although growth varies according to each child, parents have an important role here. A growth chart should be drawn by a pediatric endocrinologist, taking into account the child's bone age and genetic factors, and families should follow the development according to this chart. Among the factors affecting growth are the height ratios of the parents as well as the age of entry to puberty. In addition to these factors, nutrition, healthy functioning of organs and hormones are also important in growth.
Obesity is an increase in body fat according to the body mass index. There are different causes of obesity after the deterioration of the balance between the calories consumed and the calories burned. Although genetic predisposition, lack of movement, consumption of ready to eat meals and sugary foods are among the causes of obesity, a hormonal disease can also cause obesity in children. Children who are not taken under control and treated at an early age may experience various diseases such as diabetes, heart and blood pressure in their later years. Therefore, it is possible to prevent obesity with the efforts of both the child and the parents.
The pancreas secretes insulin to convert the sugar in the blood into energy by the cells. Insufficient secretion of insulin leads to diabetes. After insufficient amount of insulin is secreted, blood sugar rises because the sugar in the blood has not been used by the cells.
There are two types of diabetes. Among Type 1 and Type 2 diabetes, the one seen in children is Type 1. Diabetes can appear in children at a very early age, as well as in adolescence. Diabetes is treated with insulin. Therefore, children should be under the control of a pediatric endocrinologist until adulthood.
Thyroid and Goiter
Thyroid hormone is one of the hormones that control the body's metabolic rate and affect muscle and brain development. When the thyroid gland works less than it should, it is called hypothyroidism, and when it overworks, it is called hyperthyroidism. Enlargement of the thyroid gland causes goiter. The correct functioning of the child's thyroid gland is important in many ways. Thyroid disorders that cannot be diagnosed with early diagnosis negatively affect intelligence and brain development in children. In addition, weight gain, excessive sleepiness, constipation, growth retardation, dry skin and fatigue are other diseases that can be seen.
Rickets is a bone disorder that occurs in children with a deficiency of vitamin D. In children who cannot get enough vitamin D from the sun and food from the moment they are born, it is possible to see a delay in tooth eruption, sitting and walking, as well as curvature of the legs and head deformities. Fractures are among the possible ailments, as the bones do not receive enough vitamins, which will lead to weakness. This process, which starts in the mother's womb and should be followed after birth, should be controlled by a pediatric endocrinologist.
Turner syndrome, which is not observed in boys, is seen in one of every 2,500 girls born. The cause of this disease is a chromosomal disorder. Every human has 46 chromosomes. There are 2 X chromosomes in girls, and 1 X and 1 Y chromosome in boys. The absence of one of the 2 X chromosomes in girls reveals Turner's syndrome. This diagnosis can be made in the womb or at the time the child is born. Neck thickness, swollen hands and feet are the first symptoms at this stage.
In children, this disease can also be seen at later ages. Although short stature is one of the most common symptoms of the disease, it can vary from person to person. Turner syndrome also has symptoms such as narrowing of the main vessel coming out of the heart, shorter 3rd and 4th fingers on the hand, abnormalities in the eyelid and eye, strabismus and farsightedness. This disease also causes other diseases such as celiac disease, ear inflammation, inverted nipple, drooping lower jaw in many children. Turner syndrome can be seen at any age up to the age of marriage. Therefore, a pediatric endocrinologist should be consulted in any different situation observed in the child.
In addition to these diseases, sexual development disorders, excessive hair growth, penile problems (micropenia), adrenal gland diseases, pituitary gland diseases, menstrual irregularities, delayed puberty, calcium and phosphorus metabolism disorders are also among the diseases that pediatric endocrinology treats.
Sexual Development Disorders
There is no distinction between the male and female gonads in the womb until the 5th week of pregnancy. Testicular formation in males begins around the 7th week of pregnancy. The gonad differentiates into the male ovaries earlier than the female. Continuing the maturation process during pregnancy, the ovaries descend into the sac in the last 2/3 of the pregnancy. The ovaries are observed in the sac in more than 95% of term children and 80% of premature babies. However, in some cases, the descent of the ovaries into the sac may take up to 1 year.
In females, the differentiation of the gonad into the female ovary begins later. However, about 2 million cells are formed in the eggs until birth.
For males, the external genitalia starts to become prominent in the 9th week of pregnancy, and completes this process in the 13th week. Differentiation of external genital organs in males occurs with the hormone testosterone secreted from the testicles, which are the male ovaries. Testosterone and its by-product dihydrotestosterone hormones are also responsible for the so-called secondary sex characteristics, such as beard and mustache growth. These hormones are secreted from the ovaries and show their effects with the effect of LH and FSH hormones secreted from the pituitary sac in the brain where many hormones are secreted.
Sexual differentiation that begins in the mother's womb determines whether a person is male or female, and with the effect or lack of certain hormones, the sexual structure of the person matures, and finally, sexual identity, sexual role and sexual orientation are determined.
Osteoporosis (Bone loss)
Rickets is a bone disease seen in childhood and is manifested by enlargement, loss and deformity in especially the ends of the long bones, which we call the epiphysis, due to lack of mineralization. Rickets is seen in 6% of children under the age of 3 in our country. Clinical findings in a child with rickets are as follows;
- The fontanelle is large, closing late or not closing
- Wrists are wider than normal
- The back of the head collapses like a ping pong ball when pressed by hand
- Weakness in muscles, bone pain
- Inward bending of the legs after the child starts walking
- Delay in tooth eruption