Thyroid
Thyroid disorders are among the commonest of the endocrine disorders. The thyroid
gland is normally situated in the front of the neck below the voice box. The thyroid gland
produces thyroid hormones which have an effect on virtually every organ in the body.
Thyroid hormones regulate the bodies thermostat making bodily functions speed up when
over active and slow down when the thyroid is underactive.
Disorders of the thyroid can be grouped into those that cause the thyroid to be enlarged
(goiter) or shrunken away. The thyroid can be overactive and produce too much thyroid
hormone (hyperthyroid) or it can produce too little hormone (hypothyroid).
A problem can be suspected because of symptoms related to too much or too little thyroid
hormone, or to an enlargement or pain in the thyroid gland.
A separate group consists of congenital thyroid problems- that are those presenting at
birth and this is usually screened for at or soon after birth.
Links to thyroid sites
Hyperthyroid-graves, toxic nodule, tumor
Hypothyroid-hashimotos,
RAI
Goiters
Thyroid tumors
Keywords: eltroxin, diotroxin, tertroxin, neomercazole
Growth
Growth is the work of childhood. Poor growth may be an indicator of an underlying
problem and should be investigated and the cause treated as soon as possible. There are
many causes of poor growth, some permanent and others transient. Short stature out of
keeping with that of the family, or where a child fails to grow along their growth
percentile when plotted on a growth chart warrants further investigation.
Growth hormone may be required in some children to achieve a height within the adult
normal range, and is given by daily injection. Because of the expense of growth hormone
a thorough evaluation by a paediatric endocrinologist is required before growth hormone
can be recommended and therapy is often carried out by or under the supervision of such
a specialist.
Tall stature or excessive growth may also be an indicator of an underlying disorder and
warrant investigation.
The earlier growth disorders are detected and therapies instituted, the better the outcome.
A common pitfall is to wait for a pubertal growth spurt that does not occur.
Growth disorders
Short stature
Skeletal dysplasias - hypochondoplasia, achondroplasia
Syndromes- Turner syndrome, Down syndrome, Noonan syndrome, Russel-Silver
syndrome
Small for gestational age
Constitutional growth delay
Genetic short stature
Growth hormone deficiency, panhypopituitarism, thyroid hormone deficiency, Cushing
syndrome
Nutritional deficiency
Tall stature
Syndromic- Marfan syndrome, Klinefelter syndrome
Keywords
Growth, Short stature, Humatrope, Norditropin Nordilet
Puberty
Puberty is defined as the onset of secondary sexual features due to the activation and
maturation of the hormone systems and glands related to adult sexual function and
fertility.
Puberty can be early (precocious) or delayed. Typically girls should not show signs of
puberty before 8 years of age and boys should not show signs of puberty before 9 years
of age. These signs include development of breast buds, enlargement of the testes or
penis, pubic hair growth or development of adult body odour and acne.
Girls should develop breast buds by 12 years of age and boys should show some signs of
puberty by 14 years of age.
Both early and delayed puberty may be abnormal and deserve further investigation.
Precocious puberty
Premature thelarche
Premature adrenarche
Premature menarche
Central or peripheral precocious puberty
Delayed puberty
Klinefelter syndrome
Turner syndrome
Keywords:
Puberty, adrenarche, precocious
Weight
Overweight and obesity are an international pandemic. The causes are mostly nutritional
and are related to excessive caloric intake and a sedentary lifestyle. Often investigations
are done to look for an underlying cause such as an hormonal imbalance (thyroid,
cortisol), or to investigate for associated disorders that may accompany or be caused by
the obesity such as polycystic ovarian syndrome, dyslipidemia (high cholesterol), type 2
diabetes and insulin resistance.
Whatever the cause the condition requires a careful assessment and intervention because
the short, intermediate and long term consequences of obesity are dire.
Many people think that children can regulate their own food intake, this is a myth.
Children need to be taught the principles and practice of a healthy life-style from an early
age.
Some specific obesity syndromes need specialist intervention such as Prader-Willi
syndrome, Bardet-Biedl syndrome, Alstrom syndrome and Down syndrome.
Key words:
Metabolic syndrome
Prader-Willi syndrome
Low GI Diet
PCOS
Dyslipidemia
Type 2 diabetes
Insulin resistance
Diabetes
Children are presenting with diabetes at an ever increasing rate and at younger and
younger ages. Type 1 diabetes (juvenile onset diabetes, insulin dependent diabetes) is the
most commonly encountered form of diabetes presenting in children, but type 2
diabetes(adult onset, non-insulin dependent) is now presenting in adolescence and
childhood associated with the obesity epidemic and is prevalent in certain ethnic groups.
Type 1 diabetes requires the use of injected insulin from the time of diagnosis, but type 2
diabetes may initially be managed by weight loss, exercise and a tablet called metformin.
Failing this other tablets may be required (sulphonylureas) or even insulin by injection.
The treatment goals in diabetes are to keep blood sugar levels as close to normal to
prevent the devastating short and long-term complications of diabetes.
Insulin pumps are a valuable part of the diabetes armamentarium and help motivated well
educated patients to achieve and maintain optimal blood glucose control.
Typical presenting signs and symptoms that should prompt further investigation include:
increased frequency of urination, urinating at night or new onset bedwetting, excessive
thirst, weight loss, blurred vision and tiredness. If early symptoms are missed, diabetic
ketoacidosis may develop and has symptoms of rapid breathing, tummy pain, nausea and
vomiting and even coma. The index of suspicion needs to remain high when any of the
previous symptoms are present.
Children with diabetes should be referred to a centre that has a team that specializes in
the treatment of children with diabetes because care is very different from adults with
diabetes.
Listed below are paediatric specialist centres in South Africa that manage children with
diabetes, and also a list of support groups and societies.
Johannesburg- Dr David Segal
Pretoria- Dr Jacobus van Dyk
Bloemfontein- Dr Chris Diffenthal
Durban- Dr Kuben Pillay
Cape Town- Red Cross Children’s Hospital
Youth with Diabetes
Key words
Insulin, insulin pump, Medtronic, Roche-Accuchek, Abbott, Lifescan, Bayer,
NovoNordisk, Eli-Lilly, Sanofi-Aventis,