Pediatric Endocrine Disorders

Hormones are chemical messengers in the body that travel through the bloodstream to specific receptors on cells throughout the body where they elicit a response. Hormones play a key role in many physiologic processes, including metabolism, blood pressure regulation, blood glucose regulation, growth and development, reproduction, the sleep-wake cycle, and mood. This lesson provides a brief overview of some key pediatric endocrine disorders.

Type 1 Diabetes Mellitus (DM1)

Type 1 DM is an autoimmune disorder that causes the body’s immune system to attack and destroy the beta cells, which are the cells that produce insulin. It is generally diagnosed in childhood, so you may see it referred to as juvenile diabetes. 

The classic signs of DM1 are polydipsia, polyuria, polyphagia, and weight loss. Other signs and symptoms include weakness, fatigue, severe diaper rash, yeast infections in females and mood changes. When diabetic ketoacidosis develops, the child may have decreased LOC, rapid and deep breathing (Kussmaul respirations), and fruity-smelling breath. 

Diabetes is treated with insulin and the child will need to have their blood sugar tested multiple times per day. In addition, the child will need to follow a carb-controlled diet and avoid skipping meals.

It’s important parents and older children recognize the signs of hypoglycemia and understand that too much insulin, inadequate food intake, and exercise can all cause blood glucose levels to decrease. The treatment for hypoglycemia is administration of glucose in some form. This may be drinking juice or eating something sugary like cake icing, utilizing IM glucagon, or receiving IV dextrose if in the clinical setting.

Type 2 Diabetes Mellitus (DM2)

Type 2 diabetes used to be called “adult onset diabetes,” but it is now occurring in children due to the increase in childhood obesity. In addition to being overweight, other risk factors for the development of DM2 in children includes:

• Inactivity
• A diet high in red meat and processed foods
• A high sugar diet (such as sugary beverages)
• Low birth weight or preterm birth
• Children born to women who had gestational diabetes
• Family history of DM2

Type 2 diabetes is treated in children with a combination of pharmacologic interventions and lifestyle changes that include losing weight, increasing activity, and following a healthy diet.

Want to dive deeper into diabetes? Learn more about diabetes here and explore diabetes medications here.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid produces an excess of thyroid hormone. The two main hormones are thyroxine (T-4) and triiodothyronine (T-3). Thyroid hormones impact cells throughout the body and play a key role in controlling heart rate, temperature, protein synthesis and metabolism. 

The most common cause of hyperthyroidism in children is Graves’ disease, an autoimmune condition that attacks the thyroid gland. In Graves’ disease, antibodies cause the thyroid to release excess hormone. Other possible causes include:

• Thyroid nodules (goiters) are growths in the thyroid gland that can produce excess thyroid hormone.
• Thyroiditis (inflammation of the thyroid) causes the gland to leak extra hormones into the bloodstream. This condition often resolves on its own.
• Neonatal Graves’ disease is rare but can occur when the mother has Graves’ disease and her antibodies cross the placenta and affect the thyroid gland of the fetus.
• An excess of dietary iodine, which can be in the form of supplements or even eating a lot of seaweed.
• Taking too much thyroid hormone replacement can also lead to hyperthyroidism.

Classic signs and symptoms of hyperthyroidism in children include tachycardia, hypertension, weight loss, increased appetite, tremors, sweating and heat intolerance, loose stools, hyperactivity, difficulty concentrating, insomnia, and bulging eyes in the case of Graves’ disease.

Untreated hyperthyroidism can lead to cognitive delays in children under three years of age, and can be life threatening for a child of any age, especially newborns. In addition, hyperthyroidism can cause children to grow quickly when they are younger, but growth tends to stop early leading to an overall short stature. To learn more about the treatments for hyperthyroidism, review Hyperthyroidism Nursing Care.

Hypothyroidism

Hypothyroidism is a condition in which there is not enough thyroid hormones in the body.

• Congenital hypothyroidism – In congenital hypothyroidism, the thyroid gland fails to develop properly in utero. The condition is so common (occurring in 1 in every 2,500 to 3,000 children) that all babies born in the U.S. are tested for this condition. Note that congenital hypothyroidism can be chronic, but it can also be transient in babies whose mothers took antithyroid medications to treat hyperthyroidism during pregnancy. Left untreated, congenital hypothyroidism can cause significant mental and physical developmental delays.
• Acquired hypothyroidism –  Acquired hypothyroidism is typically caused by an autoimmune disorder called chronic lymphocytic thyroiditis (also known as Hashimoto’s thyroiditis). It is more common in girls and in those with other autoimmune conditions such as DM1.
• Iatrogenic hypothyroidism – This form of hypothyroidism occurs in children who have had their thyroid either partially or fully removed or ablated. 
• Central hypothyroidism – In central hypothyroidism, a disorder of the pituitary or hypothalamus causes insufficiency in thyroid stimulating hormone (TSH). Without this key hormone, the thyroid gland is not stimulated to produce T3 and T4. It is usually related to a benign brain tumor called a craniopharyngioma or prior radiation therapy for a malignant brain tumor. Children with central hypothyroidism may have deficiencies in other hormones such as growth hormone, antidiuretic hormone, or adrenocorticotropic hormone.  

Signs and symptoms of hypothyroidism include fatigue, slowed mental processes, bradycardia, weight gain, constipation, dry and thinning hair, intolerance to cold, hoarse voice, facial edema, and goiter. The condition is typically treated with levothyroxine, and you can learn more details in this podcast episode.

Growth Hormone Deficiency

Growth hormone deficiency (GHD) is a condition in which the pituitary does not produce an adequate amount of growth hormone. This can be due to underdevelopment or damage to the pituitary or hypothalamus, but can also be idiopathic. Some common specific causes of acquired GHD include brain injury, brain tumor, and radiation treatment to the head.

A child with GHD will be of short stature, typically less than 5% on the growth chart. Specifically, the child’s growth slows each year after the child’s 3rd birthday for a total gain of less than 1.4 inches per year. Other manifestations include delayed permanent teeth, underdeveloped lower jaw and delayed puberty. Children with GHD are of normal intelligence as the condition does not affect brain development. However, due to their small size they may have emotional or academic problems related to lower self esteem and others treating them as much younger than they actually are.

Growth hormone deficiency is diagnosed through blood tests and imaging studies to estimate bone age, which will be less than calendar age. The treatment for GHD is daily injections of synthetic growth hormone until puberty is complete, and children have better outcomes when treatment is started early.

Hyperpituitarism

Though rare in children, hyperpituitarism can occur in those with small, benign pituitary tumors called a microadenoma. The condition can cause a wide range of hormonal disorders including hypercortisolism (Cushing’s syndrome), hyperthyroidism, hypothyroidism, and acromegaly. 

Children with acromegaly have an increased amount of growth hormone which can lead to unusually long legs and arms, height up to 8 feet, and changes in facial structure such as a larger brow and jaw. Treatments for hyperpituitarism are aimed at the specific hormonal disorder the child has. For example, a child with acromegaly may receive medication to lower growth hormone levels and undergo a surgical procedure called a transsphenoidal adenomectomy which removes the tumor.

Congenital Adrenal Hyperplasia (CAH)

In congenital adrenal hyperplasia (CAH), a specific enzyme that is needed to produce aldosterone and cortisol does not work properly. Children with CAH have cortisol insufficiency, adrenal insufficiency, altered growth patterns (early rapid growth but overall shorter stature), atypical genitalia, and excess androgens (early puberty, acne, hirsuitism)

When diagnosed prenatally, treatment involves maternal dexamethasone administration. Infants and children take replacement hormones which can include corticosteroids to replace cortisol  and possibly mineralocorticoids to replace aldosterone and help maintain sodium and potassium levels.

To learn more about adrenal insufficiency, read Nursing Student Guide to Addison’s and Cushing’s Disease.

Take this topic on the go by tuning in to episode 306 of the Straight A Nursing podcast. Listen from any podcast platform, or straight from the website here.

_____________________________________

The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

References: