Get to know all about Paediatric Endocrinology and its conditions from Dr Venkatachalapathy, Best Paediatric Surgeon Hebbal, Bangalore

What is paediatric endocrinology?

Paediatric Endocrinology involves diagnosis, prevention and treatment of children and adolescent populations with endocrinological conditions. The science of Paediatric Endocrinology specializes in the prognosis and treatment of the disorders of the endocrine glands. Dr Venkatachalapathy, a notable paediatric surgeon, explains paediatric endocrinology and its conditions.

The disorders of the endocrine system may include:

Disruptions in physical growth and variations involving lack of physical and sexual development in childhood

What are the objectives of a paediatric endocrinologist?

The objectives of a paediatric endocrinologist include:

  1. understanding the anatomy and functionality of the endocrine system
  2. Identifying the endocrinological diseases linked to the environment
  3. Discovering the chemicals that disrupt the endocrine system

What are the common endocrinological issues in kids? 

  1. Endocrine cancers
  2. Hypospadias and Cryptorchidism
  3. Precocious puberty
  4. Diabetes
  5. Obesity
  6. Thyroid disorders 

Why do kids suffer from endocrinological disorders?

A few challenges with the endocrine system may create disruptions. Any hormone in excess may complicate paediatric health. Similarly, lack of secretion of a hormone or its scarcity may be harmful to the body. One of the examples may be taller kids owing to the excess of the growth hormone. The lack of growth hormone may disrupt the natural height of kids.

What are the main constituents of the human endocrine system?

The glands that constitute the human endocrine system are:

  1. Reproductive glands
  2. Adrenals
  3. Pineal body
  4. Parathyroids
  5. Thyroid
  6. Hypothalamus
  7. Pituitary

Despite being a part of the digestive system, the pancreas is also a part of the endocrine system. The pancreas secretes and produces digestive enzymes. Endocrine glands are those that generate hormones. Pancreas, liver, thymus, lungs, heart, brain and skin, placenta and kidneys are also the organs that release hormones. 

Endocrinological disorders and kids:

  • Hyperthyroidism:

Hyperthyroidism involves excessively high levels of thyroid hormones in the blood. There are various symptoms of hyperthyroidism.

What are the symptoms of hyperthyroidism?

A. Weight loss

B. Protrusive eyes

C. Swollen neck with an enlarged thyroid gland (goitre)

D. Excessive perspiration

E. Increase in the heart rate

F. Blood pressure or hypertension

G. Tremors

H. Nervousness

  • Hypothyroidism:

Hypothyroidism involves abnormally low levels of thyroid hormones in the blood. The deficiency of thyroid hormone may slow the body processes. There are various symptoms of hypothyroidism.

The symptoms of hypothyroidism may include:

A. slow heart rate

B. Dry skin

C. Fatigue

D. Delay in the puberty

E. Slow growth

Hashimoto’s thyroiditis is one of the autoimmune conditions children may suffer. It involves an autoimmune response from the immune system, which ends up blocking thyroid production. 

  • Endemic Cretinism:

Endemic cretinism involves the onset of hypothyroidism during conception. The cause of endemic cretinism is dietary iodine deficiency hindering the normal thyroid hormones. There are various symptoms of endemic cretinism.

The symptoms of endemic cretinism may include:

A. Spastic Dysplasia

B. Problems with Gross Motor Skills and Fine Motor Skills. These problems stem from damage to both pyramidal and extrapyramidal systems.

  • Diabetes:

Diabetes is a severe condition involving abnormal elevation of blood glucose. Inadequate insulin production is the primary cause of diabetes. It may lead to serious health concerns, including premature death.

It is already affecting over 220 million people worldwide. Low-income countries and middle-income countries are in the clutches of this illness, with over 80% of deaths linked to these countries.

What are the types of diabetes?

  1. Type-1 diabetes
  2. Type-2 diabetes

Type-1 diabetes was previously called insulin-dependent diabetes mellitus (DDM) or juvenile-onset diabetes. Type 1 diabetes stems from an autoimmune process destroying the pancreatic islets. The condition mainly affects kids and youngsters. The main risk factors for diabetes mellitus type 1 may be hereditary, autoimmune or environmental. There are various symptoms of type-1 diabetes.

The symptoms of diabetes mellitus type-1 include:

A. Excessive thirst

B. Abnormal hunger

C. Weight loss

D. Excessive urination

Are there any risk factors linked to type-1 diabetes? 

There are various chemicals or drugs which may trigger diabetes.

They may include:

A. Alloxan

B. Streptozotocin

C. Pentamidine

D. Rodenticides

These are the risk factors that may trigger an autoimmune response. The response may end up destroying the pancreatic islets. 

  • Type 2 Diabetes:

Type 2 diabetes is often called non-insulin-dependent diabetes mellitus or adult-onset diabetes. 

Type 2 diabetes affects over 90% of diabetics worldwide. The risk factors for type 2 diabetes are obesity and deskbound lifestyle or inactive lifestyle. 

The symptoms of diabetes mellitus type 2 are similar to that of type 1 diabetes. The symptoms of type 2 diabetes remain latent for years to decades. Therefore, the diagnosis may occur later in life. Most patients report that they discovered their diabetes after the complications arose. The prevalence of diabetes mellitus is leading to obesity in children worldwide. 

Are there any risk factors for diabetes mellitus type 2?

  1. Old age
  2. Family history 
  3. History of gestational diabetes
  4. Impairment in the glucose metabolism
  5. Deskbound or sedentary lifestyle
  6. Obesity or being overweight 
  • Hypospadias:

Hypospadias is one of the common birth defects. Hypospadias may affect 1 in 250 newborns. The number has recently doubled. The cause of Hypospadias remains unknown. Some studies correlate it with maternal exposure to endocrine disruptors. 

Are there any risk factors for Hypospadias and Cryptorchidism?

Preterm birth may lead to Cryptorchidism. Small gestational age and paternal smoking may lead to hypospadias. Paternal pesticide exposure may be one of the risk factors for Cryptorchidism.

Are there any ways to cope with these problems?

Positive changes in the environment and maintaining an ideal weight are two essential parts of a healthy lifestyle. Youngsters should develop healthy food habits. Parents should encourage their children to eat more organic foods. Children may prefer regular exercise and reduce sedentary lifestyle. Curbing the global problem of obesity requires us to opt for a multidisciplinary approach. 

Dr Venkatachalapathy, an expert paediatric surgeon in Hebbal, affirms that it’s necessary to abide by the doctor’s guidance. A paediatric surgery may help diagnose, treat, and manage the surgical needs of kids. Finding a good paediatric surgeon in Bangalore is subject to a general knowledge of endocrinology. 

Gestational Diabetes

It is a state of increased sugar level which generally normalizes after childbirth.

This occurs due to increased sugar level during pregnancy which is due to decreased insulin production or insulin resistance.

Incidence Ÿ??10% of the population is affected by GDM and it is increasing due to advanced maternal age and sedentary lifestyle.

Why does it occur– During pregnancy, an organ called placenta is formed which provides food and oxygen to the baby from the mother. This also produces certain hormones which prevent the action of Insulin on sugar. This increases the sugar level in pregnant patientŸ??s blood. Our pancreas produces insulin, but as the sugar during pregnancy is already high the amount of insulin produced is not enough to metabolize sugar resulting in increased sugar level.

Risk factors for GDM

  • PCOS-Polycystic ovarian disease
  • Obese patient with BMI more than 30
  • Previous history of having diabetes during pregnancy.
  • History of diabetes in a family
  • Having the previous baby of more than 4 kg
  • History of sudden still birth or IUFD.
  • An elderly primi
  • Ethnic-origin east Asian

Screening– During pregnancy visit, the doctor asks about the history and any risk-factor, if any risk factor During pregnancy visit, the doctor asks about the history and any risk-factor, if any risk factor then glucose challenge test with 75 gm Glucon-D is done. Or GCT is done routinely at 24-28 weeks.

Then glucose challenge test with 75 gm Glucon-D is done. Or GCT is done routinely at 24-28 weeks.


  • Increased thirst
  • Increased urination
  • Weakness
  • Increased appetite

Sign-During check up there is increased girth of the abdomen.

Sonographic Findings

  • Abdominal circumference is more than gestational age in growth scan at 28 weeks
  • Amniotic fluid is more than 20.

Effects on mother

  • Breathing difficulty due to increased girth
  • Repeated vaginal infection
  • High blood pressure
  • Sometimes retinal detachment due to small vessel damage

Effects on baby

  • Macrosomia or big baby
  • Difficult shoulder delivery during birth
  • Inside uterus death of a baby (IUFD)
  • Post-delivery hypoglycemia of baby management
  • If GCT at 28 weeks more than 140 or above>

Strict sugar monitoring by glucometer.

The patient is asked to follow a strict low sugar diet.

Good exercise and walking.

Sonography is repeated to see fluid and growth of baby and size of a baby.

If sugar is under control, the same diet and exercise are continued or else tablet like metphormin is added to lower the sugar level or else sometimes insulin must be added.

Time of delivery: Mostly between 38-40 weeks as sugar tends to increase after.

Between 38-40 weeks induction of labor is offered.

If baby size is too big then C-section is planned.

Birth difficulty:

  • Prolonged labor
  • Shoulder dystocia (shoulder can get stuck)
  • Perineal laceration

Post-delivery care: BabyŸ??s kept in neonatal care unit and sugar monitored regularly for 24 hours. If sugar is normal baby is shifted to the mother. Baby sometimes may have respiratory distress. BabyŸ??s more prone to develop jaundice. These babies are more prone to have diabetes, so breastfeeding is very important.

For motherŸ??s the sugar is checked for 24 hours. Then after discharge sugar is checked after 6 weeks and then every 6 months. These mothers are more prone to have diabetes after 15 to 20 years.

So once diagnosed by gestational diabetes patient should follow a strict discipline and visit a Gynec, physician and dietitian.

Tips To Tackle Gestational Diabetes

Tips to Tackle Gestational Diabetes in Pregnancy - Motherhood Hospital India

Gestational diabetes involves poor maternal regulation of blood sugar and can cause potential health problems for both the mother and the baby. Prevention is better than cure. Treatment involves making healthy choices. Women who adapt to changes in food habits and exercise regimen can keep their blood sugar level in check.

It is said that around 5% of pregnant women are diagnosed with gestational diabetes. Divide your calorie intake into roughly 45% carbohydrates, 25% protein, and 30% fats. The constant change of hormones can mess with your body big time! Untreated gestational diabetes can cause your baby to gain weight too quickly, which increases the risk of premature delivery.

Regular Exercise Regimen

Moderate exercise during pregnancy helps your body control your blood sugar level. Ensure you work out 30 mins a day. You may also notice that you feel better and have more energy.

Slack The Sugar

We know you donŸ??t want to hear this one, especially if you have a sweet tooth. Limit the sugar content you eat. Be aware of the sugars in fruits and starchy foods with high glycemic index like potatoes and white bread. Every time your sugar is high, your pancreas goes into overdrive, trying to make enough insulin. Guess what itŸ??s doing to your babyŸ??s pancreas? The same thing. Avoid the sports drinks, canned juices, sodas and artificial sweeteners as well. If you crave sweets, opt for a small amount of something natural like fruit or sweet corn.

Plenty Of Protein

Women should get not more than 20% of their calories from protein. Meat, milk and dairy products, soybeans, legumes, nuts, and eggs are good sources.

The Friendly Fibers

Since our body takes longer to digest high fiber foods, it has plenty of time to deal with the sugars in those foods. So pairing a carb with a protein still gives the calories, without the extra carbs. That prevents harmful blood sugar spikes. Good sources of fiber include whole grains, leafy green vegetables like lettuce and broccoli, and beans.

Cut the Carbohydrates

When you digest carbohydrates, they quickly turn into simple sugars (glucose), often raising your blood sugar before your body has enough time to produce sufficient insulin to regulate the situation. Avoid any packaged foods, processed foods or restaurant foods. Include foods such as whole grain bread or an apple with the skin on. Include milk, brown rice, quinoa, peas, yogurt, beans, beetroot, sprouts and carrots.

Fats Off The Rack

Indulge in unsaturated fats like nuts, avocados, olive oil and fish. Keep the amount of saturated fats (animal fats) to 7% of your calorie intake. Obese women have a higher risk for high blood pressure and a blood circulation problem called preeclampsia. Monitor you glucose level closely every day.

Insulin Shots

If your blood sugar levels are still too high after changing the way you eat and exercising regularly, you may need insulin shots. Insulin can help lower your blood sugar level without harming your baby.

P.S Ÿ?? DonŸ??t quit

The lifestyle changes you make now will help you have a healthy pregnancy and prevent diabetes in the future.