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Afecciones y tratamientos

We treat many children with diabetes and other conditions related to endocrine issues, including common and rare diseases involving the thyroid, pituitary and adrenal glands. At Arkansas Children's, our pediatric endocrinology doctors are experts in diagnosing and treating these conditions. Our team provides the most advanced care. Many of our doctors, nurses and staff are actively involved in research to improve care outcomes and find new treatments that can help your child live a healthy life, especially for those with chronic conditions.

Diabetes

When your child has diabetes, the body does not produce or respond to insulin, the hormone that breaks down sugar and carbohydrates into energy. This leads to high levels of glucose in the blood. Diabetes mellitus is the most common form of diabetes and there are two types:

  • Type 1 Diabetes is an autoimmune condition. The body attacks its own cells in the pancreas until they can no longer produce insulin. If left untreated or not well managed, the extra sugar in the blood can damage blood vessels in the eyes, nerves and kidneys and increase the risk of heart disease and stroke. The only treatment for Type 1 diabetes is insulin replacement.
  • Type 2 Diabetes occurs when the body becomes resistant to insulin or cannot make enough insulin to keep sugar levels normal. Type 2 diabetes often affects children who are obese. Fat, liver and muscle cells can become insulin resistant. Treatments include weight management, proper nutrition and exercise. If blood sugar levels are high enough, insulin is a first-line treatment.

Short Stature or Growth Hormone Deficiency

Short stature or Growth Hormone Deficiency is an endocrine condition related to the pituitary gland. The pituitary gland is about the size of a pea and is located at the base of the brain. When the pituitary gland does not make enough growth hormone, development is impacted. The lack of growth hormone causes:

  • Short stature
  • Reduced bone strength
  • A rounder face
  • Delayed puberty
  • Fatiga
  • Sensitivity to hot and cold temperatures

Behavioral and psychological symptoms may also be present, including:

  • Depression
  • Anxiety
  • Lack of concentration
  • Poor memory

Treatments include daily hormone injections to boost growth and muscle strength. Counseling can also help if your child is insecure about his or her appearance or is concerned about not keeping up physically with peers.

Thyroid Disorders

Thyroid disorders are caused by abnormalities in the thyroid gland. This is a butterfly-shaped gland at the front of the windpipe. Children need thyroid hormones to maintain normal growth and bone development and regulate metabolism. Problems occur when the thyroid makes too much or too little of the thyroid hormones.

Hypothyroidism (underactive thyroid) is the most common thyroid condition in children. If untreated, hypothyroidism can lead to intellectual disability and growth failure. Hashimoto’s thyroiditis is the most common form of hypothyroidism in children and teens. The autoimmune disease causes the body to attack thyroid cells. Los tratamientos incluyen:

  • Medicines to help the thyroid make more hormones
  • Medicines replace missing hormones

Hyperthyroidism happens when the thyroid is too active and releases too much thyroid hormone into the bloodstream. With this condition a child may:

  • Feel the need to be very active
  • Have a fast heartbeat
  • Sweat a lot
  • Does not gain weight or loses weight

Los tratamientos incluyen:

  • Medicines to make less thyroid hormone
  • Rarely surgery to remove all or part of the thyroid when it is too active

Obesidad

Obesity affects a child’s physical and mental health and can cause other major health problems, such as:

  • High blood pressure
  • Abnormal cholesterol
  • Fatty liver disease
  • Sleep apnea

Obesity in children is measured by body mass index and age. A child who is obese has a BMI-for-age percentile greater than 95 percent. Children who are obese are more likely to be obese as adults. Obesity can be caused by:

  • Genética
  • Metabolism
  • Food choices
  • Activity levels
  • Environment

Treatment for obesity often focuses on managing weight with food choices and activity levels. Treatment programs may include working with a dietitian, psychologist and exercise specialist. The American Academy of Pediatrics recommends using the 5, 2, 1, 0 approach:

  • 5 - Eat at least five fruit or vegetable servings every day. Limit 100 percent fruit juices to 4 ounces a day.
  • 2 — Limit screen time to less than two hours a day.
  • 1 — Get at least one hour of activity every day: walk, play outside, dance, jump rope.
  • 0 — Focus on zero calorie drinks except for skim, fat-free or 1 percent milk.

In some cases with adolescents, bariatric surgery may be an option.

Panhypopituitarism

The pituitary gland is called the master endocrine gland because it controls the function of other endocrine organs. Hypopituitarism is when there is a partial hormone deficiency in hormones made by the pituitary gland. Panhypopituitarism is when all pituitary hormones are missing.

The hormones made by the pituitary gland include:

  • Growth hormone
  • Adrenocorticotropic or stress hormone
  • Thyroid stimulating hormone
  • Gonadotropins or puberty hormones
  • Antidiuretic or water hormone
  • Oxytocin
  • Prolactin

Treatments involve medicines and replacement of the missing hormones.

Prader Willie Syndrome and Turner Syndrome

Prader Willie Syndrome is a genetic disorder that affects many different parts of the body. Early signs of the condition include:

  • Feeding difficulties in infancy
  • Weak muscle tone
  • Poor growth
  • Delayed development

Children develop big appetites and an uncontrollable urge to eat between ages 2 and 4. This leads to chronic overeating. Some children become obese and develop Type 2 diabetes.

Other issues caused by Prader-Willie syndrome include:

  • Mild to moderate intellectual impairment
  • Learning disabilities
  • Problemas conductuales
  • Short stature
  • Almond-shaped eyes
  • Narrow forehead
  • Small hands and feet
  • Underdeveloped genitals
  • Delayed or incomplete puberty

Treatments focus on maintaining optimum health through:

  • Growth hormone replacement to build strength, improve height and muscle mass
  • Exercise and therapy to build strength and maintain weight
  • Mental health and behavioral counseling
  • Hormone replacement at puberty

Turner Syndrome affects girls and impacts their development. Turner syndrome involves low levels of growth hormone that can lead to:

  • Short stature
  • Webbed neck
  • Swollen hands and feet
  • Infertility

Children with Turner Syndrome are at risk for other health issues, including:

  • High blood pressure
  • Kidney problems
  • Diabetes
  • Cataracts
  • Osteoporosis
  • Thyroid problems

Treatments for Turner Syndrome include:

  • Growth hormone replacement to obtain close-to-average height.
  • Hormone replacement at puberty to boost sexual development.

Congenital Adrenal Hypoplasia

The small adrenal glands sit on top of each kidney. They produce hormones needed to live, including cortisol and sex hormones. Cortisol controls our response to stress and many other functions.

Congenital Adrenal Hypoplasia affects boys. It occurs when the adrenal glands do not fully develop and cannot produce the level of hormones the body needs. Children with adrenal hypoplasia show signs of the condition as infants or in early childhood. Los síntomas incluyen:

  • Vómitos
  • Difficulty feeding
  • Dehydration
  • Extremely low blood sugar
  • Low sodium levels
  • Shock

If untreated, these symptoms can be life-threatening.

Boys with adrenal hypoplasia may lack sex hormones, which can delay puberty and cause infertility.

Initial treatments include intravenous saline and dextrose to treat dehydration and bring blood sugar and sodium levels up to normal. Other treatments can include:

  • Glucocorticoids to stop inflammation
  • Hormone replacements

Addison’s Disease (Adrenal Insufficiency)

Addison's Disease occurs when the adrenal glands that sit on top of the kidneys are damaged and do not make enough of the hormones cortisol and aldosterone. These hormones give instructions to many other organs and tissues in the body. Addison's disease affects boys and girls and can be life-threatening. Los síntomas incluyen:

  • Extreme fatigue
  • Low blood pressure, fainting
  • Decreased appetite and weight loss
  • Salt craving
  • Skin darkening
  • Náuseas
  • Abdominal and joint pain

Addison’s disease can be caused by:

  • Autoimmune conditions
  • Infections, such as tuberculosis
  • Cancer or bleeding that spreads to the adrenal glands

Treatments include taking hormones to replace those not being made by the adrenal glands, to restore normal body functions.

Diabetes Insipidus

Diabetes Insipidus is a rare disorder that is not related to diabetes mellitus. When a child has diabetes insipidus, the body cannot properly regulate fluids. This leads to:

  • Extreme thirst
  • Extra urine output

Vasopressin is a hormone that helps to control water balance in the body. It is made in the hypothalamus and stored in the pituitary gland. Vasopressin is released into the bloodstream when you are becoming dehydrated to tell the kidneys to concentrate the urine and conserve water.

There are different forms of diabetes insipidus, depending on its root cause. The most common treatment is replacing the vasopressin hormone. Other medicines and a low salt diet can also help reduce symptoms.

Metabolic Bone Disease

Metabolic bone disease can be congenital or acquired, most often from poor nutrition. There are different forms of the metabolic bone disease, which include:

  • Abnormal bone formation and growth
  • Vitamin D disorder
  • Brittle bones (osteogenesis imperfecta)
  • Rickets

Rickets is a more common form of metabolic bone disease that develops when a child does not have enough calcium or phosphate for bones to grow and be normally strong. It can cause softer bones, which can lead to bowed legs, widened wrists, and fontanels that don't close.

Los tratamientos incluyen:

  • Proper nutrition to replace lost nutrients, such as calcium, vitamin D, phosphate, bisphosphonates, calcitonin
  • Physical activity to keep bones strong  
  • Replacement therapy for growth and sex hormones
  • Thiazides, a diuretic medicine used to increase bone density