Paediatric and Adolescent Endocrinology 

Our paediatric endocrinologists can diagnose and treat a wide range of hormonal disorders for children, adolescents and young people up to 20-25 years.  

Abnormal growth disorders 

If your child appears to have a problem with their height, weight or sexual maturity, it might be a sign of a growth or pubertal delay/disorder. Conditions we treat include: 

• Short stature – There are many reasons your child might be below average height for their age and sex, including family predisposition, underlying chronic disease, growth hormone deficiency and genetic conditions which result in an abnormal skeleton. 
• Delayed puberty – If a teenage girl has not experienced any breast budding and its accompanying growth spurt by age 13 or had her first period by age 15, she has delayed puberty and needs assessment. Boys have delayed puberty if they have not experienced any pubic hair or testicular enlargement by age 14.  
• Early puberty – Also called precocious puberty, this is when your child enters puberty unusually early. For girls, this is when they develop breasts before age 8 or get their first period before 10. For boys, this means pubic hair development and testicular enlargement before age 9. 

• Gigantism – This rare condition causes your child to grow abnormally tall due to an overproduction of growth hormone caused by a tumour. There are other syndromes associated with tall stature, the most common of which is overfeeding and obesity from infancy.  

Thyroid disorders 

The thyroid gland produces the hormones responsible for regulating our metabolic rate, which in turn affect growth, weight, energy levels, body temperature, heart rate, kidney function and blood pressure, as well as our intellectual function. (This is why all babies are screened for thyroid deficiency at birth). Our specialists can treat: 

• Hypothyroidism – This condition is when the thyroid gland is absent, maldeveloped, malfunctioning or underactive. Outside infancy, this is generally due to a hereditable tendency to autoimmune disease. When your child’s thyroid levels fall significantly, it could cause weight gain, poor growth and delayed puberty, slower heart rate, constipation, reduced reaction time, inactivity and placidity. Another sign might be lower academic performance.   

• Hyperthyroidism – If your child’s thyroid gland is overactive, you might notice symptoms of hyperactivity and increased metabolic rate, such as excess hunger associated with weight loss (and sometimes weight gain), diarrhoea, anxiety, palpitations, fast heart rate, sweaty and trembling hands, problems sleeping, missed periods, exhaustion and changes in school academic performance.  
• Goitre – An enlarged thyroid gland will cause noticeable swelling in your child’s neck, evident on swallowing. If it grows very large, it can obstruct breathing and swallowing.  

Parathyroid disorders 

Parathyroid gland disorders are very rare in childhood but can arise from congenital disorders. Problems with the parathyroid glands can cause disturbances in calcium and bone metabolism from the newborn period and require specialist blood, urine and bone investigations and assessments.  

Hypothalamo-Pituitary disorders 

The pituitary gland, together with the hypothalamus, is often called the ‘conductor of the endocrine orchestra.’ When the pituitary gland is damaged or doesn’t function properly (e.g., because of damage to the hypothalamus), it can cause severe life-threatening repercussions to many vital functions, including metabolic control (salt, water and glucose balance), childhood growth and development, fight-flight stress response and reproductive functioning.  

• Hypothalamo-Pituitary tumours – Although rare in children, tumours of the pituitary gland and in the hypothalamus and visual pathways can disrupt your child’s hormonal balance by causing too much or too little of a particular hormone to be produced at time-inappropriate developmental windows. They can have damaging effects on your child’s vision, or they might present with weight and growth disorders.   
• Hypopituitarism – This rare disorder causes your child’s pituitary to underproduce one or more hormones. When all the pituitary hormones are underproduced or absent, this is called panhypopituitarism and is a potentially life-threatening disorder. If children lack one or more hormones, a number of endocrinological conditions, including short stature, delayed puberty, hypothyroidism or adrenal insufficiency, can result. 
• Pituitary diabetes insipidus – Not to be confused with diabetes mellitus, which involves high blood sugar levels, diabetes insipidus is a disorder in which the kidneys cannot balance fluids in the body. It is characterised by excessive thirst and urination, particularly at night.  

• Craniopharyngiomas – These are rare, slow-growing developmental tumours which are the most common type of pituitary tumour found during childhood. They do not produce hormones but have an invasive capacity to destroy cells that produce pituitary hormones, affecting growth and development and threatening nearby visual pathways in infants and young children.  
• Prolactinoma – Although rare in children, prolactinomas are the most common form of pituitary tumour after 15 years of age. These tumours may be the first sign of a familial/genetic disposition in children. They can arise in both adolescent boys and girls, causing an overproduction of prolactin, the hormone responsible for breast milk production. Delayed puberty, headaches or vision problems can result in either sex, but post-pubertal girls, like adult women, may experience early symptoms of irregular periods or a milky breast discharge. 
• Gigantism / Acromegaly – This is another overproducing and genetically predisposed pituitary tumour that results in the overproduction of growth hormone. It results in excessively fast growth, tall stature and often delayed puberty. In the growing child, it can cause secondary diabetes mellitus, headaches and visual symptoms.   
• Cushing’s syndrome – This condition results from an overproduction of cortisol, causing excess central weight gain, slow growth, abnormal and precocious puberty, evidence of androgen excess (acne, hirsutism, menstrual irregularity, virilisation), high blood pressure and secondary diabetes mellitus. It is typically caused by tiny tumours of the pituitary gland – when it is referred to as Cushing’s Disease – or, more rarely, tumours of the adrenal gland. 

Adrenal disorders 

Our adrenal glands release the hormones cortisol, adrenaline, and aldosterone, as well as many intermediate ‘steroids’ and weak male hormones (adrenal androgens) in a complex cascade. These hormones are essential for our healthy daily life, including regulating the body’s ‘fight or flight’ response, blood pressure, blood sugar, salt metabolism, fluid balance, heart rate, immunity and healing capacity. A specialist analysis of a 24-hour urine collection can be very informative in diagnosing adrenal disorders. 

• Adrenal insufficiency – This condition can result from the destruction of the adrenal gland by haemorrhage, an autoimmune disease called Addison’s Disease or from a loss of pituitary function control (ACTH deficiency). It can also result from temporary but prolonged suppression of the adrenal glands by glucocorticoid steroids, which are prescribed to treat severe chronic diseases such as asthma, arthritis, nephritis and autoimmunity. All forms of adrenal insufficiency are life-threatening and require a programme to replace cortisol both with and without aldosterone. 
• Congenital adrenal hyperplasia (CAH) – This adrenal insufficiency genetic disorder is often first diagnosed at birth if severe or later in childhood if it takes a milder form. It most commonly results in excess androgenic steroids (which can virilise a girl) and critical insufficiency of aldosterone and cortisol production.