Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
What does a pediatric endocrinologist do? Well, first we
should ask what an endocrinologist does. They deal with
hormonal problems in the body. One major hormonal problem in
adults is thyroid disease, but this is rare in children.
In children, there are three main problems seen. One is a
problem not seen in adults that is a growth hormone
deficiency. Growth hormone stimulates the body to grow and
failure of this can cause dwarfism, or midgets. They may have
large heads and meaty arms and legs, but they are very short.
Nowadays, growth hormone injections are available but they are
very expensive.
A second problem they deal with is precocious maturity, where
children show signs of adulthood when they are still at an
early age. This may be due to disease in the pituitary gland
which is located in the brain, but it should be tended to
early as early maturity can close up the growth plates in the
bones and result in short stature. Menstrual failure in
adolescent females is also a common problem that comes to
these physicians. Medication is often sufficient for this
problem.
Probably the most common disease coming to these physicians is
diabetes, which is due to failure of the hormone called
insulin. When it occurs in childhood, it rarely can be
controlled by pills and shots of insulin are usually
necessary. It is often genetic, and is not related to eating
too many sweets. These children can have more severe problems
with glucose control which may lead to horrible effects such
as kidney failure or blindness later in life. They also fight
infection poorly.
Fortunately, massive research in this field has made these
children live normal lives, and technology is bringing in new
ideas yearly. Glucose can now be checked without pricking the
skin and computerized insulin pumps help control the
disease.
The most feared complication of childhood diabetes is
ketoacidosis, which is a massive buildup of acid in the blood
as a result of lack of insulin. High sugars, and lethargy are
usual signs, abdominal pain may be present as well. A support
group of parents with diabetes has been formed in Israel. I
believe it's operating in Great Britain as well.
What does a pediatric rheumatologist do? These doctors deal
with arthritis, and by far the most common arthritis in kids
is juvenile rheumatoid arthritis, which may begin with just
fever without a source, that doesn't go away. Another disease
occasionally seen by these doctors is arthritis due to Crohn's
disease or ulcerative colitis or psoriasis, but we'll discuss
these under the a different heading. Write me in care of the
Yated.
A message from Glaxo, sponsor of this column. I had
strep throat last week accompanied by a horrible migraine. I
was working and needed fast relief. Naramig would have been
ideal, as it has rapid onset and it lasts. But all I could
find was Imitrex. It also worked well. Guess what? Both are
from Glaxo.
