Emergencies in Endocrinology
In pediatric endocrinology, emergencies may present with non-specific symptoms, which is why parents should inform the pediatrician about anything unusual so that the young patient can be referred and treated promptly.
A particularly urgent condition is diabetic ketoacidosis, which usually manifests as juvenile diabetes mellitus and can be easily avoided if parents and/or the pediatrician recognize its early signs: polyuria-polydipsia, polyphagia and unexplained weight loss. With a simple blood sugar test at an early stage, it is possible to even avoid hospitalization. Otherwise, the condition can progress rapidly and the child may experience abdominal pain, nausea-vomiting, general depression, drowsiness and impaired level of consciousness that can even lead to diabetic coma.
More rare but equally life-threatening, especially in newborns and infants, is adrenal insufficiency, the inability of the adrenal gland to properly produce cortisol (a hormone essential for dealing with stress) and aldosterone (regulates Na and K). The causes are many, congenital or acquired and may be due to damage to the adrenal gland itself or to the brain centers that control its function. The clinical picture may include hyperpigmentation of the skin (as if you have tanned from prolonged exposure to the sun), anorexia, weight stagnation, vomiting, fatigue and hypoglycemia.
A proper laboratory test with blood electrolytes and adrenal-pituitary hormone levels confirms the diagnosis. Of course, easy fatigue during exercise, unexplained weight loss together with tachycardia or palpitations and difficulty sleeping should lead to the exclusion of hyperthyroidism. On the other hand, hypothyroidism can cause anything from delayed psychomotor development and physical growth to psychological disorders with an expressionless face and a picture of depression.
Early recognition of hypoglycemia is crucial, as it can cause brain damage soon after the onset of symptoms, especially in newborns and infants. For this reason, every child with a serious illness and affected general condition must have their blood sugar levels checked.
The diagnosis of hypoglycemia will be delayed if we do not consider it for any patient who repeatedly presents or even a single episode of impaired consciousness or behavior. If we suspect hypoglycemia – which we can easily prove by measuring capillary sugar with a portable meter on the child’s finger – we should immediately proceed with a blood test with accompanying hormonal and metabolic testing before starting its correction so that the etiological diagnosis can be correctly established, which will also lead to its correct treatment.
