The Endocrine Center treats patients with a variety of disorders of the endocrine system. Various hormones in the endocrine system can effect a person’s growth and development, tissue function and metabolism, sexual function and reproductive processes. Endocrinologists and the endocrine specialty care team work with children and their parents to diagnose, treat and manage conditions affecting the endocrine system, including disorders of the hypothalamus, pituitary gland, thyroid gland, parathyroid glands, adrenal glands, ovaries/testes pancreas.
Evaluation
A primary care physician refers a patient to a pediatric endocrinologist for evaluation of the function of the endocrine glands. The endocrine glands are responsible for the secretion of hormones throughout the body. Endocrine glands include the adrenals, gonads (ovaries or testicles), pancreas, parathyroids, pituitary and thyroid.
While hormones are chemical messengers that tell the body’s cells what they need to do to help support the normal process of the brain and body. Too much or too little of a hormone may be harmful to a person’s body. Consultation with a pediatric endocrinologist includes a recount of the history, physical examination, height and weight growth charts, and appropriate diagnostic evaluation.
Diagnostic studies often include laboratory evaluation and may include imaging studies in order to determine if the child’s endocrine glands are functioning properly.
Treatment & Condition Management
The replacement of specific hormone levels that are lower than normal, or reduction of specific hormone levels that are higher than normal within the body help the body have the appropriate amounts of hormone levels for everyday function, as well as for recovering from stresses such as illnesses. Early and timely treatment with medication, if needed, is necessary and effective to help manage the child’s hormonal condition and minimize future complications. Depending on which medication treatment is needed, this can involve medication taken by mouth, injection, a patch on the skin or an implant under the skin. Referral to other specialists may be needed for co-management.
Continued follow-up visits, along with monitoring labs and/or imaging studies, will ensure children continue to have the appropriate amounts of hormonal regulation while they are growing and developing.
Approved CCS Center
The Endocrine Center is a California Children’s Services (CCS) approved Special Care Center (SCC). This means a specially designated multi-disciplinary care team is responsible for all care coordination and case management of a patient in this program. Patients typically qualify for CCS by medical diagnosis, complexity of their disease and financial status.
The most common disorder of the adrenal gland in childhood is congenital adrenal hyperplasia (CAH). This disorder is characterized by a lack of or decreased production of cortisol (the stress hormone), with or without production of aldosterone (the salt retaining hormone, which also helps with preventing low blood pressure). Instead, other hormones such as the male hormone testosterone are produced at high levels, which can lead to a difference of sexual development (DSD), early pubertal development and early closure of growth plates. In order to reduce complications associated with this disease, medications are taken by mouth to help replace cortisol, aldosterone and/or salt. Other disorders of the adrenal gland include Addison disease (an acquired defect in cortisol and/or aldosterone production), Conn disease (excess production of aldosterone), Cushing disease (excess production of cortisol), X-linked adrenoleukodystrophy (X-ALD, a genetic condition causing cortisol deficiency in addition to neurologic problems), and various other adrenal problems. These disorders can be managed with medication and/or surgery.
Disorders of growth is one of the more common conditions in pediatric endocrinology. The most common reason for slow growth in childhood is constitutional delay (“late bloomer”), which does not need treatment. Growth may also be affected by other factors including nutrition, steroid use, bone disease and a variety of other chronic illnesses. Growth disorders can also be caused by a hormonal imbalance such as hypothyroidism, rarely Cushing syndrome (excess production of cortisol), or Growth Hormone (GH) deficiency.
Growth is regulated by the pituitary gland, which is known as the master gland of the endocrine system. The pituitary gland releases growth hormone, in addition to multiple other hormones. Growth hormone stimulates height and is important for the development of muscle and bone. It also helps prevent low blood sugars and supports normal distribution of fat throughout the body.
Besides growth hormone, the pituitary gland secretes a hormone called Thyroid-stimulating hormone (TSH), which signals the thyroid gland to produce thyroid hormone. Thyroid hormone has a major impact on growth and development (including brain development and puberty).
Some children are born with growth disorders, whereas other children develop issues with growth over time. Growth disorders can be a significant psychological issue for children, and should be addressed as soon as it becomes apparent. If growth hormone therapy is necessary, children tend to have a greater improvement in height with a longer duration of therapy.
Growth hormone therapy is indicated for the treatment of growth hormone (GH) deficiency, Turner Syndrome, Prader-Willi syndrome (PWS), Noonan syndrome, chronic renal failure, small for gestational age without catch up growth by 2 years of age, HIV wasting, and idiopathic short stature as defined by <1.2% on the standard growth chart.
Patients are screened and tested to ensure there is no other cause for growth failure, such as low thyroid hormone levels, malnutrition, malabsorption, anemia or other chronic illnesses. In addition, Bone Age X-Rays are obtained in children older than 3 years old to assess how the growth plates are developing compared to the child’s actual age.
It is important to identify the underlying cause of slow growth so that the child receives appropriate treatment. Growth hormone therapy is given as an injection under the skin, which could be daily or once-weekly depending on the diagnosis. When tests show that patients are candidates for growth hormone therapy, the patient, family and care team discuss the patient's potential adult height, length of treatment, laboratory and imaging monitoring, and other treatment options, if these are indicated.
The parathyroid glands are located next to the thyroid gland and send parathyroid hormone (PTH) to the kidneys to turn vitamin D into the active form called 1,25 Vitamin D (calcitriol). The active form of vitamin D helps with ensuring the body has an appropriate balance of calcium and phosphorous levels in the blood, as well as in the bones to make them stronger. Calcium is an important mineral that helps with the electrical signaling in cells, maintaining a normal heart rhythm and normal brain and muscle function.
If the parathyroid glands do not produce enough PTH, or the body does not respond to it, then low calcium levels can lead to a dangerous irregular heart rhythm, seizures, numbness, tingling, or painful tightening of muscles called tetany. Therefore, medication replacement of calcium, vitamin D/calcitriol and/or PTH may be needed, along with routine laboratory monitoring.
If the parathyroid glands produce too much PTH, the bones become weaker, and blood calcium levels can reach high levels. Associated health problems can lead to an irregular heart rhythm, painful kidney stones, broken bones and abdominal pain. Imaging and nuclear medicine studies are needed to determine the cause of high PTH levels. Treatment often involves referral to a surgeon if an overactive parathyroid gland is identified and may possibly involve medication to help balance calcium levels.
Endocrinologists are also involved in the treatment of skeletal dysplasias that have specific approved treatments, such as Achondroplasia or Hypophosphatasia.
The pancreas has areas that produce both digestive enzymes (exocrine function) and hormones (endocrine function). Disorders involving the exocrine function are managed be a gastroenterologist, whereas disorders involving the endocrine function are managed by an endocrinologist. Insulin is a hormone that helps lower blood sugar levels when they are rising but moving sugar into cells to be used as “fuel” or energy. Part of the sugar is moved into glucose stores in the liver that get released while fasting (such as during sleep).
Having too much insulin (hyperinsulinism) can lead to hypoglycemia (low blood sugar) as too much of the sugar is being moved into the liver and not enough is available for other cells to use for energy (including the brain). Frequent and severely low blood sugars can affect brain development and function, so it is important to identify the cause of low blood sugar episodes to ensure the child is on the right treatment. This may involve special laboratory studies, blood glucose monitoring and/or imaging studies. Depending on the cause, treatment may include medication or referral for surgery.
Not having enough insulin (diabetes mellitus) can lead to high blood sugar which is treated with insulin and/or other medications, and blood glucose monitoring.
The pituitary gland is referred to as the master gland because it controls many other glands in the body. The pituitary makes several important hormones. Over or under production of pituitary hormones can lead to any one or combination of these disorders: precocious puberty, lack of puberty, infertility, growth disorders, thyroid abnormalities, adrenal abnormalities, and diabetes insipidus (a condition when the body is not able to control water loss). The abnormal production of pituitary hormones may be caused by an abnormality in the size and/or location of the pituitary gland, or by a growth or tumor affecting the gland.
Endocrinologists manage these conditions by controlling the amount of pituitary hormone with medications and, if needed, can evaluate whether the patient needs to be referred to a neurosurgeon and or hematologist/oncologist for further treatment. Pituitary hormone imbalances can develop over time. Continued follow-up is important to ensure the body has the appropriate amount of hormones, as these needs change over time with growth and development.
The gonads (ovaries or testicles) produce reproductive hormones that stimulate pubertal changes and the development of fertility. The ovaries produce estrogen and progesterone, and the testicles produce testosterone. Sufficient amounts of these hormones are needed during the expected timing of pubertal development to ensure children have a normal growth spurt, bone strength and healthy heart function.
If the gonads are not producing enough of these reproductive hormones, then replacement medications are needed with low doses initially, and increasing over time to mimic normal pubertal development. Once puberty is completed, continuing adult doses of hormone replacement are necessary to support the body’s normal function.
If high levels of reproductive hormones are being produced, the underlying cause of this needs to be determined. Treatment may involve medications that help balance the hormones, so they are normal for age, or referral to a surgeon, gynecologist and/or hematologist/oncologist if there is a growth causing high hormone levels.
Treatments for puberty and menstrual conditions may involve medications taken by mouth, injections, patches on the skin, or implants under the skin.
Thyroid hormone plays a major role in the body’s metabolism and overall well-being. Too much thyroid hormone due to an overactive thyroid gland can lead to weight loss, diarrhea, nervousness, difficulty with sleep and a fast heart rate.
An underactive thyroid gland produces too little thyroid hormone, which can lead to poor growth with relatively faster weight gain, constipation and excessive fatigue.
Endocrinologists treat patients with thyroid disorders by replacing or reducing the amount of thyroid hormone in the body, with medication taken by mouth. Endocrinologists also receive special training to manage patients with thyroid nodules or thyroid cancer. Evaluation and treatment involve imaging such as ultrasounds and/or nuclear medicine studies and treatment. Referrals to other specialists may be needed for ultrasound-guided needle biopsy of nodules, surgical treatment and/or radioactive iodine.
Centers & Programs
Every pediatric patient will need to transition to an adult physician, so they remain in an age-appropriate health care setting. Done abruptly, this change can be overwhelming and cause anxiety...
Your Care Team
There is a shortage of pediatric endocrinologists across the nation; however Miller Children’s & Women's has five board-certified pediatric endocrinologists that rotate throughout the Endocrine Center and the general pediatrics units.
Providers


Other Team Members
A physical therapist (PT) is a healthcare professional concerned with prevention, treatment and management of movement disorders arising from conditions and diseases occurring throughout the child’s growth.
A nurse who has graduated from an accredited school of nursing and has been registered and licensed to practice by a state authority.
A clinical nurse specialist (CNS) is a registered nurse with advanced education in special areas. A CNS nurses help coordinate your child’s care while in the hospital.
Dietitians and nutritionists assess patients’ nutritional needs, develop and implement nutrition programs, and evaluate and report the results. They also confer with doctors and other health care professionals to coordinate medical and nutritional needs.
Social workers help provide referrals to a broad range of community based agencies and organizations to assist the child and family in obtaining supportive care and assistance. The social worker also is available to provide crisis counseling, individual and family counseling.