Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Pediatric Endocrinology Services
The Vermont Children’s Hospital provides expert care for children and adolescents with diabetes mellitus or other conditions affecting the endocrine glands and their respective hormones. We treat a wide range of endocrinology conditions, but some of the common conditions include:
There are approximately 200,000 individuals less than 20 years of age in the United States living with diabetes. It is one of the most common chronic diseases in childhood. The vast majority of these young people have Type 1 Diabetes (previously known as juvenile-onset diabetes).
This condition results from an inability of the body to produce adequate amounts of insulin. Insulin is a critical hormone that regulates blood glucose levels and allows the body to generate energy from the food we eat. This differs from Type 2 Diabetes, in which the body can produce insulin but the hormone does not function adequately.
While most young people diagnosed with diabetes typically have Type 1 Diabetes, there has been a significant increase in the number of cases of Type 2 diabetes in children over the last few decades. Distinguishing between these two types can sometimes be difficult but is critical as the treatment options for these conditions are different.
In children and adolescents, normal growth of both height and weight is a reflection of overall health and nutritional status. Pediatric growth disorders may be diagnosed if a child grows too slowly (resulting in short stature) or too rapidly (resulting in excessively tall stature). Failure to grow at an appropriate rate may be the first sign of a hormone disorder or other chronic disease. Ensuring normal patterns of growth is essential, as it can enable the early detection of serious chronic conditions and also prevent unnecessary testing of children with acceptable normal variations in growth.
Pubertal disorders refer to a range of conditions that affect a child’s ability to reach physical and sexual maturity properly. The most visible changes during puberty are growth in height and development of secondary sexual characteristics such as breasts, pubic hair or acne. The normal timing of puberty and sequence of changes that occur is variable. It can differ depending on a variety of factors, such as ethnicity and family history. It is necessary to have a clear understanding of the normal variations in pubertal development to determine if testing/treatment is needed. In some cases, reassurance or observation alone may suffice.
Pubertal development disorders fall into two broad categories:
- Delayed (late) puberty
- Precocious (early) puberty
Adolescents experience the stages of puberty differently and in many cases, a delay in sexual maturity does not indicate a health problem. In some cases, however, it can be a sign of a more serious medical problem.
For females, delayed puberty is defined as:
- Lack of breast development by age 13
- Lack of menstruation by age 16
- Lack of menstruation five years or more after initial breast development
For males, it is defined as a lack of pubic hair by age 14.
Precocious puberty refers to the onset of puberty at too young an age. While there may be normal variations in puberty depending on ethnicity, it is generally defined as the onset of any secondary sexual characteristics prior to age 8 in females and age 9 in males. An evaluation is necessary to determine the cause. There are some normal variations in pubertal onset in which minor pubertal changes may occur at a younger age without any underlying problem. However, in general, children with suspected precocious puberty should be evaluated by a pediatric endocrinologist to determine what investigations are required and if any medical intervention is necessary.
The thyroid gland is a small butterfly shaped gland in the lower mid-region of the neck. It produces thyroid hormones. These hormones regulate the rate of metabolism — the rate at which the body uses energy — and affect the growth and rate of function of many other body systems. In children, it plays a critical role in height gain and brain development. The thyroid must produce the right amount of hormones to keep the body’s metabolism functioning properly. Hypothyroidism is when the thyroid gland is unable to produce sufficient amounts of thyroid hormones. Hyperthyroidism refers to the condition when the thyroid gland produces excessive amounts of thyroid hormones.
Symptoms of Thyroid Disorders
Hypothyroidism (underactive thyroid): fatigue, weight gain, poor height gain, dry skin, constipation and sensitivity to cold.
Hyperthyroidism (overactive thyroid): irritability, nervousness, weight loss, heart racing, tremors, problems sleeping, frequent bowel movements and heat sensitivity.
Other endocrinology conditions we treat include:
- Abnormal growth: short stature, failure to thrive, excessively rapid linear growth
- Abnormal hypothalamic and pituitary function
- Adrenal gland disorders: Addison's disease, Cushing's syndrome, congenital adrenal hyperplasia
- Bone disorders: osteopenia, rickets
- Calcium disorders: hypocalcemia, hypercalcemia
- Diabetes insipidus
- Diabetes mellitus: Type 1, Type 2, cystic fibrosis related
- Disorders of pubertal development: delayed puberty, precocious puberty
- Disorders of sexual development: genital ambiguity
- Endocrine late effects of childhood cancer treatment
- Parathyroid gland disorders: hypoparathyroidism, hyperparathyroidism
- Short stature: familial short stature, constitutional delay of growth, idiopathic short stature (ISS), growth hormone (GH) deficiency
- Thyroid gland disorders: hypothyroidism, hyperthyroidism, thyroid nodules
- Thyroid gland cancers
- Turner Syndrome