Introduction

Hormones are natural substances that act as chemical messengers in your body - travelling through your bloodstream and exerting effects on different tissues and organs. They are secreted by specialised groups of cells called endocrine glands - including the pituitary and adrenal glands - and affect processes such as growth and development, metabolism, and sexual function. 

In children, proper hormonal function is crucial as they undergo rapid growth and development. Any disruption can lead to a range of health issues - from stunted growth to early puberty or problems with weight regulation. Hormonal imbalances must be recognised and addressed as early as possible to ensure optimal health and development in children.

There are a multitude of different hormonal disorders that can affect people of all ages. This article aims to highlight the most common disorders that occur in children - empowering parents and caregivers to recognise the potential signs and provide the necessary support for children affected by hormonal disorders. 

Diabetes mellitus

Type 1 diabetes

The most common form of diabetes diagnosed in children is type 1 diabetes, which is characterised by an inability of the body to make the hormone insulin. This occurs due to the immune system attacking and destroying the insulin-producing cells (beta cells) in the pancreas, meaning insulin is not produced and thus cannot reduce glucose (sugar) levels in the bloodstream.¹

Therefore, without insulin, affected children will have uncontrolled high blood sugar levels and will likely exhibit these common symptoms:

• Frequent urination and possibly bed-wetting
• Excessive thirst
• Fatigue
• Weight loss

The exact cause of type 1 diabetes is unknown, but research suggests that genetics and environmental factors - such as viral infections - can trigger its development. In children, it can develop from as young as six months old. 

Diagnosing type 1 diabetes typically involves several blood tests to measure blood glucose levels and detect the presence of antibodies that target insulin-producing cells. On top of this, a urine test may be required.

While there is no cure for type 1 diabetes, it can be effectively managed with daily injections of insulin - given either by injection or insulin pump. If your child has type 1 diabetes, they will be monitored by a paediatric diabetes care team until the age of 17 or 18. This team will help with things like injecting insulin, testing blood glucose levels, and diet. 

Type 2 diabetes

Children can also develop type 2 diabetes. This is characterised by resistance to the hormone insulin or too little insulin being produced by the pancreas - leading to high blood sugar levels.²

Type 2 diabetes is more aggressive in children than in adults, and it can cause permanent damage if left untreated. Therefore, it is vital to know the signs and symptoms; they are similar to those seen in type 1 diabetes but can develop more slowly. Common symptoms include:

• Frequent urination, especially at night
• Excessive thirst
• Fatigue
• Weight loss
• Genital itching or thrush
• Slow wound healing
• Blurred vision

The primary risk factors for childhood type 2 diabetes are being obese or overweight. To reduce your child’s risk, ensure they engage in frequent physical activity and eat a healthy, balanced diet high in fruit and vegetables and low in added sugar. Besides an unhealthy lifestyle, there are other risk factors to be aware of:

• Ethnicity - children of African Caribbean, Black African, South Asian, or Chinese descent are at an increased risk³
• Family history - children are more at risk if they have a first-degree relative (parent or sibling) with diabetes
• Medical history - a history of issues such as high cholesterol and high blood pressure leads to an increased risk

To confirm a diagnosis of childhood type 2 diabetes, a GP or paediatrician will carry out blood tests to measure blood glucose concentration.

If your child is diagnosed with type 2 diabetes, they will likely be prescribed metformin - which improves the body's response to insulin and thus lowers blood sugar levels. Alternatively, they may be given insulin or drugs called GLP-1 receptor agonists or SGLT-2 inhibitors. Alongside medication, your child should engage in a healthy lifestyle to manage their diabetes.

Thyroid disorders

Hypothyroidism

Hypothyroidism, or underactive thyroid, occurs when the thyroid gland doesn’t produce enough hormones. Common symptoms in children include:

• Tiredness and sluggishness
• Sensitivity to the cold
• Constipation
• Slowed growth
• Weight gain

Hypothyroidism can be congenital or acquired. A common cause of acquired hypothyroidism is an autoimmune disease known as Hashimoto’s thyroiditis - which occurs when antibodies attack and damage the thyroid. This disease is more common in girls, and it runs in families. 

If your child is suspected to have hypothyroidism, they will be given a blood test known as a thyroid function test, which measures levels of hormones produced by the thyroid. A thyroid antibody test may also be carried out if it is suspected that your child has an autoimmune disease such as Hashimoto’s thyroiditis. 

Hypothyroidism is treated with hormone replacement therapy, administered in the form of a tablet or liquid that contains synthetic (man-made) thyroid hormones. For people of all ages, the most commonly prescribed medication is levothyroxine. Your child’s hormone levels will be monitored during treatment to ensure they are responding appropriately. 

Hyperthyroidism

Hyperthyroidism, or overactive thyroid, occurs when the thyroid gland produces excessive levels of hormones. Whereas hypothyroidism slows down the body’s metabolism, hyperthyroidism speeds up metabolism and subsequently causes different symptoms, including:

• Irritability and nervousness
• Feeling hot
• Diarrhoea
• Growth acceleration
• Weight loss

Hyperthyroidism in children is most commonly caused by an autoimmune disease called Graves’ disease, which leads to the production of antibodies that cause the thyroid to make hormones in excess.⁴

Your child will be given a thyroid function test if they are exhibiting signs and symptoms of hyperthyroidism. A separate blood test to identify anti-thyroid antibodies may also be carried out if Graves’ disease is suspected. 

Treating hyperthyroidism in children requires medication to slow down the production of thyroid hormones. The most commonly prescribed drug is carbimazole, which can be taken in tablet or liquid form. 

Growth hormone deficiency

Growth hormone deficiency (GHD) occurs when the pituitary gland does not produce enough growth hormone - which is essential for a child’s growth and development.⁵

The primary symptoms of GHD are short stature and slow growth; these often become evident from the age of two or three onwards. Other symptoms of GHD in children include:

• A younger-looking face than expected for their age
• A chubbier appearance, due to the influence of growth hormone on fat storage⁶
• Delayed or absent puberty

The cause of GHD is often unclear and thus described as idiopathic. Children born with GHD (congenital GHD) may have a genetic defect that affects the function of the pituitary gland. 

GHD is diagnosed using blood tests that measure the levels of certain hormones and proteins in the blood. Additionally, if your child is suspected to have GHD, they may undergo an MRI scan or a DEXA scan to assess their bone health. 

GHD is typically treated with growth hormone replacement therapy, which involves daily injections of synthetic growth hormone. The dose that your child receives will be calculated according to their weight, so it will increase as they grow. 

Puberty disorders

Puberty normally begins at any point between the ages of 8-13 in girls and 9-14 in boys. Among children assigned female at birth (AFAB), signs of puberty include breast development, growth of underarm and pubic hair, and starting periods. Among children assigned male at birth (AMAB), signs of puberty include developing a larger penis and testicles, growth of body and facial hair, and a deeper voice. 

Early puberty

Early puberty, or precocious puberty, is characterised by signs of puberty occurring before the age of 8 in AFAB children and before the age of 9 in AMAB children. 

The cause of early puberty is often unclear, and it may just be something that runs in your family. It is most common among AFAB children and is typically not associated with underlying health conditions. However, sometimes it can be caused by conditions such as:

• Issues with the brain, for example, a brain tumour
• Damage to the brain caused by things like infection or surgery
• Issues with the thyroid gland, ovaries, or testicles
• Genetic disorders, such as McCune-Albright syndrome, which can cause very early periods in girls - often occurring by the age of 2

If your child is showing signs of early puberty, they will likely be referred for a blood test to check their hormone levels. X-rays of their wrist may also be carried out to determine whether their bones are maturing too early. To rule out serious underlying conditions such as tumours of the brain, ovaries, or testes, an MRI scan or ultrasound scan may also be performed.

If it is found that your child’s early puberty is caused by an underlying condition, they will be treated for this condition. Otherwise, treatment is typically only recommended if it’s thought that their early puberty is likely to cause them emotional distress or physical problems in later life. In such cases, they will be prescribed medication to slow down sexual development. 

Delayed puberty

Delayed puberty is when girls have no signs of puberty by the age of 13 or boys have no signs of puberty by the age of 14. 

Delayed puberty is generally more common in boys. As with early puberty, its cause is not always known, and it may just run in your family. Occasionally, it can be caused by underlying conditions such as:

• Long-term illness, including cystic fibrosis or diabetes
• Malnutrition
• Issues with the ovaries, testes, thyroid gland, or pituitary gland
• Abnormalities in sex development, for example, androgen insensitivity syndrome
• Genetic disorders, such as Klinefelter syndrome, which only affects boys

The same tests and checks used to diagnose early puberty are used to diagnose delayed puberty. 

If an underlying condition is causing your child’s delayed puberty, they will be treated for this condition. If there is no underlying condition, your child may be prescribed medication for a short period to increase hormone levels and trigger the start of puberty, but this is only recommended if their delayed puberty is causing significant issues or distress. 

Other hormonal disorders that can affect children

As mentioned already, there are a wide variety of hormonal disorders that can affect children as well as adults. This article only covers the most prevalent disorders in children, but others include:

• Parathyroid disorders: hypoparathyroidism and hyperparathyroidism
• Adrenal disorders, such as congenital adrenal hyperplasia (CAH), Addison’s disease, and Cushing’s syndrome
• Turner syndrome
• Tumours, for example, on the pituitary gland

Summary

Children can be affected by a wide range of hormonal disorders - including diabetes, thyroid disorders, and puberty disorders. By understanding the causes, symptoms, diagnosis, and treatment of these disorders, you can feel empowered to recognise the early signs and seek appropriate medical intervention if your child is affected.