Pediatric Endocrinologist

Pediatric endocrinologists specialize in child related developmental problems. Pediatric endocrinologists are specialists in physical and sexual growth developments in children and specialize in childhood diabetes and other endocrine gland disorders. The most commonly faced endocrine problems in children are Type I diabetes, growth hormone treatment, intersexes disorders, hypoglycemia and puberty problems.

After completion of medical school and internship and after a three-year pediatric residency, a period of three years is spent to specialize in pediatric endocrinology. Pediatric endocrinologists help in:

• Problems related to early or delayed puberty
  
• Growth problems such as height related problems
  
• Thyroid problems
  
• Intersex problems
  
• Pituitary, Adrenal gland problems
  
• Ovarian or testicular problems
  

Gestational diabetes

Gestational diabetes insipidus occurs during pregnancy. This is a type of diabetes and about 2-10 percent of expectant mothers develop this condition. When pregnant, hormonal changes make your cells less responsive to insulin. But during pregnancy, the pancreas cannot keep up with the increased insulin demand, and hence blood glucose levels rise resulting in gestational diabetes.

Significantly, most women with gestational diabetes do not remain diabetic after the baby is born. Once you've had gestational diabetes, though, you are at higher risk during a future pregnancy and for developing diabetes later in life.

Symptoms of gestational diabetes

There are no symptoms and that is perhaps why all pregnant women have to undergo a glucose screening test between 24 and 28 weeks. If you are at a high risk for diabetes and are showing signs of it, then the doctor would recommend this screening test at the first prenatal visit and then repeat at 24 weeks, the initial test being negative. Follow up tests are done to find out if the result on glucose screening is positive.

High risk factors for gestational diabetes

The American Diabetes Association prescribes the following condition for early screening, in case of high risk namely:

Obesity and BMI over 30
If you have had gestational diabetes in previous pregnancy
If the urine has sugar and
If you have a strong family history of diabetes.

Other risk factors

If earlier delivery was a big baby
If you have had a stillbirth
If you have high blood pressure and
If you are over 35.

An association between excessive weight gain during pregnancy, particularly in the first trimester and risk of gestational diabetes has been established.

Gestational diabetes: Pregnancy and baby

Poorly controlled diabetes may have short and long term consequences for you and your baby. If blood sugar levels are too high, the baby's blood may have too much glucose. The excess blood sugar and insulin can cause the baby to put on extra weight particularly in the upper body. This can lead to a condition called macrosomia. This baby may be too large to enter the birth canal or the baby's head may enter but shoulder may get stuck. This is a tricky condition called dystocia and the doctor has to use special procedures to deliver the baby.

Sometimes delivery of such babies may result in fractured bone or nerve damage which could become permanent in 99% of babies. It is better that babies of mothers with gestational diabetes, check their blood sugar regularly and breast feed the baby immediately after birth to prevent or correct hypoglycemia.

Such babies with hypoglycemia at birth are given IV glucose solution. Testing the baby's sugar and providing an IV if necessary can prevent serious problems such as coma, brain damage and seizures. The baby also exhibits high risk for breathing problems and newborn jaundice. In addition, the baby is also at risk for polycythemia or increase in the number of red cells in the blood and hypocalcaemia or low calcium in the blood. Women with gestational diabetes are at an increased risk of developing Preeclampsia, particularly those who are obese before pregnancy and blood sugar levels are uncontrolled.

Celiac Disease

Celiac disease is an inherited auto-immune disease that is characterized by diffused damage to the small intestinal mucosa leading to malabsorption of nutrients. The development of Celiac disease is attributed to a combination of genetic (HLA alleles) and environmental (gluten ingestion) factors. Celiac disease patients carry the gene identified as HLA DQ2 and/or HLA DQ8. Approximately 30% - 40% of the population in general carry one or both of these genes out of which about 1-5% are expected to develop Celiac disease. The incidence of disease is on the rise, and September 13 is observed as Celiac Awareness Day across the world.

The damage and the discomfort associated with Celiac disease is triggered by consumption of gluten. Gluten is a protein that is present in certain grains such as wheat, rye, barley but absent in rice, oats and corns. In a genetically susceptible host, gluten stimulates autoimmune responses wherein the body's immune system mounts an attack on its own tissues. Due to damage to the villi in the intestines, there is malabsorption of nutrients from food.

Celiac disease is not the same as gluten intolerance. Celiac disease involves autoimmune reaction to gluten and begins to target its own tissue, whereas gluten intolerance is when ingestion of gluten causes the body to have a stress response that does not involve the immune system. The symptoms of both the conditions may appear identical. However, Celiac disease has severe manifestations and may involve hives and rashes.

In case of Celiac disease, blood test shows the higher the levels of class IgA anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies. Gluten intolerance is marked by gastrointestinal symptoms and no specific immunological mechanisms or serological markers are identified for this condition.

Risk factors

Celiac disease is partly a genetic condition and hence tends to run in families. Individuals with Celiac patient in their immediate family have a higher chance of developing Celiac disease. People with other autoimmune conditions like Type 1 diabetes, Thyroid disorders, Addison's disease and Autoimmune hepatitis are more likely to develop Celiac disease. People with other genetic conditions like Down's syndrome, Williams syndrome and Turner's syndrome are also at higher risk of developing Celiac disease.

Signs and symptoms of Celiac disease

Symptoms range from mild to severe manifestations and vary from adult patients to children. Celiac disease presents itself with both gastrointestinal and extra-intestinal symptoms. Abdominal pain, Type I diabetes, chronic constipation, recurrent non-bloody diarrhea, anemia, delayed puberty are some of the prominent symptoms noticed in children with Celiac disease. Intussusceptions, mouth ulcers, osteoporosis, brain fog, neurological dysfunction, unexpected weight and hair loss, nausea, bloating, anemia, inability to retain the pregnancy, migraines are the signs and symptoms identified with adult Celiac patients.

Diagnosis

Diagnosis of Celiac disease is always a two step procedure - beginning with tTG-IgA and total serum IgA tests and conforming it with intestinal biopsy. The diagnosis is never based only on serology as anti tTG may be high in others diseases like inflammatory bowel disease and chronic liver disease. In addition, serology may be negative in patients with low IgA levels, or in children less than 2-3 years. Along with blood tests, genetic tests may also be ordered to check for the presence of the gene HLA DQ2 or HLA DQ8 in an individual. Almost all Celiac disease patients carry one of these genes. Finally the disease is confirmed by performing intestinal biopsy.

There have been recent guidelines by world renowned medical institutions that immediate family members should be screened for the disease as Celiac disease is genetic and other immediate blood relations in the family have a higher probability of developing Celiac disease than the general population. They should be screened at the time the index patient is diagnosed and thereafter, if they exhibit any symptoms, or at least annually. Early diagnosis can help prevent complications.

Treating Celiac disease

Right now, the only treatment for Celiac disease is to strictly adhere to lifelong gluten-free diet. Fruits, vegetables, dairy, fish and other seafood, beans, legumes can be safely consumed as all of these are gluten-free food groups. Grains such as rice, corn, quinoa, millet, teff, flax, chia and starchy roots like tapioca, potato are all gluten-free.

Avoiding gluten completely is not easy. Any occasional slip leads to a flare-up of symptoms instantly. Considering the fact that there are numerous cases of Celiac disease every year and the increasing numbers, there is serious research being conducted to come up with drug therapy. New drug treatments for Celiac disease are now being tested in clinical trials - some are designed to be taken alongside a gluten-free diet, whereas other set of medicines free the patient from all diet restrictions. Three main approaches have been proposed as new therapeutic modalities that include: gluten detoxification, inhibition of intestinal permeability and modulation of immune response.

Currently there are three drugs that are under clinical trails and seem to be successful in treating the condition.:

ALV003: It contains the enzymes that chop up gluten before it starts to activate the immune system.

AN-PEP: An enzyme that breaks down the residual gluten in the stomach.

Larazotide Acetate: May help inhibit immune reaction by blocking a protein that carries pieces of gluten across the gut.

However these drugs still require medical approval to be commercially available in the market.