Pediatrics
Endocrinology
Paediatric endocrinology for NEET-PG: type 1 diabetes, DKA, thyroid disease, congenital adrenal hyperplasia and rickets, mapped to NMC PE33 codes.
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Endocrinology
Paediatric endocrinology for NEET-PG: type 1 diabetes, DKA, thyroid disease, congenital adrenal hyperplasia and rickets, mapped to NMC PE33 codes.
This chapter covers paediatric endocrinology from type 1 diabetes and diabetic ketoacidosis through thyroid disease, congenital adrenal hyperplasia, disorders of puberty and growth to rickets, obesity and ambiguous genitalia. It emphasises safety rules in DKA, agranulocytosis on carbimazole and the salt-wasting CAH pattern.
High-yield: Endocrinology
- Ketosis with weight loss and insulin deficiency, rather than the absolute glucose value alone, separates typical new type 1 diabetes mellitus from many mimics.
- New bedwetting in a previously dry child is a high-value diabetes symptom and deserves a glucose check before behavioural explanations.
- Do not give an intravenous insulin bolus to a child with diabetic ketoacidosis.
- In diabetic ketoacidosis, insulin is continued to stop ketogenesis even after dextrose is added to the fluids.
- Headache, irritability, a falling heart rate, rising blood pressure, recurrent vomiting or unequal pupils during diabetic ketoacidosis treatment suggests cerebral oedema.
- A low free thyroxine with a normal or non-elevated thyroid-stimulating hormone is not reassuring and suggests central hypothyroidism, with adrenal status considered before thyroid replacement.
- Fever or sore throat in a child on carbimazole requires an urgent complete blood count because of agranulocytosis risk.
- A high 17-hydroxyprogesterone with hyponatraemia and hyperkalaemia is the classic 21-hydroxylase deficiency pattern of congenital adrenal hyperplasia.
- Absence of ambiguous genitalia does not exclude salt-wasting congenital adrenal hyperplasia in a male newborn, who may present with vomiting, hyponatraemia, hyperkalaemia or shock.
- Boys with true precocious puberty need a more aggressive search for organic disease than most girls, and testicular enlargement is the first reliable sign of true gonadal puberty in boys.
- Delayed bone age with healthy growth and a supportive family history suggests constitutional delay only after disease has been screened for.
- Endocrine short stature often has preserved or increased weight for height, unlike many systemic diseases, and height velocity is the vital sign of growth.
- In rickets, metaphyseal cupping, fraying and widening at the wrist or knee are classic radiographic signs, and treatment fails when calcium deficiency is ignored.
- Acanthosis nigricans is a bedside marker of insulin resistance and should prompt metabolic screening, while most obese children are normally growing.
- Ambiguous genitalia is a referral diagnosis, but electrolytes and glucose are immediate safety tests before transfer, since adrenal crisis is possible.
Endocrine safety anchors
- **DKA insulin rule:** No intravenous insulin bolus; continue insulin to stop ketogenesis even after dextrose is added.
- **Cerebral oedema in DKA:** Headache, falling heart rate, rising blood pressure, vomiting or unequal pupils during treatment.
- **Carbimazole warning:** Fever or sore throat requires an urgent complete blood count for agranulocytosis.
- **21-hydroxylase deficiency:** High 17-hydroxyprogesterone with hyponatraemia and hyperkalaemia.
NMC competencies in this chapter
- **PE33.1:** Type 1 Diabetes Mellitus in Children
- **PE33.2:** Diabetic Ketoacidosis in Children
- **PE33.3:** Hypothyroidism in Children
- **PE33.5:** Congenital Adrenal Hyperplasia
- **PE33.9:** Rickets and Vitamin D Deficiency
- **PE33.11:** Ambiguous Genitalia and Initial Referral
Frequently Asked Questions
What are the key insulin rules in paediatric diabetic ketoacidosis?
Do not give an intravenous insulin bolus. Insulin is continued to stop ketogenesis even after dextrose is added to the fluids, and treatment is watched closely for cerebral oedema signalled by headache, a falling heart rate, rising blood pressure and vomiting.
Why does fever on carbimazole need urgent action?
Carbimazole can cause agranulocytosis, so fever or sore throat in a child taking it requires an urgent complete blood count to exclude neutropenia before the drug is continued.
What is the classic biochemical pattern of 21-hydroxylase deficiency?
A high 17-hydroxyprogesterone with hyponatraemia and hyperkalaemia. Absence of ambiguous genitalia does not exclude salt-wasting congenital adrenal hyperplasia in a male newborn, who may present with vomiting and shock.
What is the vital sign of growth in endocrine short stature?
Height velocity is the vital sign of growth. Endocrine short stature often has preserved or increased weight for height, unlike many systemic diseases, so a slowing height velocity is a key warning.
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