Endocrine Problems in Children and Adolescents Who Have Disabilities

Abstract

The consequences of disability span almost all aspects of life, for families and for an affected individual. Endocrine aspects of disability cover disorders of hypothalamic pituitary dysfunction, bone health, puberty, fertility, sexual function and contraceptive needs. Adequate endocrine assessment for a child with a disability requires extensive and sensitive history to address social issues, general nutrition, vitamin D status, specific hypothalamic pituitary problems, together with parental concerns regarding puberty and contraception. Bone health assessment includes history of minimal trauma fracture, need for intervention or fitness for surgery. Strategic interventions to improve outcome include management of puberty, vitamin D status, biomechanical stimulation with vibration and standing and possible consideration for bisphosphonate in special circumstances. Both early and late puberty cause major family concerns. The paediatrician must be aware of a range of management options to improve outcomes for the child and family.

Central Precocious Puberty and Response to GnRHa Therapy in Children with Cerebral Palsy and Moderate to Severe Motor Impairment: Data from a Longitudinal, Case-Control, Multicentre, Italian Study

“…CP is a complex condition that affects individuals differently. Its treatment and management are challenging because families, caregivers, and clinicians have to face, besides motor, cognitive, and neurologic disorders, also nutritional and respiratory concerns, infections, osteoporosis, and more rare endocrine problems [ 9 ]. Data from Worley et al described the physiological pattern of pubertal development observed in 207 CP children with moderate to severe motor impairment: girls seemed to enter puberty earlier but tended to mature over a longer period of time, menstruating later; boys followed more regular patterns but tended to start earlier [ 4 ].…”

RASopathies Are Associated With Delayed Puberty; Are They Associated With Precocious Puberty Too?

“…It remains possible that, in children with developmental delay, precocious puberty might occur as an indirect result of the gene mutation and derive from disease-associated hypothalamic dysfunction, which could occur even without causative structural brain abnormalities. 28 Because the RAS-MAPK pathway is 1 of the intracellular signaling e2 pathways involved in growth hormone action, 29 -31 it is perhaps not surprising that growth hormone deficiency (GHD) has been described in patients with RASopathies, 9,10,23 although as with precocious puberty the exact etiology of this association is not fully understood.…”

Maternal attitude towards delaying puberty in girls with and without a disability: a questionnaire-based study from the United Arab Emirates

“…In girls who wear a harness in a wheelchair, breast development in puberty can cause discomfort due to chest tenderness with the harness impinging on the developing breast tissue. 15 If the girl is unable to express the pain, this might not be recognised by families and may just manifest as irritability.…”