The Role of the Primary Doctor in the Early Diagnosis of Endocrine Diseases in Children.

Abstract

In the context of the reform of modern medicine, endocrine pathology is encountered not only by pediatric endocrinologists, but also by doctors of other specialties, primarily primary care doctors - pediatricians and family doctors. Currently, there is a tendency to increase the prevalence of endocrine pathologists in all age groups of the children's population of Ukraine. Purpose of the study. To assess the frequency of detection of the most common endocrine diseases in children by primary care doctors and the timeliness of referral to a pediatric endocrinologist. Materials and methods. In the conditions of children's outpatient clinics, 4273 children were consulted and examined, aged from 0 to 18 years. Children were evaluated anthropometric indicators, the state of the thyroid gland and sexual development. Examination of all children for the presence of endocrine pathologists and confirmation of the diagnosis were carried out on the basis of the Order of the Ministry of Health of Ukraine No. 254 of 04/27/2006. "On the approved protocol for the medical support of children for the specialty" Child endocrinology ". Results. Among the total number of children consulted, endocrine pathology was manifested in 36.7%. The diagnosis of newly diagnosed endocrine pathology was first confirmed in 29, 9% of children. Among endocrine pathologists, perovism is occupied by obesity - 39.9%, the second - thyroid pathology - 36.4%, the third - impaired growth - 18.3%, the fourth - impaired sexual development - 7.4%. In 40% of cases, a violation of sexual development is combined with a violation of growth. It has been established that primary care doctors in 40-50% of cases do not perform anthropometry for children at all, the state of sexual development is not evaluated in 70% of cases, which leads to an untimely referral to a pediatric endocrinologist and complicates further treatment. Findings. A high percentage of children with first diagnosed endocrine pathology at the stage of primary care and the late delivery by doctors of children to a pediatric endocrinologist was established, which is due to the lack of primary care physicians' assessment of anthropometric indicators of the child’s physical development, thyroid and sexual development.

The structure of morbidity of secondary school children

“…There is a direct correlation between the content of thyroid hormones and nutritional status, fat content in the body [4]. The development of a child during early childhood and puberty is influenced by both the quality of nutrition and a number of neuroendocrine, genetic and environmental factors [14,23,31].…”

“…Decreased physical activity of adolescents is not only a poor physical form, but also a factor in the development of significant somatic and psychological problems in adolescents [5,7,21]. A high medical and social problem is the high prevalence of endocrine pathology, including childhood obesity, as excessive fat deposition is associated with decreased cognitive abilities, school performance and professional achievement in the future [18,23].…”