ESPE Abstracts

Background: There is significant disparity in pediatric endocrinology and diabetes care between developed countries and developing countries. Over the years nevertheless, the diagnosis and management of pediatric endocrine conditions has improved. However, there is paucity of data on clinical presentation and incidence trend amongst pediatric endocrine conditions in sub-Saharan Africa.

Methods: A hospital-based retrospective, descriptive study was carried out at Kenyatta National Hospital between 2008 to 2021 to determine the clinical presentation and incidence trend of pediatric endocrine conditions among patients aged 25 years and below. Data was analyzed using Statistical Package for Social Science version 23.0.

Results: A total of 2238 cases were seen in the 14-year period. Calcium and phosphate disorders were the leading at 35.2% (n=788) followed by glucose and lipid metabolism disorders, growth disorders, testes and male reproductive tract conditions and thyroid disorders at 17.02% (n=381), 14.3% (n=321), 11.2% (n=252) and 7.55% (n=169) respectively. There was a decline in rickets and growth disorders with an increasing trend in type 1 diabetes and thyroid conditions. Diabetic ketoacidosis (DKA) was the most common clinical presentation at diagnosis of type 1 diabetes at 90.2%. Approximately 35.7% of those who presented with DKA reported concomitant weight loss. Fever from various infections including pneumonia, vaginal candidiasis, urinary tract and ear infections formed 16% of all the presenting complaints. A few patients presented with polyphagia and secondary enuresis at 2.7% and 2% respectively while just 2% of the patients presented with classical symptoms of polyuria, polydipsia and hyperglycemia. Amongst disorders of the testes, 50% and 43% of patients presented with unilateral and bilateral undescended testes correspondingly whereas 88.4% of patients with disorders of the penis presented with hypospadias. Disorders of Sexual Differentiation (DSD) commonly presented with ambiguous genitalia at 84.6%. Congestive cardiac failure was the mostly occurring initial presentation amongst cases of hypothyroidism followed by poor growth at 56.3% and 33% sequentially. Patients with rickets commonly presented with pneumonia, delayed milestones and fever at frequencies of 36.3%, 34% and 30% correspondingly.

Conclusion: An increasing trend in type 1 diabetes and thyroid conditions mirrors several studies hence the need to allocate more resources towards these conditions. Most children presented with symptoms suggesting longstanding effects of the disease and this poses an increased risk of mortality and reduced quality of life. There is need to sensitize primary care physicians and the general public on early identification of pediatric endocrine conditions and appropriate referral.