A Ten-Year Review of Childhood Pattern of Endocrine Disorders seen in Federal Teaching Hospital Gombe

Background: The endocrine system is a network of glands which produce hormones that regulate metabolic functions of other cells and organs. Disruption of this system results in abnormalities of growth, development and reproduction. These conditions are not rare in childhood but due to lack of diagnostic facilities, they are not looked for and are therefore under-reported. However, they should be detected early and managed promptly to avert the morbidity and possible mortality that may be associated. Objectives: To describe the pattern of childhood endocrine diseases in Federal Teaching Hospital Gombe. Methodology: A retrospective hospital-based study in which data were extracted from case notes of children with endocrine disorders. These case notes were traced from the registers of all paediatrics units and general out-patient departments. These case notes were subsequently reviewed and relevant data extracted and entered unto a proforma. Outcome measures as well as complications of those admitted were also noted. Results: Ninety-four out of 14,943 paediatric cases seen were endocrine disorders giving a prevalence of 6.3/1000 with a male/female ratio of 1.5/1. Most of the cases (75%) presented before the age of ten years and Type 1 Diabetes Mellitus was the commonest disorder recorded. Conclusion: Type 1 Diabetes Mellitus is the commonest paediatric endocrine disorder seen in Federal Teaching Hospital Gombe.


Introduction
The Endocrine System is a network of glands that produce and release hormones into the body to regulate important functions of all cells and organs 1 .When this system is disrupted the results are a mixed picture of both overactivity and underactivity of the glands 2 .The manifestation of such include pituitary diseases, diabetes mellitus, non-nutritional disorders of growth, thyroid and parathyroid dysfunction, disorders of adrenals and sexual development, obesity and its complications as well as endocrine cancers 3-6.Many other endocrine diseases have no distinctive features in their early stages and may present with problems like malnutrition, diarrhoea and malaria which are very common in the tropics and subtropics 7 .Although these disorders are relatively uncommon, they tend to run a chronic course, resulting in long-term morbidity and, sometimes, mortality, if not diagnosed and treated promptly 8 .Some of these conditions may however present as emergencies and majority of children with such

ORIGINAL ARTICLE
diseases report to non-specialists, who may make a great impact, but with so many limitations 9 .The prevalence of such disorders is underappreciated in low and middle-income countries (LMICs) 10 .These are the developing countries of the world which generally experience 90% of the world's disease burden mainly due to ignorance, civil unrest and poverty 11 .Unfortunately, such countries have just about 10% of the global health care fund at their disposal 12 .This therefore means that many children with endocrine diseases may not receive qualified and sufficient treatment 13 ; some may die either undiagnosed or untreated because their families cannot afford the medications 14 .In these situations, endocrine diseases may only be suspected and would therefore require a series of investigations which unfortunately are unavailable in developing countries 15 .This may compound the diagnostic limitations, leading to many missed cases and giving a wrong impression that endocrine diseases do not occur in such countries 16 .This study describes the pattern of childhood endocrine diseases in Federal Teaching Hospital Gombe.

Materials and Methods
This was a retrospective study conducted in the Department of Paediatrics, Federal Teaching Hospital, located in Gombe, which is the headquarters of Gombe State, situated in the middle of North East geopolitical zone of Nigeria between latitudes 9030' and 12030'N and longitude 805' and 11045'E.Departmental registers from the Emergency Paediatric Unit (EPU), Paediatric Medical Ward (PMW), Paediatric Surgical Ward (PSW) and the Paediatric Outpatient Department (POPD) as well as the Filter (General Out-patient) Clinic were reviewed.All entries with diagnoses of endocrine disorders made between 1 st January, 2006 and 31 st December, 2015 were noted, case notes of such diagnoses were traced from the records department, studied and relevant data on age, sex, tribe, clinical features, duration of symptoms, final diagnosis, treatment and outcome were extracted and entered into a proforma.Outcome measures such as "improved and discharged", "discharged against medical advice" and "death" were also noted for those who were admitted.Complications which occurred during treatment were also noted.
Ethical Permission: This was obtained from the Research and Ethics Committee of the Federal Teaching Hospital, Gombe.

Results
A total of 14,943 paediatric cases were seen during the study period, out of which 94 presented with various endocrine disorders giving a prevalence of 6.3/1000.There were 57 males and 37 females giving a male/female ratio of 1.5/1.Most of the endocrine disorders presented between the ages of 1 and 10 years with the highest number of cases (42%) seen in the age group 6-10 years.Table 1 shows the age group and gender distribution of the children who presented with various endocrine disorders.The number of paediatric endocrine cases seen appear to be on the increase each year with the lowest number seen in 2006 and the highest in 2015.There was no seasonal variation in the cases seen and the patients came from within Gombe state as well as the neighbouring states.The types and pattern of the cases seen had no variation according to the different states of origin.The socio-economic status seems to have an effect such that 56% of the cases came from the middle socio-economic class, 26% from the high socio-economic class and 18% from the low socio-economic class.Type 1 Diabetes Mellitus was the commonest endocrine disorder constituting 34%, followed by disorders of sex differentiation (26%) and Obesity (12%).Others were rickets (11%), cryptorchidism (7.2%), short stature (3.2%), thyroid and parathyroid disorders (2.2%), gynaecomastia (2.2%) and micropenis (2.2%).They however seem to be on the increase since the past ten years and this may be due to increases in population, public awareness of endocrine conditions or diagnostic ability of the hospital staff.The pattern of such disorders in order of frequency shows Type 1 diabetes mellitus as the commonest childhood endocrine disorder in Federal Teaching Hospital Gombe.Others are disorders of sex differentiation, obesity, rickets, cryptorchidism, thyroid disorders, short stature, gynaecomastia and micropenis.This pattern is not very different from what was reported in other parts of Nigeria like Benin 17 and Abakaliki 18 .It was however different from the study in Ibadan 19 and Saudi Arabia 20 as well as that reported from Romania 21 where Turner's Syndrome was the commonest disorder detected.This variation may be due to geographical difference even though Gombe and Ibadan are in the same country.In this study It was also found out that childhood endocrine disorders in FTH Gombe occurred more frequently in the middle socio-economic class where more than half (56%) of the cases were seen.This may be because those from the lower socio-economic class may not be able to afford to come to the Federal Teaching Hospital and may resort to other lower hospitals, the traditional healers or worse still languish at home without any help.Those from the high socio-economic class can afford to take their children to more developed countries abroad and may not bother coming to the Federal Teaching Hospital.There is also a male preponderance with a male/female ratio of 1.5/1 in this study.

Conclusions
Childhood endocrine disorders are increasingly being detected over the years in Federal Teaching Hospital Gombe with childhood diabetes as the commonest.This may be due to change in lifestyle and eating habits of the populace which may necessitate nutritional/dietary advice as well as other changes in lifestyle Limitations: The major limitation in this study is confirmatory diagnosis for type 1 diabetes which requires detection of auto-antibodies such as Glutamic Acid Decarboxylase Antibodies (GADA) and Anti-Islet Cells Antibodies; all the cases of Type 1 Diabetes were therefore diagnosed based on the clinical presentation and index of suspicion.

Statistical Analysis:
Data is presented in numbers and frequencies.Means, ratios, standard deviations, confidence intervals, odds ratios and percentages are used to describe all variables.Chi Alkali YS et al Borno Medical Journal January -June 2018 Vol. 15 Issue 1 Page 79 This work is licensed under a Creative Commons Attribution 4.0 International License square is used to compare groups and a p-value of<0.05 is considered significant.

Table 2 :
Gender distribution of various endocrine disorders DiscussionPaediatric endocrine disorders have long been noticed in Federal Teaching Hospital Gombe.