Paeds · clinical-pharmacology-and-therapeutics
Endocrine and diabetes medicines
Also known as Paediatric endocrine prescribing · Insulin therapy in children · Levothyroxine in children · Recombinant growth hormone therapy · Diabetes and thyroid medicines in childhood
A fellowship approach to the three highest-yield paediatric endocrine medicine families: insulin for type 1 diabetes and diabetic ketoacidosis, levothyroxine for congenital and acquired hypothyroidism, and recombinant human growth hormone for growth hormone deficiency and licensed growth-failure indications. Covers insulin pharmacokinetic classes, the 0.05 to 0.1 unit per kg per hour DKA infusion, basal-bolus and pump regimens, ISPAD 2024 glycemic targets, neonatal levothyroxine 10 to 15 microgram per kg per day, and recombinant growth hormone 0.045 to 0.050 mg per kg per day with monitoring and safety surveillance from neonatal life through transition.
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Target exams
Red flags
- Child in DKA given an insulin bolus or insulin before intravascular volume is restored
- Child on an insulin pump with no ketone or pump-failure plan at home
- Neonate with a positive thyroid screen and levothyroxine not started within the first two weeks
- Levothyroxine stopped or inconsistently given during the first two years of life
- Child on growth hormone with new headache, vomiting or visual change not assessed for intracranial hypertension
- Adolescent with erratic glucose control, missed doses and no structured transition plan
- Carer unable to demonstrate the device or repeat the dose change after counselling
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Clinical Pharmacology and Therapeutics
- Endocrinology and Diabetes
- Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Sciences — Pharmacology 10–12
- Clinical Sciences — Endocrinology and metabolism
- Clinical Applications
- Patient safety and quality
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- 11. Complex long-term conditions
- 8. Long-term conditions (endocrinology and diabetes)
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Universal Task 4: Pharmacology and Pain Management
- General Pediatrics Content Outline — Domain 24: Patient Safety, Quality Improvement, and Research Methods
- General Pediatrics Content Outline — Domain 15: Endocrine Disorders
- General Pediatrics EPA 7: Prescribing and Administering Medications Safely
- Patient Care 4: Pharmacotherapy and Safe Prescribing
- Medical Knowledge 9: Endocrine
- Systems-Based Practice 1: Patient Safety and Quality Improvement
- Systems-Based Practice 2: System Navigation for Patient-Centred Care – Coordination of Care
- Medical Expert — Pharmacotherapy and safe prescribing
- Medical Expert — Endocrine
- Collaborator
- Leader
- Pediatrics: Foundations EPA #7 — Prescribing medications safely
Overview & Definition
A child walks in. The endocrine axis that quietly ran their metabolism has failed, and the fix is to give back the missing hormone from the outside. Endocrine prescribing is the deliberate act of choosing the right hormone preparation, the right weight-based dose, the right timing, and the right monitoring — so that the child grows, metabolises and develops as if the gland were still working. [1]
Three medicine families carry almost all of the exam weight, and they are the ones a general paediatrician writes in everyday practice rather than leaving entirely to the specialist. Insulin replaces hormone beta-cells can no longer make in type 1 diabetes and is the definitive, switch-off-ketogenesis drug in diabetic ketoacidosis. Levothyroxine replaces thyroxine thyroid cannot make in congenital and acquired hypothyroidism, and in the first two years of life it is a neurodevelopmental drug as much as a metabolic one. Recombinant human growth hormone drives linear growth in growth hormone deficiency and a handful of licensed growth-failure indications, and it is a daily, self-injected, years-long commitment that tests adherence and safety surveillance at every visit. [1] [6]
The reason these three dominate is that they are common, they are dangerous when misprescribed, and they sit at the centre of the fellowship written and clinical exams. A child in DKA given an insulin bolus before fluids can die of cerebral oedema; a neonate whose levothyroxine is delayed past the first weeks loses IQ points that never come back; an adolescent on growth hormone with a new headache may have intracranial hypertension. The fellowship candidate is expected to write the dose, defend the regimen, and explain the safety-net — not to defer the whole problem to an endocrinologist. [4] [6]
References12ShowHide
- [1]Cengiz E, Danne T, et al International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Insulin and Adjunctive Treatments in Children and Adolescents with Diabetes Horm Res Paediatr, 2024.PMID 39884261
- [2]de Bock M, Agwu JC, et al International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets Horm Res Paediatr, 2024.PMID 39701064
- [3]Tauschmann M, Cardona-Hernandez R, et al International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024 Diabetes Technologies: Glucose Monitoring Horm Res Paediatr, 2024.PMID 39884260
- [4]Wolfsdorf JI, Glaser N, et al ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state Pediatr Diabetes, 2018.PMID 29900641
- [5]Brown SA, Kovatchev BP, et al Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes N Engl J Med, 2019.PMID 31618560
- [6]Léger J, Olivieri A, et al European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism J Clin Endocrinol Metab, 2014.PMID 24446653
- [7]Esposito A, Vigone MC, et al Effect of initial levothyroxine dose on neurodevelopmental and growth outcomes in children with congenital hypothyroidism Front Endocrinol (Lausanne), 2022.PMID 36133316
- [8]Kanakatti Shankar R, Quigley CA, et al Growth and Growth-Promoting Treatments in Turner Syndrome Am J Med Genet C Semin Med Genet, 2025.PMID 39950365
- [9]Azova S, Rapaport R, et al Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema Pediatr Diabetes, 2021.PMID 33197066
- [10]Brown KM, Glaser NS, et al Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis Pediatrics, 2023.PMID 37920947
- [11]Marks BE, Grundman JB, et al Hybrid Closed Loop Systems Improve Glycemic Control and Quality of Life in Historically Minoritized Youth with Diabetes Diabetes Technol Ther, 2024.PMID 38444316
- [12]Chen SC, Bryce J, et al Development of a Minimum Dataset for the Monitoring of Recombinant Human Growth Hormone Therapy in Children with Growth Hormone Deficiency: A GloBE-Reg Initiative Horm Res Paediatr, 2024.PMID 37703843