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General FAQ's

   When do I need a Paediatric endocrinology consultation ?

Hormonal conditions in children could be very subtle and therefore, could be going on for a long time before it might strike anyone, even a good healthcare professional for that matter, to deal with them. However, it is well known that early attention to these enables better treatment results for the child. If your child has any of the following, please seek a consult. This is advisable even if you have been to your local doctors and have been reassured. The reason is that, in most instances, all these conditions are too specialized even for many healthcare professionals to be aware of. Medicine itself has specialized so much, it is well-nigh impossible to keep uptodate with everything. I recommend the ‘refer early, repatriate early’ slogan i.e, if either the doctor or the parent is concerned, it is best to consult early rather than late. It is always, “better safe than sorry!”

Symptoms :

  1. URGENT cases (needing same-day discussion) -
    • Drinking too much water, passing too much urine, eating lots and still losing weight, looking and feeling extremely tired. These may be symptoms of Juvenile Diabetes. Please get a fingerprick blood sugar test done (regardless of what time of day and when the last meal was) ASAP, and wait there for the result. If the result is abnormal, the child needs to be seen on the same day. Kindly call Dr. Koppikar directly on her mobile. It is preferable if your doctor rings so I can get a clearer picture.
    • if the blood sugar test is normal, and the problem goes on, the child still needs to be seen early (within a few days) to look for some other conditions. Please DO NOT stop the child’s liquid intake till the consultation.
    • If your child has had low blood sugar problems: This needs to be looked into, diagnosed and treated urgently. The lower the blood sugar drops, the more the risk of long-lasting ill-effects on the child. Kindly get your doctor to talk to me BEFORE leaving to see me. We FIRST need to ensure the child is stable for the trip.
  2. Non-Urgent cases and symptoms -
    • putting on weight, black patches on skin, increased hairiness in some areas, lots of acne, irregular periods
    • parental concerns about child being too tall or too short
    • maturity problems {developing into an adult either too early or too late}
    • For symptoms of thyroid conditions: please read the blog: give link
    • If you are concerned your child’s genitalia are looking unusual

Already diagnosed conditions :

  • Children’s Diabetes {including consideration for modern technology treatments like Insulin Pumps and continuous glucose monitoring}
  • Children’s Growth problem
  • Children’s Obesity {overweight}
  • Thyroid : underactive, overactive or any other
  • Some type of Bone and calcium and Vitamin D problems
  • Intersex problems
  • Adrenal gland or pituitary gland problems
  • Low blood sugar problems
  • Turner syndrome, Klinefelter syndrome, Noonan syndrome

Conditions that get hormonal hits as a result of the treatment :

  • Children’s Cancer - Many of the treatments needed for Childhood cancer have side effects on other organs, notably the hormonal system. In as much as the treatments are really needed to deal with the cancer, the side-effects need to be anticipated and dealt with as early as possible. Simplistically speaking, over the past few decades, improvements in medical technology have led to increasing numbers of cancer survivors. Whilst this is fabulous news, it is just as true that the survivors end up having side-effects of the medications. Dealing with these conditions can enable a much better life. More detail on this in a little while.
  • Children’s Thalassemia - Children getting recurrent blood transfusions end up with their hormonal system getting burdened. Whilst these children now are living longer, would it not be better if their overall quality of life could be improved? The hormonal system hits from multiple blood transfusions can easily be anticipated and dealt if seen early. More detail on this in a little while. The same applies to children with conditions like aplastic anaemia.

Coming soon :

  • Children with any diagnoses on High-dose steroids for more than 2-3 weeks at a stretch. For example: 1) Duchenne Muscular Dystrophy 2) Asthma 3) severe epilepsy.
  • Cerebral palsy and conditions where children are immobile.

Conditions that may have a hormonal cause but may appear to be another problem :

  • Recurrent fits - many children with multiple fits (convulsions / seizures) get started on long-term medicines. In reality, some of them could be having fits due to some blood abnormalities. Until and unless these blood abnormalities are looked for and treated, the fits would continue, no matter what medicines are thrown at them. Though I will not advise on treatment of epilepsy, looking for those abnormalities and liaising with your Paediatrician/ Paediatric Neurologist is done, if a fault in the blood is detected. Please read blog

Conditions that have links with hormonal conditions :

  1. cleft palate And / OR BOTH –SIDED cleft lip
  2. born blind in one or both eyes due to ‘optic atrophy’

These conditions are known to be linked with defects in the Pituitary gland in the brain. The pituitary is the master of all other hormones in the body and it does so by secreting 6 main hormones. Many of these may or may not be apparent at birth. Dealing with the hormonal deficit in an anticipatory manner helps better outcomes for all these babies.

   That is strange !! Do children have hormones too ?

yes, they do ! In lay terms, hormones are associated with being grown up, ie the naughty hormones. However, there are also many other hormones that play important roles in adults and children. In chidlren, these hormones make a child grow tall {Growth Hormone} , grow intelligent {thyroid hormone}, grow up into adults {puberty hormones -oestrogen in girls and testosterone in boys} . There are hormones that make children stay well {cortisol produced by the adrenal glands}, and keep bones strong {parathyroid and related hormones } and keep the child's blood sugar in check {insulin produced by the pancreas }. This is just a brief overview, there is much more, but let's keep it simple.

   Why do you recommend only a certain lab or scanning center ?

There are a lot of factors {equipment quality, experience, standardization practices, accreditation etc. etc.} that can influence the accuracy of a blood, urine or scanning result. This gets even more complex the more specialized the field is, that is, in Paediatric endocrinology, we might need to do tests that not every lab or scan center is used to doing. Apart from the procedure of doing the test, the ‘reporting’ factor, where in the laboratory or radiology doctor gives his/her interpretation of the test is also equally important. Most of the tests needed may not be something that smaller labs see and do routinely. We are also used to working in collaboration with these lab and radiology doctors to discuss any complex or grey areas of the report, which is very much recommended practice internationally. This is the only consideration in choosing labs and scan centers. Kindly note -There is ABSOLUTELY NO cash or kind incentive behind it. However, if you wish you may still go ahead and do the test at a center of your choice, but liaising with their doctors in case of doubts is something you would need to do by yourself.

   But why do I need to travel so far to see you, doctor ?

It is the question of your child's best outcomes. Why would you be so concerned about travelling if it meant the best for your child ? The entire approach to the problem on hand, the way the diagnosis is made, the way it is discussed with yourselves and the child is a whole lot different, because I am trained to see only children. If you do not need to be seen by me, I will make it clear at the first opportunity. Also, there are some conditions that can be managed on a shared-care basis. ie If you live far away, after the first few visits, we will co-ordinate with your local paediatrician and set up an individualised care package that will ensure less trips to Dr. Koppikar, but ALSO at the same time, ensure that the QUALITY OF CARE your child receives is not compromised.

    What conditions does a Paediatric endocrinologist deal with ?

Pediatric endocrinologists deal with any suspected or proven hormonal conditions in the children and adolescents.

   What tests should we do before we come to see you Dr. Koppikar ?

We recommend you first visit with all your previous reports, all the previous records of the child, regardless of which doctor they have seen for what complaint. This along with examining your child, enables us to get complete information to decide whether or not tests are needed, and which ones.

   What age group do you deal with ?

Paediatric endocrinology deals with 0-18 year olds. Beyond age 18, some conditions will still be seen, for example ‘delayed puberty’, ie. If you have not achieved pubertal maturity, ie, growing fully from girl to woman or boy to man. Any other conditions are best dealt with by an Adult Endocrinologist. If you however, wish to see Dr. Koppikar, please be aware it may be only a partial consultation.

    Where all do you practice? What is the best place to get information about all this?

Dr. Koppikar practices solely at Sir H. N. Reliance Foundation Hospital. All other practice locations showing up on an internet search are earlier or incorrect locations. This website and the two facebook pages on it are the best online resources to look for accurate information about Dr. Koppikar’s practice. If you spot any irregularity, or have feedback to improve the site, kindly use the feedback form here or email Dr. Koppikar.

   Do I need to bring my child to the appointment?

It will be advisable to bring the child so that a full consultation can be done. If only parents wish to come, only a provisional initial consultation will be done. We treat the child, not just the reports. No tests or medicines can be prescribed, and no definitive treatment plan can be made unless the child has been examined. After the first meeting with the child, we will decide at which further appointments the child needs to be/ need not be present, based on each individual case.

   Why do you still charge if I did not get my child?

The charge is for the professional consultation, which is determined simply by the length of time taken for the consult, which will be recorded on the notes.