TN 13 (06-11)
DI 34005.109 Endocrine Disorders - Child
109.00 Endocrine Disorders
A. What is an endocrine disorder?
An endocrine disorder is a medical condition that causes a hormonal imbalance. When
an endocrine gland functions abnormally, producing either too much of a specific hormone
(hyperfunction) or too little (hypofunction), the hormonal imbalance can cause various
complications in the body. The major glands of the endocrine system are the pituitary,
thyroid, parathyroid, adrenal, and pancreas.
B. How do we evaluate the effects of endocrine disorders? The only listing in this body system addresses children from birth to the attainment
of age 6 who have diabetes mellitus (DM) and require daily insulin. We evaluate other
impairments that result from endocrine disorders under the listings for other body
systems. For example: 1. Pituitary gland disorders can disrupt hormone production and normal functioning in other endocrine glands and
in many body systems. The effects of pituitary gland disorders vary depending on which
hormones are involved. For example, when pituitary growth hormone deficiency in growing
children limits bone maturation and results in pathological short stature, we evaluate
this linear growth impairment under 100.00 . When pituitary hypofunction affects water and electrolyte balance in the kidney
and leads to diabetes insipidus, we evaluate the effects of recurrent dehydration
under 106.00 .
2. Thyroid gland disorders affect the sympathetic nervous system and normal metabolism. We evaluate thyroid-related
changes in linear growth under 100.00 ; thyroid-related changes in blood pressure and heart rate that cause cardiac arrhythmias
or other cardiac dysfunction under 104.00 ; thyroid-related weight loss under 105.00 ; and cognitive limitations, mood disorders, and anxiety under 112.00 .
3. Parathyroid gland disorders affect calcium levels in bone, blood, nerves, muscle, and other body tissues. We
evaluate parathyroid-related osteoporosis and fractures under 101.00 ; abnormally elevated calcium levels in the blood (hypercalcemia) that lead to cataracts
under 102.00 ; kidney failure under 106.00 ; and recurrent abnormally low blood calcium levels (hypocalcemia) that lead to increased
excitability of nerves and muscles, such as tetany and muscle spasms, under 111.00 .
4. Adrenal gland disorders affect bone calcium levels, blood pressure, metabolism, and mental status. We evaluate
adrenal-related linear growth impairments under 100.00 ; adrenal-related osteoporosis with fractures that compromises the ability to walk
or to use the upper extremities under 101.00 ; adrenal-related hypertension that worsens heart failure or causes recurrent arrhythmias
under 104.00 ; adrenal-related weight loss under 105.00 ; and mood disorders under 112.00 .
5. Diabetes mellitus and other pancreatic gland disorders disrupt the production of several hormones, including insulin, that regulate metabolism
and digestion. Insulin is essential to the absorption of glucose from the bloodstream
into body cells for conversion into cellular energy. The most common pancreatic gland
disorder is diabetes mellitus (DM). There are two major types of DM: type 1 and type 2. Both type 1 and type 2
DM are chronic disorders that can have serious, disabling complications that meet
the duration requirement. Type 1 DM--previously known as “juvenile diabetes” or “insulin-dependent
diabetes mellitus” (IDDM)--is an absolute deficiency of insulin secretion that commonly
begins in childhood and continues throughout adulthood. Treatment of type 1 DM always
requires lifelong daily insulin. With type 2 DM--previously known as “adult-onset
diabetes mellitus” or “non-insulin-dependent diabetes mellitus” (NIDDM)--the body’s
cells resist the effects of insulin, impairing glucose absorption and metabolism.
Type 2 is less common than type 1 DM in children, but physicians are increasingly
diagnosing type 2 DM before age 18. Treatment of type 2 DM generally requires lifestyle
changes, such as increased exercise and dietary modification, and sometimes insulin
in addition to other medications. While both type 1 and type 2 DM are usually controlled,
some children do not achieve good control for a variety of reasons including, but
not limited to, hypoglycemia unawareness, other disorders that can affect blood glucose
levels, inability to manage DM due to a mental disorder, or inadequate treatment.
a. Hyperglycemia. Both types of DM cause hyperglycemia, which is an abnormally high level of blood
glucose that may produce acute and long-term complications. Acute complications of
hyperglycemia include diabetic ketoacidosis. Long-term complications of chronic hyperglycemia
include many conditions affecting various body systems but are rare in children.
b. Diabetic ketoacidosis (DKA). DKA is an acute, potentially life-threatening complication of DM in which the chemical
balance of the body becomes dangerously hyperglycemic and acidic. It results from
a severe insulin deficiency, which can occur due to missed or inadequate daily insulin
therapy or in association with an acute illness. It usually requires hospital treatment
to correct the acute complications of dehydration, electrolyte imbalance, and insulin
deficiency. You may have serious complications resulting from your treatment, which
we evaluate under the affected body system. For example, we evaluate cardiac arrhythmias
under 104.00 , intestinal necrosis under 105.00 , and cerebral edema and seizures under 111.00 . Recurrent episodes of DKA in adolescents may result from mood or eating disorders,
which we evaluate under 112.00 .
c. Hypoglycemia. Children with DM may experience episodes of hypoglycemia, which is an abnormally
low level of blood glucose. Most children age 6 and older recognize the symptoms of
hypoglycemia and reverse them by consuming substances containing glucose; however,
some do not take this step because of hypoglycemia unawareness. Severe hypoglycemia
can lead to complications, including seizures or loss of consciousness, which we evaluate
under 111.00 , or altered mental status, cognitive deficits, and permanent brain damage, which
we evaluate under 112.00 .
C. How do we evaluate DM in children?
Listing 109.08 is only for children with DM who have not attained age 6 and who require daily insulin.
For all other children (that is, children with DM who are age 6 or older and require
daily insulin, and children of any age with DM who do not require daily insulin),
we follow our rules for determining whether the DM is severe, alone or in combination
with another impairment, whether it meets or medically equals the criteria of a listing
in another body system, or functionally equals the listings under the criteria in
§416.926a, considering the factors in §416.924a. The management of DM in children
can be complex and variable from day to day, and all children with DM require some
level of adult supervision. For example, if a child age 6 or older has a medical need
for 24-hour-a-day adult supervision of insulin treatment, food intake, and physical
activity to ensure survival, we will find that the child’s impairment functionally
equals the listings based on the example in §416.926a(m)(5).
D. How do we evaluate other endocrine disorders that do not have effects that meet or
medically equal the criteria of any listing in other body systems? If your impairment(s) does not meet or medically equal a listing in another body
system, we will consider whether your impairment(s) functionally equals the listings
under the criteria in §416.926a, considering the factors in §416.924a. When we decide
whether you continue to be disabled, we use the rules in §416.994a.
109.01 Category of Impairments, Endocrine
109.08 Any type of diabetes mellitus in a child who requires daily insulin and has not attained
age 6. Consider under a disability until the attainment of age 6. Thereafter, evaluate the
diabetes mellitus according to the rules in 109.00 B5 and C.