When Should You See a Cardiologist?

Adrenarche is a natural developmental phase in childhood when the adrenal glands begin to produce increased amounts of the hormone dehydroepiandrosterone (DHEA). This process usually occurs between the ages of 6 and 8 and precedes true puberty, known as pubarche, by about two years. DHEA is a precursor hormone, meaning that the body converts it into stronger hormones such as androgens (testosterone, androstenedione) and estrogen. These hormones play an important role in initiating puberty, supporting reproductive health, and influencing body growth and development. In the bloodstream, DHEA mostly circulates as DHEA-sulfate (DHEAS), and its presence in blood tests indicates that adrenarche has begun. However, since adrenarche is a normal stage, this test is not routinely ordered for children. What Happens During Adrenarche? During adrenarche, the adrenal cortex—the outer layer of the adrenal gland—undergoes further maturation, especially in its innermost zone (zona reticularis). This development triggers the production of DHEA, which then transforms into androgens responsible for stimulating various glands and bodily changes, such as: • Sebaceous glands: These glands in the skin produce sebum, a protective oily substance that helps retain moisture and contributes to body odor. • Apocrine glands: Located in the underarm and genital regions, these glands remain inactive until activated by adrenal hormones. It’s important to distinguish adrenarche from gonadarche, the stage when the ovaries or testes mature and start producing major sex hormones like estrogen or testosterone. Adrenarche and gonadarche are separate but complementary processes, each marking different aspects of development. Premature Adrenarche Premature adrenarche refers to the early appearance of pubic or underarm hair and body odor—before age 8 in girls or age 9 in boys. In most cases, this early onset is not harmful, but it can sometimes be confused with precocious puberty, which involves early breast or genital development. Common symptoms include: • Pubic and/or underarm hair growth in young children. • Noticeable body odor that may require deodorant use. Children with premature adrenarche are often taller than average for their age. Although the exact cause remains unclear, girls experience it more frequently than boys. To rule out other possible conditions such as congenital adrenal hyperplasia, hormone-secreting tumors, or external hormone exposure, a pediatrician may recommend physical and laboratory examinations. About 90% of early pubic hair cases are due to premature adrenarche rather than disease. Is It Dangerous or Treatable? Premature adrenarche is generally not dangerous and usually doesn’t require medical treatment. However, research suggests a slightly increased risk of conditions such as obesity, insulin resistance, polycystic ovary syndrome (PCOS), and mood disorders later in life. Emotional well-being can also be affected—children who mature earlier than peers may experience embarrassment or social discomfort. There is no medication to reverse or slow adrenarche-related hair growth, and prevention is not typically possible. Some studies associate early adrenarche with factors such as low birth weight, premature birth, or past brain injury. Final Note Adrenarche and pubarche are natural, healthy stages in a child’s growth. While premature adrenarche can be concerning for parents, it’s rarely a sign of illness. If your child shows early signs of puberty or experiences emotional distress related to these changes, consulting a pediatrician or child psychologist can help ensure healthy development and support their confidence during this transition.

Dehydroepiandrosterone sulfate (DHEA-S) is a steroid hormone synthesized in the adrenal cortex’s reticular zone under the influence of adrenocorticotropic hormone (ACTH). Like other steroids, DHEA-S is synthesized from cholesterol. DHEA-S is considered a prohormone. It is hormonally inert but can be converted into other, more potent androgens and estrogens. It is an important marker of adrenal function and is useful for diagnosing various endocrine disorders, as well as for evaluating premature adrenarche in children. During fetal development, DHEA-S is produced in the adrenal glands; its level rapidly decreases during the first year of life and then rises again at adrenarche (around 6–8 years old), gradually increasing during puberty and reaching its peak between the ages of 20–30. After that, DHEA-S levels steadily decline. In males, the adrenal glands contribute only a small portion of total androgen production, while in women of reproductive age, the adrenal glands play a more significant role in androgen production. In women, elevated DHEA-S levels may cause signs of hyperandrogenism (hirsutism, acne, virilization). Men are usually asymptomatic, but due to peripheral conversion of androgens to estrogens, a mild excess of estrogens may sometimes be observed. Common causes of elevated DHEA-S levels include: 1. Androgen-secreting adrenal tumors (adenomas or carcinomas), especially when DHEA-S is markedly elevated (more than 5 times above normal). 2. Congenital adrenal hyperplasia. 3. Polycystic ovary syndrome (PCOS), often with mild to moderate elevation. Common causes of low DHEA-S levels include: 1. Adrenal insufficiency, such as Addison’s disease or secondary adrenal insufficiency due to hypopituitarism. 2. Subclinical or overt hypercortisolism. 3. Severe systemic illnesses, acute stress, or chronic conditions such as anorexia. DHEA-S affects immune modulation, inflammation, and neuronal protection; low levels are associated with cognitive decline and mood disorders. It is important to regularly monitor the hormone level, as its deviations may indicate adrenal or hormonal disorders at an early stage. Timely DHEA-S testing contributes to accurate diagnosis and the selection of effective treatment.

With the beautiful autumn days and colors, upper respiratory tract infections or acute respiratory viral infections (ARVI) become more frequent. People often call them seasonal colds. Let’s understand together how children get infected with these viruses and what should be done to prevent them. Upper respiratory tract infections are seasonal viral diseases transmitted by airborne droplets (coughing/sneezing on each other, touching household items/toys of an infected person, using the same dishes). These infections are self-limiting and usually start in autumn, continuing until late spring (or, as they say, along with the school year). The main symptoms are: • Sudden and frequent fever (38°C and above) • Chills, shivering • Headache, muscle pain, body aches • Sore throat • Cough • Runny nose • Sometimes vomiting or diarrhea Respiratory viruses mainly affect the upper respiratory tract — the nasopharynx, throat, and trachea — but sometimes can also involve the bronchi. The illness usually lasts up to one week, sometimes a little longer. What to do in case of viral infection When a child gets infected, the main goal is to ease their condition and prevent complications. • Offer plenty of fluids (water). • Clean the nasal passages with saline solution (NaCl 0.9%) or sea salt sprays. • In case of fever, give Acetaminophen (Paracetamol) or Ibuprofen (Nurofen) in syrup, suppository, or tablet form — according to age and weight, and only as prescribed by a pediatrician. • Ensure constant room ventilation and maintain air humidity. • In case of cough, honey can be useful for children over 1 year old (it is not allowed for younger ones due to the risk of botulism). Important facts about medication Ibuprofen should not be used for dehydrated or persistently vomiting children. Aspirin is prohibited under the age of 12. Antiviral suppositories (Viferon, Genferon) have no proven effectiveness and are often confused with fever reducers, which can be dangerous during high fever. The only antiviral medication with proven effect is Oseltamivir (Tamiflu), used in confirmed influenza cases, starting from the first day of illness and only by pediatric prescription. When to seek immediate medical attention If you notice that your child has: • Frequent or labored breathing • Cyanotic (bluish) lips • Retractions between the ribs while breathing • Chest pain • Severe muscle pain causing refusal to walk • Signs of dehydration (no urination for 8 hours or more, dry mouth, crying without tears) • Weakness or lack of response • Convulsions • Persistent high fever (40°C and above) • Age under 3 months • Worsening or recurrence of symptoms after a few days • Presence or exacerbation of chronic diseases (e.g. diabetes, asthma) To prevent respiratory viral infections, it is important to teach children to wash their hands frequently (especially after returning home), eat healthy and balanced meals (with plenty of fruits and vegetables), avoid contact with sick individuals, and receive all vaccinations according to the national immunization schedule (including the seasonal flu vaccine). Thus, follow and teach your children to maintain hygiene rules, eat healthy and varied food, have sufficient physical activity, and good sleep.

Cough is a natural protective reflex of the body and plays an important role in the innate immunity of the respiratory system. It helps clear mucus, microorganisms, and irritants from the airways. The mechanism of coughing includes three phases: inhalation, compression, and exhalation. The effectiveness of a cough depends on several factors: • the proper width of the airways (narrowing reduces its efficiency), • the properties of mucus, • and the strength of the respiratory muscles. It’s very important not to suppress the cough reflex without identifying and treating the underlying cause. Cough occurs in almost all children, including premature infants (about 10% of babies born at 27 weeks and up to 90% of full-term newborns). It is one of the main clinical signs of respiratory diseases, but it can also appear in non-respiratory conditions. Types of Cough • Normal (expected) — during viral infections • Specific — with sudden shortness of breath, recurrent pneumonia, neuromuscular disorders, or chest/jaw anomalies • Nonspecific — dry cough without an identified respiratory disease (may resolve spontaneously) Cough is also classified by: 1. Cause 2. Duration: Acute — up to 4 weeks Chronic — longer than 4 weeks 3. Nature: Dry or wet (productive) Acute Cough In children, acute cough is most often associated with viral infections of the upper respiratory tract. It usually resolves on its own after the infection and rarely requires further testing. If the cough is persistent, lasts more than 4 weeks, or is accompanied by other concerning symptoms, a doctor’s visit is necessary. Acute cough may also develop after foreign body aspiration, especially in children aged 3–5 years, who tend to put small objects in their mouths. This situation requires immediate medical attention. Acute cough can indicate both respiratory and non-respiratory diseases. Respiratory causes include: nasopharyngitis, sinusitis, false croup, tracheitis, bronchitis, pneumonia, and asthma. Non-respiratory causes include neurological problems, congenital heart defects, and others. The most common cause of acute cough is the common cold, accompanied by sneezing, fever, runny or blocked nose, headache, and sore throat. These are usually self-limiting viral infections that don’t require antibiotics. However, if the child breathes rapidly, has a persistent fever, weakness, or refuses fluids — medical evaluation is necessary. Chronic Cough Chronic cough lasts more than 4 weeks and may be accompanied by wheezing, burning, breathing difficulty, nasal congestion, or hoarseness. You should see a doctor if your child has: • frequent, persistent cough, • barking or nighttime cough, • wheezing or noisy breathing, • productive cough with mucus, • rough or hoarse-sounding cough. Chronic cough may occur in both younger and older children. • In children under 5 years old, it can be caused by infections, asthma, foreign body aspiration, passive smoking, or congenital abnormalities. • In children over 5 years old, causes include asthma, prolonged bacterial bronchitis, allergies, long-term use of nasal drops, and passive smoking. What to Do During autumn, when viral infections are more common, it’s important to pay close attention to cough symptoms and seek timely care. If your child has a cough, don’t wait for it to pass on its own. Consult a pediatrician. Our clinic’s experienced doctors will identify the cause, prescribe the right treatment, and, if necessary, perform modern diagnostic tests. Our clinic offers all the necessary advanced diagnostic methods to ensure accurate diagnosis and effective treatment.