From the Guidelines
Several endocrine conditions, including hypothyroidism, hyperthyroidism, hyperandrogenism, growth hormone deficiency, Cushing's syndrome, and hypoparathyroidism, can cause hair loss in children, and management involves treating the underlying disorder with appropriate hormone replacement or regulation therapy, as supported by recent guidelines 1.
Causes of Hair Loss
- Hypothyroidism: insufficient thyroid hormone production leads to dry, brittle hair that falls out easily
- Hyperthyroidism: diffuse hair thinning due to accelerated hair cycling
- Hyperandrogenism: conditions like polycystic ovary syndrome (PCOS) or congenital adrenal hyperplasia (CAH) cause hair loss in a male-pattern distribution due to excess androgens
- Growth hormone deficiency: fine, sparse hair along with growth failure
- Cushing's syndrome: hair thinning and delayed growth due to excess cortisol
- Hypoparathyroidism: brittle hair and alopecia
Management
- Treating the underlying endocrine disorder with appropriate hormone replacement or regulation therapy, such as:
- Levothyroxine for hypothyroidism (typically 1-5 mcg/kg/day)
- Anti-thyroid medications for hyperthyroidism
- Anti-androgens like spironolactone (25-200 mg daily) for hyperandrogenism in adolescents
- Hair regrowth typically occurs once hormonal balance is restored, though it may take several months to see significant improvement, as noted in recent consensus guidelines 1.
Recent Guidelines
- A 2024 consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence highlights the importance of multidisciplinary care and treatment of underlying endocrine disorders 1.
- The guideline emphasizes the need for pituitary-specific multidisciplinary teams to manage children with pituitary adenomas, which can cause hair loss due to hormonal imbalances 1.
From the Research
Endocrine Conditions Causing Hair Loss in Pediatrics
- Congenital adrenal hyperplasia (CAH) is a condition that can cause hair loss in children, particularly androgenetic alopecia and hirsutism due to androgen excess 2, 3
- Other endocrine disorders that may be associated with hair loss in children include hypopituitarism, hypothyreosis, hyperthyreosis, hypoparathyroidism, diabetes mellitus, growth hormone deficiency, hyperprolactinaemia, polycystic ovary syndrome, Cushing syndrome, or virilising tumours 4
- These conditions can present with diffuse non-scarring alopecia, such as anagen effluvium, telogen effluvium or androgenetic alopecia, or focal non-scarring alopecia like alopecia areata 4
- Diagnosis of hair loss in children requires a thorough history, physical examination, and potential tests, including dermoscopy or trichoscopy 5, 6
Evaluation and Diagnosis
- A careful physical examination of the hair, scalp, skin, and nails, coupled with dermoscopy or trichoscopy, can help diagnose hair loss conditions in children 6
- Biopsy is rarely needed in children for hair loss conditions 6
- Classic methods of hair evaluation include hair weighing, pull test, wash test, the trichogram, and histopathological examination, while newly developed non-invasive diagnostic techniques include the phototrichogram, trichoscan, trichoscopy, and reflectance confocal microscopy 4