Paediatric endocrine disease may result in changes of the skin, hair, nails and mucosa. Cutaneous signs of congenital and acquired hypothyroidism include xerosis, thickening and doughy appearance of the skin, and brittleness of the hair. Hyperthyroidism with goiter often have skin changes which include facial flushing, hyperhidrosis and warm, moist skin. Increased serum cortisol can cause facial plethora, broad and purple striae, acne, acanthosis nigricans and skin thinning. Hyperpigmentation is seen with adrenal insufficiency. Androgen excess can present with weight gain, pubic and facial hair growth, acne, body odour and muscular habitus. Gynaecomastia is associated with hyperoestrogenism. Wrinkling of skin especially around the eyes and mouth can be seen in hypopituitarism, whereas gigantism/acromegaly is associated with hyperpituitarism. Hypoparathyroidism can result in dry skin, alopecia and brittle nails. Primary hyperparathyroidism can cause dehydration with skin tenting, prolonged capillary refill time and dry mucous membranes.