Cushing Syndrome in Childhood

Cushing syndrome is caused by glucocorticoid excess, either by an exogenous source or an endogenous disorder (pituitary corticotroph adenomas, adrenal lesions, or ectopic sources of ACTH/CRH secretion). Typical presentation of Cushing syndrome in children includes weight gain with height deceleration, among other findings such as striae, facial changes, acne, decreased bone mineral density, and others. Screening tests for suspected Cushing syndrome should include two or more of the following tests: 24-h urinary-free cortisol, late-night salivary cortisol, and/or dexamethasone suppression test. Further testing should be directed to the identification of the source of hypercortisolemia. Treatment is usually surgical, but medical and radiation therapy may be additional options in certain cases.