Cushing Syndrome In Children: Causes, Symptoms & Treatment
Excessive weight gain and high levels of blood sugar might indicate Cushing syndrome.
Specialty: Neonatology and PediatricsExperience: 5 yearsDr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.
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In This Article
Cushing syndrome in children is mainly characterized by excessive weight gain, high blood sugar levels, and decreased growth rate. Also known as hypercortisolism, it is a hormonal disorder that occurs due to the overproduction of cortisol by the adrenal gland. Cortisol is known as the body’s stress hormone and helps the body respond to adverse situations. It is also responsible for maintaining blood pressure and blood sugar levels (1). This is a rare disorder affecting around two to five per million people per year, with only 10% of new cases occurring in children (2).
Read through the post to learn the causes, symptoms, complications, diagnosis, and treatment for Cushing syndrome in children.
Causes Of Cushing Syndrome In Children
There are two variants of Cushing syndrome based on the factors that cause it. It can be either exogenous, caused due to intake of medicines containing high levels of glucocorticoids, or endogenous, caused due to overproduction of cortisol inside the body, rather than external reasons.
Cushing syndrome is often caused by exogenous factors and rarely by endogenous factors (2). Glucocorticoids administered to treat asthma, allergies, or immune disorders are often the culprits.
The other causes of Cushing syndrome include (3)
- Adrenal tumor
- Endocrine disorders that the child might have inherited
- Inflammatory bowel disease
- Some kinds of cancer
- Rheumatoid arthritis
Symptoms Of Cushing Syndrome In Children
The symptoms of Cushing syndrome can vary among children depending on the cortisol production rate in the body. Some of the common symptoms of Cushing syndrome include (3)
- High blood pressure
- Excess weight gain
- Excess fat around the neck and on the face (“Fatty hump”)
- Stretch marks on the abdomen, thighs, and arms
- Weak bones and muscles
- Excessive hair growth, mainly on the face
- Round face (“Moon facies”)
- Decreased growth rate
- Thin legs and arms compared to other children of the same age
- Fatigue
- Darkening of the skin
- High blood sugar levels
- Glucose intolerance
Complications Of Cushing Syndrome
If not diagnosed or treated on time, Cushing syndrome might give rise to certain medical conditions or complications, including (1) (4)
- Osteoporosis (weak, brittle bones)
- Infections
- Obesity
- Emotional disturbances
- Memory loss or difficulty concentrating
- Problems with vision
- Fatigue
Diagnosis Of Cushing Syndrome In Children
The initial symptoms of Cushing syndrome in children might include weight gain. However, the child’s height may not increase consistent with the weight gain (2). As the symptoms of Cushing syndrome may be similar to those of other health conditions, always seek a pediatrician for an accurate diagnosis.
The doctor may begin the diagnosis by enquiring about the child’s medical history and doing a physical exam. Some of the diagnostic tests performed for Cushing syndrome include (1) (5)
- Corticotropin-releasing hormone (CRH) test: This test is performed to determine if the excess cortisol is being produced due to a tumor in the pituitary gland or an adrenal tumor.
- Blood tests and 24-hour urine tests: These tests are done to measure the cortisol levels in the body.
- X-ray: An X-ray may be performed to monitor bone density and structure.
- Dexamethasone suppression test: This test is performed to determine whether a tumor in the pituitary gland is producing excess adrenocorticotrophic hormone (ACTH).
- Magnetic resonance imaging (MRI): MRI is done to obtain detailed pictures of the internal organs and muscles of the body.
Treatment For Cushing Syndrome In Children
The treatment options for Cushing syndrome in children may vary depending upon the amount of cortisol released in the body and the visible symptoms. The common treatment options include (1) (3) (6)
- Surgery to remove the pituitary tumor or adrenal tumor, if present.
- Medicines to inhibit excess cortisol production.
- Radiation therapy to treat the growth of pituitary tumors.
Caring For Your Child With Cushing Syndrome
Cushing’s syndrome can affect your child’s growth and development, and as a result, hamper their quality of life (3). Early diagnosis and proper treatment can help them recover at a faster rate. But for some children, the treatment may continue for a longer period owing to other medical conditions. In such cases, frequent visits to the doctor and regular checkups can help manage cortisol levels in your child’s body and help decrease their problems.
Frequently Asked Questions
1. At what age is Cushing diagnosed?
Cushing’s syndrome is rarely diagnosed in children younger than five years. However, 12 to 14 years is the mean age when the condition is diagnosed (7).
2. What is the diet for Cushing syndrome?
For children with Cushing’s syndrome, the diet should include a variety of healthy foods rich in protein and calcium (help prevent muscle and bone loss due to high cortisol levels). After consulting the doctor, they may include a calcium and vitamin D supplement for bone health. Restricted salt (sodium) intake is important if the child has high blood pressure (8).
3. Can Cushing’s be cured?
With early and proper treatment, Cushing’s syndrome may be cured. However, some health problems may persist, such as weak bones. They also have a higher risk of developing hypertension, diabetes, and psychological issues such as depression and anxiety (9).
4. Is Cushing’s autoimmune?
No, Cushing’s syndrome is not an autoimmune disorder. In fact, higher levels of cortisol in the body mimic the effect of glucocorticoids that are usually given to suppress the immune system in people with autoimmune disorders. Therefore, when Cushing’s gets resolved, other underlying autoimmune diseases are likely to worsen (10).
Cushing’s syndrome in children is a rare medical health condition. The excess production of cortisol that characterizes the condition can be controlled by administering medicines that can bring down cortisol levels in the blood. In cases where a tumor causes the disorder, performing certain diagnostic tests and a minor surgery might be required. Generally, proper medical treatment helps improve the results for your child.
Key Pointers
- High blood pressure, abnormal weight gain, weak bones and muscles, and excessive hair growth are some common symptoms of this condition.
- Cushing syndrome can cause complications such as osteoporosis, infections, obesity, fatigue, etc.
- Cushing syndrome can also be caused by glucocorticoids, adrenal tumors, hereditary endocrine diseases, inflammatory bowel disease, and certain skin malignancies.
References
- Cushing’s Syndrome.
https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome - Constantine A. Stratakis et al.; (2012); Cushing Syndrome In Pediatrics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594781/ - Cushing Syndrome In Children.
https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/c/cushing-syndrome-in-children-1.html - Cushing Disease/Cushing Syndrome.
https://www.ohsu.edu/brain-institute/cushing-disease-cushing-syndrome - Cushing’s Syndrome.
https://www.chop.edu/conditions-diseases/cushing-s-syndrome - Cushing’s Syndrome/Disease.
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease - Rosario Ferrigno et al.; (2021); Paediatric Cushing’s disease: Epidemiology pathogenesis clinical management and outcome.
https://link.springer.com/article/10.1007/s11154-021-09626-4 - Cushing’s Syndrome.
https://www.peacehealth.org/medical-topics/id/hw71646 - Is there a cure for Cushing syndrome?
https://www.nichd.nih.gov/health/topics/cushing/conditioninfo/cure# - Filipe da Mota et al.; (2011); Overt Immune Dysfunction after Cushing’s Syndrome Remission: A Consecutive Case Series and Review of the Literature.
https://academic.oup.com/jcem/article/96/10/E1670/2834802
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