Paeds Cases · endocrinology-diabetes-and-growth
Cushing syndrome in children — structured clinical encounter
Structured encounter testing the approach to an obese adolescent whose height has fallen off the centiles: the growth-arrest discriminator, the three-test confirmatory work-up, the ACTH localisation fork, transsphenoidal surgery, and the perioperative glucocorticoid replacement that prevents adrenal crisis.
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Station brief (candidate)
You are the paediatric registrar. A 13-year-old girl presents with eight months of weight gain, a round face, purple abdominal striae and fatigue, plus worsening mood and falling school marks. Her weight has risen beyond the 95th centile while her height has crossed from the 50th to the 10th, and her blood pressure is 142 over 90. The team asks you to make the diagnosis, arrange the investigations, plan the treatment, and speak with the family. You have 12 minutes with the team and 5 minutes for examiner discussion. [1]
References6ShowHide
- [1]Magiakou MA; Mastorakos G; Oldfield EH; et al Cushing's syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med, 1994.PMID 8052272
- [3]Nieman LK; Biller BM; Findling JW; et al The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2008.PMID 18334580
- [4]Nieman LK; Biller BM; Findling JW; et al Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2015.PMID 26222757
- [5]Lacroix A; Feelders RA; Stratakis CA; Nieman LK Cushing's syndrome. Lancet, 2015.PMID 26004339
- [6]Kanter AS; Diallo AO; Jane JA Jr; et al Single-center experience with pediatric Cushing's disease. J Neurosurg, 2005.PMID 16302612
- [9]Ferrigno R; Hasenmajer V; Caiulo S; et al Paediatric Cushing's disease: Epidemiology, pathogenesis, clinical management and outcome. Rev Endocr Metab Disord, 2021.PMID 33515368