Cushing syndrome in children — branching viva

Station opening

Examiner: "Tell me the single bedside observation that frames every overweight child you suspect of Cushing syndrome, and why it matters." [1]

Strong candidate (must-hit)

• The observation is the growth chart. In a child, weight gain with a falling height velocity is Cushing until proven otherwise, because cortisol suppresses the growth-hormone axis. In simple exogenous obesity the child keeps growing, often with an advanced bone age, because over-nutrition drives growth. It matters because the growth chart separates the disease from its commonest mimic before any blood test, and missing it means treating genuine Cushing as simple obesity. [1]

Weak candidate

• "Cushing causes central obesity and a moon face." [1]