Paeds Vivas · endocrinology-diabetes-and-growth
Cushing syndrome in children — branching viva
Branching viva from the growth-arrest discriminator, through the three-test confirmatory work-up, the ACTH localisation fork, inferior petrosal sinus sampling, transsphenoidal surgery, and the adrenally insufficient child who has just been cured.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the outpatient clinic and on the ward. The consultant asks you to assess three children: an obese adolescent whose height has fallen off the centiles, a four-year-old with a large adrenal mass and virilisation, and a child on high-dose inhaled steroids with a moon face. The examiner releases information in stages.
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]
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