Best test to diagnose cushing syndrome in children is: A. ACTH level B. CT scan of abdomen C. Steroid assay D. Dexamethasone suppression test
Cushing’s Syndrome in Children The incidence of endogenous Cushing’s syndrome is approximately 2 to 5 new cases per million people per year, and approximately 10% of these new cases occur in children. The most common cause of endogenous Cushing’s syndrome in children is an ACTH-secreting pituitary adenoma (accounts for approximately 75% of all cases of endogenous Cushing’s syndrome in children older than 7 years) The most common cause of Cushing’s syndrome in infants and toddlers is an adrenal tumor (adenoma, carcinoma, or bilateral hyperplasia). Bilateral nodular adrenal disease is an ACTH-independent cause of Cushing’s syndrome. Children and adolescents with bilateral nodular adrenal disease may have periodic or “cyclic” Cushing’s syndrome. Bilateral nodular adrenal disease may be associated with genetic disorders such as Carney’s complex or McCune Albright Syndrome. Symptoms & Signs of Cushing’s in Children In many children the onset of Cushing’s syndrome may be insidious. Growth failure (or deceleration) associated with weight gain is a hallmark feature of Cushing’s syndrome in children. Other sign and symptoms often seen in children and adolescents with Cushing’s syndrome include facial plethora, increased fine downy hair on the face, body and extremities, a temporal fat pad, round face, diabetes and other symptoms listed below.
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Dexamethasone suppression test
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Cushing Syndrome ▫️Cushing's syndrome is a disorder caused by prolonged exposure of the body's tissues to high levels of corticosteroids (glucocorticoids). - Corticosteroids are powerful steroid hormones produced by the adrenal glands, located above each kidney. ▫️Corticosteroid production by the adrenal glands follows a sequence of events. - The hypothalamus releases corticotropin-releasing hormone (CRH), which causes the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to produce corticosteroid. ▫️Persons with ACTH-producing pituitary tumor (Cushing's disease) may develop headaches, polyuria (increased frequency of urination) and nocturia (increased voiding of urine at night), visual problems, or galactorrhea (breasts produce milk in a woman who is not pregnant or breastfeeding an infant). ▫️New onset or worsening of high blood pressure and diabetes mellitus. ▫️Polyuria or polydipsia (increased thirst) from diabetes mellitus or diabetes insipidus ▪️Exams and Tests for Cushing's Syndrome ▫️Measurement of 24-hour cortisol levels: The amount of cortisol excreted in the urine during a 24-hour time period is measured. Values higher than three to four times the upper limit of normal are suggestive of Cushing's syndrome. ▫️Overnight 1-mg dexamethasone suppression test: For this test, 1mg of dexamethasone (exogenous corticosteroid) is administered at 11 pm, with measurement of serum cortisol the next morning at 8 am. In healthy individuals, the serum cortisol should be less than 2-3 mcg/dL. Cushing's syndrome may be excluded with a cortisol level less than 1.8 mcg/dL. ▫️The 48-hour low-dose dexamethasone suppression test ▫️Corticotropin-releasing hormone (CRH) stimulation test: This test can detect mild corticosteroid excess. It combines the 48-hour low-dose dexamethasone suppression test with CRH stimulation. ▫️Brain CT scan: In persons with pituitary adenoma, enlarged pituitary gland can be seen on brain CT scan. ▫️Abdominal CT scan: It is recommended if a primary adrenal problem is suggested by the symptoms and clinical examination. ▫️Magnetic resonance imaging (MRI) of the brain: If a pituitary source of excess ACTH is suspected, MRI of the brain is performed.
Dr. Prashant Ved6 Likes4 Answers - Login to View the image
Saw classical case today. Spot the diagnosis and discuss managenent
Dr. Shailesh Sahay9 Likes63 Answers - Login to View the image
10 yr old boy with short stature complains of difficulty in seeing the blackboard from behind and increased no. of times he's to go to the toilet during the classes.We get CT and MRI done.Kindly describe the findings,diagnosis and management.
Dr. Sonal Jain10 Likes35 Answers - Login to View the image
A 19 yr old male complaints of morbid obesity and oozing skin ulcers. patient was born to consanguineous parents and had a normal, full-term delivery in the hospital. small size of his penis. He was initially exclusively breastfed and later given cow's milk and home food. Within the first 2 months, he developed redness and scaling of the skin; he received treatment but was never completely cured. Need your comments on the case.
Dr. Yogesh Varma1 Like13 Answers - Login to View the image
40 years male patient presented with history of gtcs four hrs back. on presentation pt is conscious oriented, no neuro deficits had two episodes of vomitings in triage.
Dr. Sushil Kabadi0 Like10 Answers
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