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turnover as suppressive effect of hypercortisolemia on stratum corneum is elimi-
nated. She had rapid disappearance of plethora within a week after surgery. At
6 weeks, she had weight loss of 5 Kg, diminution of acne, and fading away of striae
suggestive of likelyhood to achieve remission. The probability of cure in the index
case is more likely as she had microadenoma, no parasellar extension, immediate
postoperative 0800h cortisol <140 nmol/L, and histopathological documentation of
adenoma, though prolonged follow-up is required to recognize recurrence at the
earliest as the disease can resurge at any time and a prolonged remission phase
(>10 years) predicts long-term cure.
5.3 Clinical Rounds
- What is the most common cause of Cushing ’ s syndrome in children?
As in adults, the most common cause of Cushing’s syndrome (CS) in children
is the use of exogenous glucocorticoids. A detailed history of glucocorticoid
exposure (including topical and inhalational use) should be elicited in all chil-
dren presenting with Cushing’s syndrome. Eczema, bronchial asthma, and
nephrotic syndrome are common disorders during childhood for which gluco-
corticoids are often prescribed.- What are the causes of endogenous Cushing ’ s syndrome in children?
Both Cushing’s disease and adrenal disorders contribute almost equally to the
etiology of endogenous Cushing’s syndrome in children. However, adrenal
disorders are the most common cause of endogenous Cushing’s syndrome in
children <5 years of age, whereas Cushing’s disease is the commonest cause
after 5 years of age. Ectopic Cushing’s syndrome is rare in children (Figs. 4.2
and 4.3 ). The common causes of childhood Cushing’s syndrome at various ages
are listed in the table given below.4 Childhood Cushing’s Syndrome