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- What are the differences in clinical manifestations of Cushing ’ s syndrome in
children as compared to adults?
The differences in clinical manifestations of Cushing’s syndrome in children as
compared to adults are summarized in the table given below.
ParametersCushing’s syndrome in children
(%)Cushing’s syndrome in adults
(%)
Moon facies 100 81
Weight gain 90–92 90–95
Growth failure 84 –
Hypertension 51–63 71–75
Glucose intolerance – a 75
Hirsutism 46 81
Striae 36 56
Bruise 28 62
Proximal myopathy 13 56
Plethora 46 94
Osteopenia 74 50
a Data not available
It is to be noted that the features of protein catabolism are less common in chil-
dren as compared to adults, due to relatively higher IGF1 levels in children.
How to differentiate between Cushing ’ s syndrome and exogenous obesity in
children?
Children with exogenous obesity present with rapid weight gain and sometimes
with violaceous striae, mimicking CS. The presence of growth failure in an
obese child is highly suggestive of Cushing’s syndrome. On the contrary, chil-
dren with exogenous obesity commonly have normal to increased height (or
growth velocity) because of increased IGF1 generation due to hyperinsu-
linemia. Height SDS and BMI SDS are increased in children with exogenous
obesity, whereas in children with CS, BMI SDS is increased and height SDS is
reduced. In addition, striae are usually thin (<1 cm) in children with exogenous
obesity, whereas wide (>1 cm) purplish striae are characteristic of CS. Other
features of protein catabolism, if present, can also help in the diagnosis of
childhood CS.
Why is there growth failure in children with Cushing ’ s syndrome?
The impaired growth in children with CS is attributed to cortisol-mediated inhi-
bition of GHRH–GH axis, decreased pre-chondrocyte to chondrocyte differen-
tiation, chondrocyte apoptosis, impaired local IGF1 generation and action, and4 Childhood Cushing’s Syndrome