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Age Common etiology
Infancy McCune–Albright syndrome
Adrenocortical neoplasm
1–5 years of age Adrenocortical neoplasm
>5 years Cushing’s disease
Primary pigmented nodular adrenocortical disease
(PPNAD)
Is there a gender difference in the etiology of Cushing ’ s syndrome in children
as compared to adults?
In children, Cushing’s disease (CD) is more prevalent in boys during prepuber-
tal years. During adolescence, the male to female ratio is equal and in adults,
Cushing’s disease predominates in women. Both adrenocortical adenoma and
carcinoma have a female preponderance in children as well as in adults. Ectopic
Cushing’s syndrome (although rare in children) is more common in girls during
childhood; however, during adulthood it is more frequent in men.
What are the manifestations of Cushing ’ s syndrome in children?
The common presenting manifestations of childhood Cushing’s syndrome
include moon facies (100 %), weight gain (90 %), growth failure (84 %), and
delayed puberty (60 %). In addition, fatigue, hypertension, features of protein
catabolism (striae, bruise, proximal myopathy, and plethora), and hyperan-
drogenism (in girls) may also be present. The unusual features of childhood
Cushing’s syndrome include precocious puberty, gait abnormalities (slipped
capital femoral epiphyses, osteonecrosis of head of femur), and abdominal
mass (Figs. 4.4 and 4.5 ).4 Childhood Cushing’s Syndrome