Management of Cushing syndrome in children and adolescents: experience of a single tertiary centre

被引：0
作者：
Maria Güemes
Philip G Murray
Caroline E Brain
Helen A Spoudeas
Catherine J Peters
Peter C Hindmarsh
Mehul T Dattani
机构：
[1] Great Ormond Street Hospital for Children,London Centre for Paediatric Endocrinology and Diabetes
[2] University College London,Section of Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, UCL Institute of Child Health
来源：
European Journal of Pediatrics | 2016年 / 175卷
关键词：
Cushing syndrome; Cushing disease; Pituitary function tests; Hormone replacement therapy;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
The diagnosis and management of paediatric Cushing syndrome (CS) is highly challenging. This study aims to characterise its presentation, diagnosis, management and outcome by a retrospective case review of 30 patients (14 females) followed at a single tertiary paediatric endocrinology centre over a 30-year period. At presentation, median age was 8.9 years (0.2–15.5) and the commonest manifestations were weight gain (23/30), hirsutism (17/30), acne (15/30) and hypertension (15/30). Growth retardation was present in 11/30. Median body mass index (BMI) was +2.1 standard deviation score (SDS) (−6.5 to +4.6). Urinary free cortisol (UFC) was abnormal in 17/18 (94 %), midnight cortisol in 27/27 (100 %) and low-dose dexamethasone suppression (LDDS) test in 20/20 (100 %). High-dose dexamethasone suppression (HDDS) test was abnormal in 6/6 (100 %) of adrenal tumours, 1/10 (10 %) of Cushing disease (CD) and 1/2 (50 %) of ectopic tumours. Bilateral inferior petrosal sinus sampling (IPSS) identified five CD cases and one ectopic tumour. All patients underwent surgery and subsequently required cortisol replacement. Final diagnoses were 16 CD, 11 adrenal disease, 2 ectopic ACTH-secreting lesions and 1 case of unidentified aetiology. One year post-diagnosis, median BMI was 0.5 SDS (−2.5 to +3.7), hypertension was present in 4/14 (28 %), and 43 % (12/30) of individuals were off hydrocortisone.
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页码：967 / 976
页数：9
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