Juvenile Cushing syndrome manifested primarily by growth failure

Area of Science:

• Pediatric Endocrinology
• Growth Hormone Physiology
• Cushing Syndrome Pathophysiology

Background:

• Cushing syndrome, characterized by excessive glucocorticoid exposure, typically presents with various clinical features, including growth retardation in children.
• The precise mechanisms underlying growth failure in pediatric Cushing syndrome remain incompletely understood.

Observation:

• An 11-year-old boy presented with Cushing syndrome and severe growth retardation, yet lacked other typical clinical manifestations of the condition.
• Standard growth hormone therapy was ineffective in stimulating growth in this patient.

Findings:

• The failure of growth hormone treatment suggests peripheral tissue resistance to growth hormone action in the context of excess glucocorticoids.
• This contrasts with the expectation that impaired growth hormone secretion might be the primary cause of growth failure.

Implications:

• This case highlights that growth failure in pediatric Cushing syndrome may be mediated by growth hormone resistance, necessitating a re-evaluation of treatment strategies.
• Understanding tissue sensitivity to growth hormone is crucial for managing growth disturbances in endocrine disorders.