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Cushing disease as possible cause of persistent growth failure despite growth hormone therapy in a small for

MaryKathleen Heneghan1, Ramin Alemzadeh

  • 1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA.

Pituitary
|September 23, 2009
PubMed

Insights

Growth hormone therapy in children with small for gestational age (SGA) can unmask Cushing's disease. A case study shows GH therapy revealed Cushing's in a boy with short stature, leading to diagnosis and successful treatment.

Area of Science:

  • Pediatric Endocrinology
  • Endocrinology
  • Metabolic Disorders

Background:

  • Growth hormone (GH) therapy is beneficial for children with small for gestational age (SGA) and short stature.
  • Early adrenarche, hypertension, and insulin resistance are potential complications.
  • This case highlights a rare presentation in pediatric endocrinology.

Observation:

  • An 11-year-old male with SGA and short stature developed early adrenarche, hypertension, and insulin resistance during GH therapy.
  • The patient showed poor response to GH and insulin resistance symptoms, which partially responded to metformin.
  • Persistent hypertension and elevated dehydroepiandrosterone sulfate prompted further investigation.

Findings:

  • Elevated urinary free cortisol excretion indicated hypercortisolism.
  • Inferior petrosal sinus sampling and pituitary MRI confirmed Cushing's disease.
  • Partial adenohypophysectomy normalized cortisol levels and resolved associated symptoms.

Implications:

  • Growth hormone therapy may unmask underlying Cushing's disease in susceptible children.
  • Early diagnosis and treatment of Cushing's disease are crucial in pediatric patients.
  • This case underscores the importance of vigilant monitoring for metabolic and endocrine complications during pediatric GH therapy.

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