Cushing disease in pediatrics: an update

Area of Science:

• Pediatric Endocrinology
• Neuroendocrinology
• Oncology

Background:

• Cushing disease (CD) is a primary cause of endogenous Cushing syndrome (CS), driven by ACTH-producing pituitary adenomas.
• In pediatric patients, CD significantly impacts growth and development due to hypercortisolism.
• Key childhood CS symptoms include weight gain, facial changes, hirsutism, virilization, and acne.

Purpose of the Study:

• To provide a comprehensive overview of Cushing disease in the pediatric population.
• To summarize current knowledge on the pathophysiology, diagnosis, and treatment of pediatric CD.
• To highlight the challenges and importance of early management in children.

Main Methods:

• This narrative review synthesizes existing literature on pediatric Cushing disease.
• It covers diagnostic criteria, including biochemical tests and pathological confirmation.
• Treatment modalities such as surgery, medication, and radiotherapy are discussed.

Main Results:

• Diagnostic confirmation relies on establishing endogenous hypercortisolism and ACTH dependence, followed by pathology.
• Treatment aims to normalize cortisol levels and alleviate clinical signs and symptoms.
• Management strategies encompass surgical, medical, radiotherapeutic, or combined approaches.

Conclusions:

• Cushing disease in children presents unique challenges due to its effects on growth and pubertal development.
• Early diagnosis and intervention are essential for controlling hypercortisolism and optimizing prognosis.
• The rarity of pediatric CD necessitates increased physician experience and awareness for effective management.