Growth Retardation in an Adolescent Secondary to Cushing's Disease Caused by a Pituitary Microadenoma: A Case Report

Introduction and Clinical Significance: Cushing's disease is a rare but clinically consequential cause of endogenous hypercortisolism in children, most commonly resulting from ACTH-secreting pituitary microadenomas. In contrast to adults, growth deceleration accompanied by disproportionate weight gain represents the earliest and most sensitive clinical marker in pediatric cases. Sustained hypercortisolism during critical periods of somatic maturation may compromise final height, disrupt pubertal progression, and induce persistent metabolic and neurocognitive sequelae, even after biochemical remission. Early recognition and timely intervention are, therefore, essential to preserve developmental trajectories. Case Presentation: A 13-year-and-8-month-old boy was referred for evaluation of progressive linear growth impairment, markedly reduced growth velocity (0.8 cm/year; <1st percentile), and insidious weight gain over a two-year period. His height was at the 5th percentile, substantially below the mid-parental target. Biochemical assessment showed repeated elevations of 24 h urinary free cortisol and ACTH levels, consistent with ACTH-dependent hypercortisolism. Dynamic testing supported a pituitary etiology, and high-resolution MRI identified a 3 × 2 mm microadenoma. The patient underwent successful endoscopic transsphenoidal resection. Postoperatively, transient central diabetes insipidus and secondary adrenal insufficiency developed, requiring structured endocrine follow-up. Recovery of hypothalamic-pituitary-adrenal axis function was confirmed one year after surgery, allowing discontinuation of glucocorticoid replacement. Conclusions: Cushing's disease should be suspected in children presenting with growth deceleration in the context of disproportionate weight gain. Timely diagnosis and early surgical management are essential to mitigate long-term auxological and metabolic sequelae. Postoperative endocrine disturbances, particularly transient adrenal insufficiency, are frequent and require systematic follow-up with periodic functional reassessment to ensure complete endocrine recovery.