What are the symptoms of morning after the dexamethasone was PICTURES: before and after Cushing syndrome in given. Comparison children? Also, the collection of saliva at bedtime It is important to remember that not all and in the morning on several days to test people experience the exact same for cortisol may be useful. The best symptoms and that many symptoms are inpatient-screening test is measurement not specific to Cushing syndrome; but are of blood cortisol at midnight. also seen in conditions such as obesity or other endocrine or metabolic syndrome. In children, rapid weight gain accompanied How is Cushing syndrome by slowing of linear growth (height) is a treated? hallmark feature. Other clinical signs or A child suspected to have Cushing symptoms include: round face with facial syndrome must be referred to a pediatric redness (plethora), increased fine downy endocrine team that is experienced with hair on the face and body, fat pad around Cushing syndrome to confirm the the temples or at the base of the neck diagnosis and perform the testing needed (“buffalo hump”), purple stretch marks, to determine the source of the excess darkening of the skin around neck and cortisol production. Surgery is the first line skinfolds (acanthosis nigricans), and high of treatment for pituitary or adrenal slowing of growth with weight gain blood pressure. tumors, and in the hands of an typical for experienced healthcare team there is a Cushing syndrome high rate of success. 4th How is Cushing syndrome Birthday diagnosed? A good screening test for Cushing Follow-up care Early identification and treatment of syndrome in children is a 24-hour urine collection for free cortisol and creatinine. Cushing syndrome is important to The results must be adjusted for the minimize any long-term effects, child’s body size. A low-dose particularly for growth. Goals after dexamethasone test is also useful to treatment include: optimize growth and screen for Cushing syndrome. This test pubertal development, normalize body involves giving one milligram of composition, and promote psychological dexamethasone (a glucocorticoid/steroid) health and cognitive maturation. at 11PM (dose is adjusted for the child’s Behavioral and mood changes are common before and after treatment, so it weight), and measuring cortisol in the 5th blood the following morning by 9AM. The is important to reassure your child that Birthday low-dose dexamethasone test has not moodiness and fatigue are common as been validated extensively in children, but the body and brain adjust to changes in This brochure is for informational purposes results of a study at the NIH show that the cortisol levels. only. Neither The MAGIC Foundation nor the cortisol should be less than 1.8mcg/dL the contributing physician/institution assumes any liability for its content. Consult your physician for diagnosis and treatment. 1 Cushing Syndrome Contributing Medical Specialists Cushing Syndrome in Childhood M ajor in Childhood What is Cushing syndrome? Cushing syndrome occurs when the body is Meg Keil, Ph.D., CRNP exposed to excess cortisol (glucocorticoid). The most common cause of Cushing syndrome is from Maya Lodish, M.D., MPH the prolonged use of medications that are used to AAA treat medical conditions such as asthma or arthritis. spects of Cushing syndrome may be caused by M overproduction of cortisol from the adrenal glands Constantine Stratakis, due to a tumor in the pituitary or adrenal gland(s), M.D., D(med)Sci G or rarely, in other sites in the body. In young rowth children, the most common cause of Cushing MAGIC syndrome is an adrenal tumor, while in older The Foundation ® Resources: For Children’s Growth children, Cushing syndrome is more commonly due Cushing syndrome in pediatrics. Stratakis CA. to a pituitary tumor. Bilateral adrenal nodular I n Endocrinology and Metabolism Clinics of adrenal disease may also cause CS and symptoms North America , 2012, 41(4):793-803. may be periodic or ‘cyclical’. https://www.ncbi.nlm.nih.gov/pmc/articles/PM Not an illusion or magical, C3594781/ What should I do if I suspect C But the caring for children Diagnostic tests for children who are referred hildren my child may have Cushing and their families for investigation of Cushing syndrome. Batista DL, Riar J, Keil M, Stratakis CA. Pediatrics, syndrome? The MAGIC Foundation is a national * * * * 2007, 120: 575-86. Talk to your child’s pediatric healthcare provider nonprofit organization created to provide Dedicated to the growth http://pediatrics.aappublications.org/content/12 about your concerns. Ask to review your child’s 0/3/e575.long growth chart to discuss if your child is maintaining support services for the families of children and overall development afflicted with a wide variety of chronic and/or the expected growth rate. If there are concerns critical disorders, syndromes and diseases that of children Cushing syndrome in childhood: update on about your child’s growth, your child’s pediatric genetics, treatment and outcomes . Lodish M . affect a child’s growth. Some of the diagnoses healthcare provider can order tests for many Current Opinion Endocrinology, Diabetes, and conditions that may affect growth. A referral to a are quite common while others are very rare. Obesity . 2015, 22: 48-54. pediatric endocrine team may be helpful since https://www.ncbi.nlm.nih.gov/pmc/articles/PM MAGIC 4200 Cantera Dr., Suite 106 C4415092/ endocrine conditions such as a thyroid disorder Warrenville, IL 60555 also effect growth and weight. An example of a Continues and develops through membership growth chart of a child with Cushing syndrome is fees, corporate sponsorship, private donations Quality of life and other outcomes in children 630-836-8200 treated for Cushing syndrome. Keil MF. included in this pamphlet. A pediatric endocrine and fundraising. 630-836-8181 fax Journal of Clinical Endocrinology and specialist experienced with Cushing syndrome is Metabolism. 2013, 98: 2667-78. important since some of the tests require “Children have a short time to grow and a 800-3 MAGIC 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PM adjustment based in the child’s height/weight. lifetime to live with the results” ® www.magicfoundation.org C3701267/ Revised 2017 2 .