1
|
Pomahacova R, Paterova P, Nykodymova E, Sykora J, Krsek M. Pediatric Cushing's disease: Case reports and retrospective review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:85-91. [PMID: 36504094 DOI: 10.5507/bp.2022.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties. CONCLUSIONS Pediatric CD has a number of features distinct from adult CD. Our retrospective analysis confirmed the presence of growth retardation and change in facial appearance with development of moon face as the first symptoms of CS. According to our observation, growth retardation is prior to development of moon face. The other typical symptoms frequently seen in pediatric patients are pseudo-precocious puberty in both sexes, hirsutism in pubertal girls due to excessive adrenal androgen secretion and pubertal delay. A corticotropin-releasing hormone (CRH) test and especially bilateral inferior petrosal sinus sampling for ACTH (BIPSS) contribute to confirming the diagnosis of CD and excluding ectopic ACTH syndrome in children with unvisible adenoma on pituitary magnetic resonance imaging (MRI).
Collapse
Affiliation(s)
- Renata Pomahacova
- Department of Paediatrics, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Petra Paterova
- Department of Paediatrics, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Eva Nykodymova
- Department of Paediatrics, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Josef Sykora
- Department of Paediatrics, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Michal Krsek
- Third Department of Medicine, First Faculty of Medicine in Prague, Charles University, Czech Republic
| |
Collapse
|
2
|
Mitsui Y, Iizuka Y, Tanaka T, Hara T, Masuda S, Ohnishi Y, Kanai M, Kurahashi K, Yoshida S, Kondo T, Kanezaki T, Shintani Y, Yamagami H, Yamaguchi Y, Fujinaka Y, Morimoto K, Shirakami A, Aihara KI, Fukumoto S, Abe M, Endo I. An attempt to create a treatment algorithm of central adrenal insufficiency using CRH test, DHEA-S and clinical evaluation. J Med Invest 2022; 69:287-293. [PMID: 36244782 DOI: 10.2152/jmi.69.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 µg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 µg / dL required daily replacement. Among 8 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 µg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 µg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL even in combination with baseline DHEA-S. J. Med. Invest. 69 : 287-293, August, 2022.
Collapse
Affiliation(s)
- Yukari Mitsui
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuto Iizuka
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoaki Tanaka
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyo Hara
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shiho Masuda
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yukiyo Ohnishi
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Mai Kanai
- Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kiyoe Kurahashi
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sumiko Yoshida
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Kondo
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Toshiko Kanezaki
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Yasumi Shintani
- Department of Diabetes and Endocrinology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Hiroki Yamagami
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuki Yamaguchi
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto Japan
| | - Yuichi Fujinaka
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto Japan
| | - Kana Morimoto
- Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Atsuhisa Shirakami
- Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Ken-Ichi Aihara
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seiji Fukumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology & Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Itsuro Endo
- Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| |
Collapse
|