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Death in pediatric Cushing syndrome is uncommon but still occurs.
[cushing syndrome]
Cushing
syndrome
(
CS
)
in
children
is
rare
.
Delayed
diagnosis
and
treatment
of
CS
may
be
associated
with
increased
morbidity
and
,
unfortunately
,
mortality
.
We
performed
a
retrospective
review
of
all
patients
with
CS
under
the
age
of
18
Â
years
referred
to
the
National
Institutes
of
Health
(
NIH
)
from
1998
to
2013
in
order
to
describe
deceased
patients
among
cases
of
pediatric
CS
referred
to
the
National
Institutes
of
Health
(
NIH
)
.
The
deaths
of
four
children
(
three
females
and
one
male
)
,
aged
7
.
5
-
15
.
5
Â
years
(
mean
age
11
.
2
Â
years
)
with
length
of
disease
2
-
4
Â
years
,
were
recorded
among
160
(
2
.
5
Â
%
)
children
seen
at
or
referred
to
the
NIH
over
the
last
15
Â
years
.
All
died
at
different
institutions
,
prior
to
coming
to
the
NIH
(
two
)
or
after
leaving
NIH
(
two
)
.
Presenting
symptoms
included
increasing
weight
and
decreasing
height
gain
,
facial
plethora
,
dorsocervical
fat
pad
(
webbed
neck
)
,
striae
,
headache
,
vision
disturbances
,
and
depression
and
other
mood
or
behavior
changes
;
there
were
no
differences
between
how
these
patients
presented
and
the
others
in
our
cohort
.
The
causes
of
CS
in
the
deceased
patients
were
also
not
different
,
in
fact
,
they
spanned
the
entire
spectrum
of
CS
:
pituitary
disease
(
one
)
,
ectopic
corticotropin
production
(
one
)
,
and
primary
adrenal
hyperplasia
(
one
)
.
In
one
patient
,
the
cause
of
CS
could
not
be
verified
.
Three
died
of
sepsis
and
one
due
to
residual
disease
and
complications
of
the
primary
tumor
.
Conclusions
:
Despite
the
advances
in
early
diagnosis
and
treatment
of
pediatric
CS
,
a
2
.
5
Â
%
mortality
rate
was
identified
in
a
large
cohort
of
patients
with
this
condition
referred
to
an
experienced
,
tertiary
care
referral
center
(
although
these
deaths
occurred
elsewhere
)
.
Pediatricians
need
to
recognize
the
possibility
of
death
,
primarily
due
to
sepsis
,
in
a
patient
with
pediatric
CS
and
treat
accordingly
.
Diseases
Validation
Diseases presenting
"cushing syndrome"
symptom
adrenal incidentaloma
carcinoma of the gallbladder
congenital adrenal hyperplasia
cushing syndrome
This symptom has already been validated