Cushing’s syndrome is a rare condition in the paediatric population, characterized by the body having too much of the hormone cortisol for a prolonged period. While the condition is far more common in adults, it can affect children of any age, from infants to adolescents. In children, the hormonal imbalance often presents differently than in adults, primarily because cortisol has a profound impact on the processes of growth and physical development. Identifying the syndrome in younger patients requires a high level of clinical awareness, as the early signs can sometimes be mistaken for simple childhood obesity or delayed puberty. Early diagnosis is essential to prevent permanent impacts on a child’s final height and overall metabolic health.
What We’ll Discuss in This Article
- The prevalence and primary causes of Cushing’s syndrome in children.
- How symptoms of cortisol excess differ between infants, children, and adults.
- The specific impact of high cortisol on a child’s growth and bone age.
- Changes in weight and body composition across different age groups.
- The effect of the syndrome on the timing and progression of puberty.
- Frequently asked questions regarding the diagnosis of children with the condition.
Prevalence and Primary Causes in Children
In the United Kingdom, Cushing’s syndrome in children is much rarer than in the adult population. The most frequent cause for paediatric patients is the use of corticosteroid medications for chronic conditions such as severe asthma, juvenile arthritis, or skin disorders like eczema. This is known as exogenous Cushing’s syndrome. When the cause is internal (endogenous), it is typically due to a tumour in the pituitary gland, which is referred to as Cushing’s disease. In very young children, particularly those under the age of five, the condition is more likely to be caused by a tumour in the adrenal glands.
According to data from the NHS clinical overview of Cushing’s syndrome, the incidence of the condition increases as children move into adolescence, with Cushing’s disease becoming more common in teenagers. Unlike adults, where the condition is significantly more prevalent in women, the gender distribution in children is nearly equal until the onset of puberty. Identifying the source of the excess hormone is the first priority for UK paediatric endocrinologists, as the treatment for a pituitary tumour differs significantly from the management of medication induced symptoms.
Growth Failure: The Key Paediatric Symptom
The most distinctive difference between adult and childhood Cushing’s syndrome is the impact on height. In adults, the primary symptom is often rapid weight gain. In children, however, the hallmark sign is a combination of weight gain and a significant slowing or stopping of physical growth. Cortisol is a catabolic hormone, meaning that at high levels, it inhibits the production of growth hormone and interferes with the growth plates in the bones.
A child with Cushing’s syndrome will typically deviate from their established growth curve on a height chart. While they are gaining weight, their height remains stagnant, which leads to a decrease in their height velocity. This “flattening” of the growth curve is often the most reliable indicator that the weight gain is hormonal rather than nutritional. In many cases, if the condition is treated early enough, a child may experience “catch up” growth, though prolonged exposure to high cortisol can lead to a permanently shorter stature.
Body Composition Changes Across Ages
While both children and adults experience central obesity, where fat is stored in the torso and abdomen, the appearance can vary slightly by age. In infants and very young children, the weight gain is often more generalized, making the child appear “puffy” or rounded all over. As children grow older, the fat redistribution becomes more characteristic of the adult form, with the development of a “moon face” (rounded facial features) and a “buffalo hump” (a pad of fat between the shoulder blades).
| Age Group | Primary Growth Impact | Typical Fat Distribution |
| Infants | Failure to thrive | Generalized puffiness |
| Young Children | Significant slowing of height | Central obesity, moon face |
| Adolescents | Growth plate closure | Adult-like central obesity, purple striae |
| Adults | No impact on height | Torso weight gain, thin limbs |
Adolescents are also more likely to develop the wide, purple stretch marks (striae) on the abdomen and thighs that are common in adults. This happens because the skin in older children and teenagers is under more tension from rapid fat accumulation. In all age groups, the combination of a rounder face and thin arms and legs remains a highly suggestive sign of adrenal hormone imbalance.
Bone Health and Physical Strength
High levels of cortisol are detrimental to bone health at any age, but the risk is particularly high for children whose skeletons are still developing. Cortisol reduces the absorption of calcium in the gut and inhibits the cells responsible for building new bone. This can lead to a reduction in bone mineral density, making children more prone to fractures from minor falls or activities.
Muscle weakness is another common symptom that affects children’s daily lives. Like adults, children with Cushing’s syndrome often experience proximal muscle weakness, particularly in the hips and shoulders. A child may find it difficult to keep up with their peers during physical education or may struggle to climb onto a school bus or stand up from the floor. This weakness, combined with the weight gain, can significantly impact a child’s mobility and confidence, often leading to a more sedentary lifestyle that further complicates the metabolic issues.
Diagnostic Challenges in Younger Patients
Diagnosing Cushing’s syndrome in children can be challenging because the standard tests used for adults, such as the 24 hour urine collection, can be difficult to perform accurately in younger children. UK specialists often use late night salivary cortisol tests or specialized blood tests that measure the body’s response to a synthetic steroid (the dexamethasone suppression test). These tests must be interpreted carefully by a paediatric endocrinologist who is familiar with how hormone levels change as a child grows.
Imaging also plays a vital role. If blood tests confirm high cortisol, an MRI of the brain is used to look for a pituitary tumour, or a CT scan of the abdomen is used to check the adrenal glands. Because tumours in children are often very small, these scans require high resolution and expert interpretation. Once the source is found, the medical team works to restore the child’s hormone balance as quickly as possible to minimize the long term impact on their growth and bone health.
Conclusion
Cushing’s syndrome is a rare but impactful condition in children that primarily affects growth velocity, body weight, and the timing of puberty. While the core symptom of high cortisol is consistent across all ages, the stalling of physical height is the most critical diagnostic clue in younger patients. From infancy through to adolescence, the condition requires a specialized approach to ensure that the hormonal imbalance does not cause permanent damage to the developing skeleton or metabolic system. With timely diagnosis and targeted treatment, many children can return to their natural growth patterns and lead healthy lives. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Is it normal for children on steroid inhalers to get Cushing’s?
At standard doses, it is very rare for inhalers to cause the syndrome, but high doses used for severe asthma over a long period should be monitored.
Will my child grow to their full height after treatment?
If the condition is caught and treated early, many children experience a period of catch up growth, though some may remain shorter than they otherwise would have been.
Can children have the same “moon face” as adults?
Yes, the rounded, full appearance of the face is a very common sign in children with cortisol excess.
How do I know if my child’s weight gain is just “puppy fat”?
Weight gain from diet usually comes with a corresponding increase in height, whereas weight gain from Cushing’s is usually accompanied by a slowing of height.
Is Cushing’s syndrome in children always caused by a tumour?
No, it is most frequently caused by long term steroid medication, but when it occurs naturally, a tumour is the most likely source.
Can the syndrome cause learning difficulties in children?
High cortisol can cause “brain fog,” memory issues, and irritability, which may temporarily affect a child’s performance and concentration at school.
Do teenagers get more purple stretch marks than younger children?
Yes, adolescents are more prone to these striae as their skin undergoes rapid changes during the growth spurts and fat redistribution associated with the syndrome.
Authority Snapshot (E-E-A-T Block)
This article provides medically reviewed information regarding the manifestation of cortisol excess in children and the specific developmental impacts of the condition. The content has been written by Dr Rebecca Fernandez and reviewed by Dr Stefan, physicians with extensive experience in the UK healthcare system specializing in internal medicine and paediatric care. All information is strictly grounded in the latest clinical guidelines provided by the NHS and NICE to ensure maximum accuracy and safety.
