Objective
To investigate the prevalence of kidney stones in a population of children with Cushing disease (CD) and to compare this prevalence with that of healthy children.
Study design
Clinical and biochemical data from 139 pediatric patients with CD (68 female, 71 male) were retrospectively analyzed. Computed tomography (CT) scans were reviewed for kidney stones.
Results
Of 139 patients, 27 children with CD (19.4%) had either radiographic evidence and/or a history of kidney stones. Those with kidney stones had higher urine free cortisol (p-value = 0.008) and a transsphenoidal surgery at an older age (p-value = 0.007). Average urinary calcium creatinine ratio was elevated in patients with CD (0.22 ± 0.11). The prevalence of kidney stones in children with CD was higher than in normal children (19.42% vs 1.0%, p-value <0.001).
Conclusion
Our results illustrate that kidney stones are an under-estimated complication of pediatric CD, especially when compared with the prevalence of nephrolithiasis in the general pediatric population. Long term consequences for kidney function are not known and need to be studied.
We report here a pediatric patient whose Cushing’s Disease was diagnosed late because of her cyclical presentation, presumably due to subclinical pituitary apoplexy. Starting at age 8, she presented with observable signs of Cushing’s but was not clinically assessed for Cushing’s Syndrome until the age of 15. Initial tests at age 15 were consistent with Cushing’s Disease, however, the patient presented with spontaneous remission of hypercortisolemia just a few short months later. Her cushingoid features never subsided, and at age 17, her MRI showed a partially empty sella; this finding of an empty sella contributed evidence to our suspicion of asymptomatic apoplexy, especially since the patient never reported an episode of acute headache. Pituitary apoplexy in corticotroph adenomas is very uncommon, but even more rare in microadenomas, making this case very unusual. Lost to follow-up, she was not reevaluated for Cushing’s Disease until age 25, and her laboratory tests were consistent with an adrenocorticotrophic-dependent pituitary tumor; Pituitary magnetic resonance imaging revealed a 9 mm X 6 mm X 8 mm mass projecting on the superior aspect of pituitary and abutting the wall of the right cavernous sinus. The patient had a transsphenoidal surgery to remove the microadenoma and is planned to undergo radiation therapy. To the best of our knowledge, this is the first report of subclinical apoplexy of a microadenoma in a pediatric patient with Cushing’s Disease. It brings to light the importance of long term follow up for pediatric patients presenting with clinical symptoms of Cushing’s Syndrome.
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