Clinical manifestations and qualitative diagnosis of Cushing's syndrome in adolescence

Abstract

Objective To analyze the clinical features and qualitative diagnosis methods of Cushing's syndrome (CS) in adolescence. Methods The clinical features and laboratory findings of 50 adolescent patients with CS admitted to the Department of Endocrinology, Peking Union Medical College Hospital from January 1990 to March 2012 were analyzed retrospectively. Results The age of medical treatment was 14±4 years. Male︰female=1.00︰1.17. Thirty-six adolescent patients (72%) had CS, and it was the most common cause. The proportions of the typical clinical manifestations, supraclavicular fat pads, moon face, centripetal obesity, and buffalo hump of the adolescent patients were more than 90%. The height of 63% adolescent patients with CS was below the third percentile, but the body mass of 42% adolescent patients was higher than the 75th percentile. Hypertension, osteoporosis, glucose metabolism disorder, and hyperlipidemia were also more common. If the 1.8 μg/dl cut-off point was used, the diagnostic sensitivity of midnight serum cortisol was the highest (100%); followed by the classic low-dose dexamethasone suppression test, 24 h urine free cortisol and overnight low-dose dexamethasone suppression test, their sensitivities were 95%, 88%, and 70%, respectively. Conclusions The most common cause is CS in adolescent patients with CS. The clinical manifestations are more typical, including dumpy figure, etc. When the midnight serum cortisol cut-off point is 18.8 μg/dl, its diagnostic sensitivity is the highest. Key words: Cushing's syndrome; Adolescent; Qualitative diagnosis; Sensitivity and specificity