What Is Cushing Syndrome?

Cortisol is an essential hormone produced by the adrenal glands.

As we discussed earlier in this series, cortisol helps the body:

We cannot live without cortisol.

But too much cortisol for too long can also cause problems.

Cushing syndrome refers to the collection of signs and symptoms that develop when the body is exposed to excessive amounts of cortisol.

In children, it is rare—but recognising it is important because prolonged cortisol excess can significantly affect growth, puberty, bones, blood pressure, and metabolism.

Where Does the Excess Cortisol Come From?

There are several possible causes.

1. Steroid Medications

This is the most common cause of Cushing syndrome in children.

Corticosteroids such as:

are extremely useful medicines.

They may be used to treat:

When used appropriately, these medications can be life-saving.

However, prolonged exposure to high doses can produce features of cortisol excess.

Steroids can also be present in some inhaled, topical, injected or other preparations, so doctors consider the child's total steroid exposure, not simply tablets.

Importantly, steroid treatment should never be stopped suddenly after prolonged use without medical advice, because the body's own cortisol production may have become suppressed.

What If the Child Isn't Taking Steroids?

Cushing syndrome occurring naturally within the body is much rarer.

The problem can arise at different levels of the hormonal system.

The Pituitary Gland

A small pituitary tumour can produce excessive amounts of ACTH.

ACTH then stimulates the adrenal glands to produce too much cortisol.

When Cushing syndrome specifically results from an ACTH-producing pituitary tumour, it is called Cushing disease.

This is an important distinction:

The Adrenal Glands

Occasionally, an adrenal tumour or other adrenal abnormality can produce cortisol independently.

In this situation, the adrenal gland itself is responsible for the cortisol excess.

Other Sources of ACTH

Very rarely, ACTH can be produced by tumours elsewhere in the body.

This is uncommon in children.

The Biggest Clue in Children: Look at Growth

This is one of the most important messages for parents.

Children with simple obesity usually continue to grow normally in height.

Children with Cushing syndrome often do something different:

They gain weight while their height growth slows down.

A child may previously have been following the 50th percentile for height and then gradually fall toward lower percentiles while continuing to gain weight.

The change can be subtle.

Parents may notice clothes becoming tighter around the waist—but trousers are not becoming shorter as quickly as expected.

This is why a child's growth chart can sometimes reveal a hormonal disorder before a single blood test is performed.

One measurement tells us where a child is today.

Repeated measurements tell us the direction in which the child is moving.

What Other Symptoms Can Occur?

Cortisol affects many organs, so Cushing syndrome can present in several ways.

Children may develop:

Not every child will have all of these features.

Are Stretch Marks Important?

Stretch marks are common during adolescence, particularly during periods of rapid growth or weight gain.

So their presence alone does not indicate Cushing syndrome.

However, the stretch marks associated with significant cortisol excess may be:

Doctors interpret these together with the child's growth pattern and other clinical findings.

Why Does Cortisol Slow Growth?

Excess cortisol interferes with several processes needed for normal childhood growth.

It can affect:

The result is reduced linear growth.

This is why measuring height accurately over time is so valuable.

A child's height velocity—the number of centimetres grown each year—can provide important information about whether growth is progressing normally.

What Happens to the Bones?

Prolonged cortisol excess can reduce bone formation and decrease bone strength.

Children may develop:

This is particularly important during childhood and adolescence because these are critical years for building bone mass.

Can Cushing Syndrome Affect Puberty?

Yes.

Excess cortisol can interfere with the hormones responsible for puberty.

Depending on the child's age, this may result in:

Some adrenal conditions can also produce other hormones alongside cortisol, creating a more complex pattern of symptoms.

How Is Cushing Syndrome Diagnosed?

Diagnosing Cushing syndrome is more complicated than simply measuring a random cortisol level.

Cortisol naturally changes throughout the day and increases during stress and illness.

Doctors therefore use specialised tests designed to determine whether the body's normal cortisol regulation has been disrupted.

These may include:

If cortisol excess is confirmed, further tests help determine where it is coming from.

These may include:

The exact investigation depends on the child's clinical presentation.

Can Cushing Syndrome Be Treated?

Yes.

Treatment depends entirely on the cause.

If steroid medication is responsible, doctors may carefully adjust or gradually reduce treatment when medically appropriate.

If an adrenal or pituitary tumour is responsible, treatment may involve:

Children require close follow-up because the body may take time to recover after prolonged exposure to excess cortisol.

Will Growth Recover After Treatment?

Many children experience catch-up growth once cortisol excess is successfully treated.

However, the amount of recovery depends on factors such as:

This is another reason why early recognition matters.

The Growth Chart Tells a Story

Perhaps the most important lesson from Cushing syndrome is not about cortisol at all.

It is about the value of tracking growth over time.

A single height measurement may appear perfectly normal.

But if a child's height percentile has been steadily falling while their weight percentile has been increasing, that pattern tells us something very different.

For parents, keeping accurate records of height and weight can help identify these changes earlier.

When Should Parents Seek Medical Advice?

Consider discussing your child's growth with a healthcare professional if you notice:

These symptoms do not automatically mean that a child has Cushing syndrome.

The condition is rare.

But an unusual growth pattern deserves evaluation.