Final adult height and body mass index after cure of paediatric Cushing's disease.
OBJECTIVE
Linear growth data after cure of paediatric Cushing's disease (CD) have been reported infrequently. We evaluated final adult height (FH) and body mass index (BMI) in a cohort of paediatric patients treated successfully for CD.


METHODS
Fourteen patients (10 male, age range 6.4-16.6 years) fulfilled the diagnostic criteria for CD. All had had transsphenoidal surgery (TSS), combined with pituitary irradiation (RT) (45 Gy in 25 fractions) in six. All were cured (post-TSS cortisol < 50 nmol/l or mean cortisol post-RT < 150 nmol/l). Subjects analysed had bone ages at diagnosis of < 15 'years' (male) and < 13 'years' (female).


RESULTS
At diagnosis, height SDS was [mean (range)]-2.5 (-4.2 to -0.8) and body mass index (BMI) SDS +2.7 (0.8-5.1). Following cure, 13 patients had GH deficiency (peak GH < 20 mU/l) and were treated with hGH (+ GnRH analogue in four). Height SDS at FH (n = 10) or latest assessment (n = 4) was -1.3 (-3.9-0.2) and increased compared to diagnosis (P < 0.01). The difference between final or latest height SDS and target height SDS was -1.2 (-3.3-0.5), that is less (P < 0.01) than the difference between the height SDS at diagnosis and target height SDS of -2.4 (-3.9 to -0.5). At final height or latest assessment, BMI SDS was +1.7 (0.4-6.2), being decreased compared to diagnosis (P < 0.05) but greater than the normal population (P < 0.01).


CONCLUSIONS
Catch-up growth was demonstrated in paediatric patients cured from CD, with the majority achieving FH within target height range. Early diagnosis and treatment of GH deficiency is recommended to achieve optimal long-term growth. Excess adiposity remains a potential long-term complication.
Davies
J H
JH
Department of Endocrinology, Barts and the Royal London School of Medicine and Dentistry, London EC1A 7BE, UK.
Storr
H L
HL
Davies
K
K
Monson
J P
JP
Besser
G M
GM
Afshar
F
F
Plowman
P N
PN
Grossman
A B
AB
Savage
M O
MO
D000293:Adolescent; D001827:Body Height; D015992:Body Mass Index; D002648:Child; D003480:Cushing Syndrome / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D017273:Goserelin / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010902:Pituitary Gland / Q000601:surgery*; D010910:Pituitary Irradiation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D017273:Goserelin; D019382:Human Growth Hormone; D007987:Gonadotropin-Releasing Hormone