title: Factors influencing skeletal maturation at diagnosis of paediatric Cushing's disease.
abstract: OBJECTIVE
  Growth retardation is a recognised complication of paediatric Cushing's disease (CD), but there are few published data on skeletal maturation at diagnosis. We assessed factors contributing to skeletal maturation in patients with paediatric CD.
  
  
  METHODS
  17 patients, 12 males, 5 females (median age 12.1 years, range 5.8-17.4) were studied. The bone age (BA) of each child was determined by a single observer using the TW3 RUS method. BA delay, i.e. the difference between chronological age (CA) and BA, was compared with clinical and biochemical variables.
  
  
  RESULTS
  BA delay was present in 15/17 patients (mean delay 2.0 years, range -0.5 to 4.1 years) and correlated negatively with height SDS (r = -0.70, p < 0.01) and positively with duration of symptoms (r = 0.48, p = 0.05) and CA (r = 0.48, p = 0.05). No relationships were found with midnight cortisol, ACTH, DHEA-S or cortisol suppression during the low-dose dexamethasone suppression test.
  
  
  CONCLUSIONS
  BA in most children with CD was delayed and related to length of symptoms and height SDS at diagnosis. Early diagnosis will reduce delay in skeletal maturation and thus contribute to optimal catch-up growth.
authors: Department of Paediatric, The Royal London Hospital, London, UK.
authors: C J
authors: CJ
authors: Peters
authors: M L
authors: ML
authors: Ahmed
authors: H L
authors: HL
authors: Storr
authors: K M
authors: KM
authors: Davies
authors: L J
authors: LJ
authors: Martin
authors: J
authors: J
authors: Allgrove
authors: A B
authors: AB
authors: Grossman
authors: M O
authors: MO
authors: Savage
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton; D001827:Body Height; D001846:Bone Development / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D012307:Risk Factors