Overactive Adrenal Glands / Cushing's Syndrome in Children

What are overactive adrenal glands?

When adrenal glands produce excessive amounts of certain hormones, they are called overactive. Symptoms and treatment depend on which hormones are being overproduced, including the following:

  • Androgenic steroids (androgen hormones). An overproduction of androgenic steroids, such as testosterone, can lead to exaggerated male characteristics in both men and women, such as excess hair on the face and body, baldness, acne, deeper voice, and increased muscle mass. If a female fetus is exposed to high levels of androgens early in pregnancy, her genitals may develop abnormally. Young boys who experience high levels of androgen levels may grow faster, but bones may also mature faster and stop growing too soon, resulting in short height.

  • Corticosteroids. An overproduction of corticosteroids can lead to Cushing's syndrome (see below).

  • Aldosterone. An overproduction of the aldosterone hormone can lead to high blood pressure and to symptoms associated with low levels of potassium (for example, weakness, muscle aches, spasms, and, sometimes, paralysis).

The symptoms of overactive adrenal glands may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How are overactive adrenal glands diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for overactive adrenal glands may include:

  • Specific blood tests. Blood tests measure levels of hormones.

  • Urine tests. Urine tests measure levels of hormones.

Treatment of overactive adrenal glands

Treatment of overactive adrenal glands depends on the cause of the disease. Specific treatment for overactive adrenal glands will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include surgical removal of growths on the adrenal gland(s), or the adrenal gland(s) itself. Medications that block the excessive production of certain hormones may also be administered.

What is Cushing's syndrome?

Cushing's syndrome results from hypersecretion of corticosteroids by the adrenal cortex. An overproduction of corticotropin, the pituitary hormone that controls the adrenal gland, by the pituitary gland, which stimulates the adrenal glands to produce corticosteroids, may be one cause. In addition, certain lung cancers and other tumors outside the pituitary gland may produce corticotropin. Other causes include benign (noncancerous) or cancerous tumors on the adrenal glands. Cushing's syndrome is extremely rare in children and also rare in adults.

What are the symptoms of Cushing's syndrome?

The following are the most common symptoms of Cushing's syndrome. However, each child may experience symptoms differently. Children and adolescents with Cushing's syndrome primarily experience weight gain, slow growth, and hypertension (high blood pressure). Symptoms may include:

  • Slow growth

  • Upper body obesity

  • Round or moon-shaped face

  • Increased fat around neck

  • Thinning arms and legs

  • Fragile and thin skin

  • Darkened pigmentation of the skin

  • Acne

  • Bruising

  • Stretch marks on abdomen, thighs, buttocks, arms, and breasts

  • Bone and muscle weakness

  • Severe fatigue

  • High blood sugar

  • Irritability and anxiety

  • Excessive hair growth in females

  • Irregular or stopped menstrual cycles in females

  • Reduced sex drive and fertility in males

The symptoms of Cushing's syndrome may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is Cushing's syndrome diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Cushing's syndrome may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • 24-hour urinary test. Urine is collected over a 24-hour period to measure for corticosteroid hormones.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Dexamethasone suppression test. This test differentiates whether the excess production of corticotropins is from the pituitary gland or tumors elsewhere.

  • Corticotropin-releasing hormone (CRH) stimulation test. This test differentiates whether the cause is a pituitary tumor or an adrenal tumor.

Treatment for Cushing's syndrome

Specific treatment for Cushing's syndrome will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • The extent of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove tumors of the adrenal glands.