Ann Pediatr Endocrinol Metab.  2020 Dec;25(4):277-281. 10.6065/apem.2040026.013.

Cushing syndrome with acute kidney injury due to ureteral stones in a 6-year-old boy

• Song K
• Kwon A
• Suh J
• Choi HS
• Chae HW
• Kim HS

• KMID: 2510900
• DOI: http://doi.org/10.6065/apem.2040026.013

Abstract

Cushing syndrome (CS) is rare in children. The clinical presentation of CS varies according to extent and duration of glucocorticoid excess, and urolithiasis is a common complication. We report the first case of a patient with CS associated with acute kidney injury (AKI) due to urolithiasis. A 6-year-old boy presented to the Emergency Department with seizure. On physical examination, he had clinical features of CS and high blood pressure. Brain computed tomography (CT) suggested posterior reversible encephalopathy syndrome due to hypertension. On evaluation of hypertension, laboratory tests suggested adrenocortical tumor, but abdominal CT suggested pheochromocytoma. During further evaluation, his condition deteriorated with AKI due to bilateral ureteral stones, for which the patient underwent continuous renal replacement therapy in the intensive care unit. After controlling hypercortisolism with etomidate and performing ureteral stent indwelling, an adrenal mass was resected and histologically confirmed as an adrenocortical adenoma. We review the clinical manifestations, diagnosis, and management of CS associated with urolithiasis and AKI. Early recognition and careful monitoring of urolithiasis in CS patients are important to avoid severe complications of urolithiasis.

Keyword

Cushing syndrome; Adrenocortical adenoma; Urolithiasis; Acute kidney injury; Child

Figure

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  Fig. 1. (A) General appearance of the patient 10 months before admission. (B) General appearance of the patient with moon face, obesity, and hirsutism at admission.

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  Fig. 2. Abdominal computed tomography revealed a 2.7-cm-sized mass in the right adrenal gland (black arrows) in coronal (A) and transverse images (B).

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  Fig. 3. Abdominal computed tomography revealed bilateral distal ureter stones (black arrows).

Reference

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