ESPE Abstracts

Introduction: PseudoCushing is an unusual pathology. Among adults several cases have been published, however, in paediatrics it is unusual.

Objective: Description of a PseudoCushing case from a patient admitted in a hospital and results from a study to discard secondary hypercortisolism due to stress.

Patients and methods: 13 years old patient that it is admitted in hospital due to vomits and abdominal pain. A Hypercortisolism study was performed due to the presence of cutaneous striaes.

Personal history: Ileo-caecal invagination and prophylactic appendicectomy when 2 years old. Controlled by general paediatrics due to recurrent vomits (several hospital admissions).

Physical exploration: Normal phenotype. Weight: 69 kg (p90-p97), Height: 168.1 cm (p90). Blood pressure: 117/77 mm Hg. Cutaneous striaes of unusual colour on the back. There was not other signs of Hypercortisolism. Normal growth speed. During hospital admission, no medication was provided, apart from serum therapy and paracetamol.

Prospective methodology: With the current exceptional process and the possibility that these symptoms were carried out by a stress situation, a prospective study was performed to discard hypercortisolism in acute hospital admitted patients. After the 2nd day of hospital stay tests of 1st level: 24h urinary free cortisol (UFC), Night Salivary Cortisol (NSC) (23-24H) and blood analytics at 8 AM (Glycaemia, cortisol y ACTH) were performed.

Results: COMPLEMENTARY STUDIES DONE DURING HOSPITALIZATION. Complementary explorations: Glucose: 104 mg/dL; normal biochemistry, HbA1c: 4.8 % 24hUFC: 1st sample: 464 µg/24 h; 2nd sample: 428 µg/24h. (Normal values (1-100 µg/24 h)

Blood analytics: 1st sample: Cortisol: 37,3 μg/dL (normal values: 4.5-25 µg/dl), ACTH 45 pg/mL (normal values: 5-49 pg/ml) 2nd sample: Cortisol 26,2 μg/dL, ACTH: 45 pg/mL NSC (23 h): 1st sample: 1.15 mcg/dl; 2nd sample: 0.73 mcg/dl (normal values <0.2 µgr/dl) Suppression test with Dexamethasone: ACTH: non-detectable, Cortisol: 2 mcg/dl Hypothalamus-hypophysis MRI: Normal morphology and density.

ANALYTICS AFTER 1 WEEK OF BEING RELEASED: - UFC: 22 mcg/24 hours - Night Salivary Cortisol (23h): non-detectable - Night blood Cortisol: 1 mcg/dl After the disappearance of Hypercortisoluria in several determinations hypercortisolism is discarded. After one year of the release the patient is asymptomatic.

Prospective: 5 patients have been valued and in none of them Pseudo-Cushing has been objectify.

Comments: Pseudo-Cushing is rare in paediatrics, but the acknowledgement of this entity can avoid erroneous diagnostics and treatments. Normal growth speed and weight gain can orient us towards previously mentioned diagnostic.