COVID-19 Complicating Cushing Syndrome in a Nigerian Infant: A Case Report

  • OD Babatunde
  • IJ Akinola
  • ES Okere
  • LU Ebili
  • TA Lawal
  • ES Nwizu
Keywords: Adrenal adenoma, Children, Coronavirus, COVID-19, Cushing syndrome

Abstract

Cushing syndrome (CS) is an uncommon morbidity in children. As a result of this rarity, there may be a delay in making the diagnosis or it may be missed completely resulting in progression to life-threatening complications. COVID-19 is an infectious disease that is currently the cause of a global pandemic although it affects children less commonly than adults. Our patient developed CS in early infancy which was diagnosed by elevated serum cortisol and left adrenal adenoma on abdominal magnetic resonance imaging (MRI). Unfortunately, the diagnosis of CS was missed earlier thereby delaying treatment and she also contracted the COVID-19 infection. The presence of these two medical conditions in a very young child may have resulted in a more advanced diseased state and increased chances of a poor outcome. A high index of suspicion for CS is necessary to forestall delay in commencement of appropriate treatment. Parental consent was obtained to publish this report.

References

Storr HL, Savage MO. Management of endocrine disease: Paediatric Cushing's disease. Euro J Endocrinol 2015; 173: R35-R45. https://doi.org/10.1530/EJE-15-0013

Hsu PY, Tung YC, Lee CT, Lo FS, Wu MZ, Tsai WY, et al. Cushing's disease in children: report of three cases. Pediatr Neonatol 2010; 51: 303-307. https://doi.org/10.1016/S1875-9572(10)60059-9

Cushing, H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). J Neurosurg 1964; 21: 318-347. https://doi.org/10.3171/jns.1964.21.4.0318

Stratakis CA. Cushing syndrome in paediatrics. Endocrinol Metab Clin 2012; 41: 793-803. https://doi.org/10.1016/j.ecl.2012.08.002

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Eng J Med 2020; 382: 727–733. https://doi.org/10.1056/NEJMoa2001017

Information for Pediatric Healthcare Providers. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html Accessed 25 October 2020.

Li W, Zhang B, Lu J, Liu S, Chang Z, Cao P, et al. The characteristics of household transmission of COVID-19. Clin Infect Dis 2020; 71: 1943-1946. https://doi.org/10.1093/cid/ciaa450

Surveillances V. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly 2020; 2: 113-122. Accessed 28 October 2020.

Adedeji IA, Abdu YM, Bashir MF, Adamu AS, Gwarzo GD, Yaro BS, et al. Profile of children with COVID-19 infection: a cross-sectional study from North-East Nigeria. Pan Afr Med J 2020; 35: 145. https://doi.org/10.11604/pamj.supp.2020.35.2.25350

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145: e20200702. https://doi.org/10.1542/peds.2020-0702

Gunther DF, Bourdeau I, Matyakhina L, Cassarino D, Kleiner DE, Griffin K, et al. Cyclical Cushing syndrome presenting in infancy: an early form of primary pigmented nodular adrenocortical disease, or a new entity? The J Clin Endocrinol Metab 2004; 89: 3173-3182. https://doi.org/10.1210/jc.2003-032247

Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, et al. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. The J Clin Endocrinol Metab 2008; 93: 2454-2462. https://doi.org/10.1210/jc.2007-2734

Savage MO, Besser GM. Cushing's disease in childhood. Trends Endocrinol Metab 1996; 7(6): 213-216. https://doi.org/10.1016/1043-2760(96)00089-6

Pivonello R, Ferrigno R, Isidori AM, Biller BM, Grossman AB, Colao A. COVID-19 and Cushing's syndrome: recommendations for a special population with endogenous glucocorticoid excess. The Lancet Diabetes Endocrinol 2020; 8: 654–656. https://doi.org/10.1016/S2213-8587(20)30215-1

Wood PJ, Barth JH, Freedman DB, Perry L, Sheridan B. Evidence for the low dose dexamethasone suppression test to screen for Cushing's syndrome—recommendations for a protocol for biochemistry laboratories. Ann Clin Biochem 1997; 34: 222-229. https://doi.org/10.1177/000456329703400302

Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. The J Clin Endocrinol Metab 2003; 88: 5593-5602. https://doi.org/10.1210/jc.2003-030871

Published
2021-03-03
Section
Case Report