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Lessons from iatrogenic Cushing syndrome in children

Several challenges arise when considering paediatric use of longstanding corticosteroids in addition to universal problems associated with steroid withdrawal, including relapse of the underlying chronic condition, ongoing suppression of the hypothalamic pituitary axis (HPA), delayed or slow recovery from adrenal insufficiency and psychologic effects of corticosteroid withdrawal, including depression and psychosis Children have additional issues to address, including suppression of growth leading to short stature and reduced final height potential and possible arrest or failure of pubertal onset or progress. Bone health is a particular problem, with failure of accrual of optimal adult bone mass.