A child develops signs of central obesity, moon face, and striae. What is the most likely underlying cause?

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Child Health Nursing (Pediatrics)

Medium

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The combination of central obesity, moon face, and striae are hallmark features of Cushing's syndrome, a condition caused by excess cortisol.
The most common cause of Cushing's syndrome in the pediatric population is iatrogenic, resulting from the prolonged administration of exogenous glucocorticoids (steroids).
These medications are frequently used to treat common childhood conditions such as severe asthma, nephrotic syndrome, and autoimmune disorders.

Option A: This option is too vague and non-specific. It does not identify an underlying pathophysiological cause for the clinical signs presented.
Option C: Adrenal hyperplasia is a cause of endogenous, ACTH-independent Cushing's syndrome. While it can occur, especially in infants and young children, it is much less common than iatrogenic Cushing's syndrome from steroid use.
Option D: A pituitary adenoma causes Cushing's disease, the most common form of endogenous Cushing's syndrome in children over 7. However, it is still significantly less common overall than exogenous (iatrogenic) causes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Cushing's Syndrome in Children as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in monitoring children on long-term steroid therapy for signs of Cushing's syndrome and other side effects like growth suppression, hypertension, and hyperglycemia.
Patient and family education is vital. Nurses must teach families about the importance of adhering to the prescribed steroid dose, the risks of abruptly stopping the medication, and which signs and symptoms to report to the healthcare provider.
What if? If the question specified the child was an infant under 1 year old and not on any medications, an adrenal tumor or hyperplasia would become a more likely cause than a pituitary adenoma.

How to Approach the Question

First, identify the clinical syndrome presented in the question stem. The triad of 'central obesity,' 'moon face,' and 'striae' points directly to Cushing's syndrome.
Next, analyze the lead-in phrase 'most likely'. This requires you to know the relative prevalence of the different causes of the identified syndrome.
Recall or deduce the different causes of Cushing's syndrome: exogenous (iatrogenic) vs. endogenous (pituitary, adrenal, ectopic).
Compare the options. Recognize that exogenous steroid use is the most common overall cause of Cushing's syndrome in children, making it the 'most likely' answer.
Eliminate the other options by understanding their place in the differential diagnosis (e.g., pituitary adenoma is the most common endogenous cause, but not the most common cause overall).

Concept Tested & Keywords

Concept Tested: Etiology of Cushing's Syndrome in Children
Stem keywords: child, central obesity, moon face, striae
Lead-in keywords: most likely
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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