Abnormal growth in a child with Cushing's disease

Growth chart of a girl diagnosed with Cushing's disease at age 11.25 years. The patient had poor height velocity since age 9.6 years, in conjunction with a 2.25-year delayed bone age (leftward arrow from height point at actual age 11.25 years), and excessive weight gain over the same time period. An ACTH-producing pituitary adenoma was discovered and removed by transsphenoidal surgery at age 11.5 years. The patient subsequently had full biochemical recovery, initially followed by a significant improvement in height velocity and a significant reduction in weight (loss of 16 pounds over 6 months). With progressive puberty, the patient's bone age delay decreased (1.25 years at actual age 12.25 years, and 0.5 years at actual age 14 years) in association with physiological height plateauing. The progressive acceleration in bone age was likely due to the effects of pubertal estrogen. The bracket at the far right of the height curve represents the mid-parental target height range (±1 SDS). As is typical in patients with childhood Cushing's disease, the mid-parental target height was not achieved^[1].