If a clinician suspects Cushing syndrome in a child with obesity, what is the recommended action?

• A. Refer to a pediatric endocrinologist.
• B. Wait and see.
• C. Start dieting.
• D. Annual check-up.

Answer: (A)

When Cushing syndrome is suspected in a child who has obesity, specialized evaluation is needed rather than generic management. This condition is rare but important to diagnose early because it can cause rapid weight gain, growth slowing, high blood pressure, glucose intolerance, and bone health issues, and its signs can overlap with ordinary obesity. A pediatric endocrinologist has the expertise to perform the appropriate screening and to interpret results in the context of a growing child and obesity. They will coordinate tests such as late-night cortisol or diurnal cortisol measurements, dexamethasone suppression testing, and 24-hour urinary free cortisol, and determine whether imaging or further workup is necessary. They can distinguish true Cushing syndrome from other causes of weight gain and, if confirmed, guide the specific treatment approach for the underlying source, while also managing related metabolic and growth concerns.

Delaying evaluation by waiting, starting a diet, or relying on routine annual check-ups does not address the potential seriousness of the condition and could miss timely diagnosis and treatment.