Successful treatment of Cushing's disease in a pediatric patient with Gamma Knife radiosurgery: a case report.

Introduction: Cushing's disease in young-onset cases is a rare and diagnostically challenging endocrinopathy, most commonly caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma. Early recognition and management are crucial to preventing long-term complications associated with hypercortisolism. This report highlights the case of a pediatric patient with Cushing's disease, emphasizing diagnostic challenges and treatment considerations. Case presentation: We present the case of a 14-year-old male from Kashmore with a 4-year history of progressive truncal obesity, growth failure, and episodic headaches. Clinical evaluation revealed hallmark cushingoid features, including moon facies, dorsocervical and supraclavicular fat accumulation, acanthosis nigricans, and hypertension. A hormonal assessment confirmed hypercortisolism, and magnetic resonance imaging (MRI) revealed a 0.9 cm pituitary microadenoma. Clinical discussion: Cushing's disease in pediatric patients presents unique diagnostic and therapeutic challenges due to its rarity and insidious onset. First-line treatment for pituitary-dependent Cushing's disease is transsphenoidal surgery; however, in cases where surgery is declined or contraindicated, alternative therapies such as medical management and radiosurgery become viable options. In this case, Gamma Knife radiosurgery (GKRS) led to significant clinical improvements, including weight loss and biochemical remission. However, the patient later developed adrenal insufficiency, necessitating immediate steroid therapy, a known risk associated with successful treatment of hypercortisolism. Conclusion: GKRS has proven to be an effective treatment for Cushing's disease in younger individuals, both as a standalone therapy and as an adjunct to other interventions. This case underscores the importance of individualized treatment approaches and close post-treatment monitoring for potential complications such as adrenal insufficiency.