Poor head growth as a presenting sign of a cortisol-secreting adrenal adenoma in a 2-year-old boy.

Adrenal cortical tumors are rare in children, comprising less than 0.2% of all pediatric neoplasms. There is a female predominance and bimodal age occurrence, with a peak incidence before 5 years and a second peak in the fourth and fifth decades of life. (1) Pure cortisol-secreting adrenal adenomas are even rarer, with only a few cases reported. (2,3) Cortisol is secreted by the adrenal cortex and regulated by adrenocorticotropin (ACTH). Chronic excessive cortisol exposure can suppress the immune system, increase weight gain, decrease muscle mass, increase blood pressure and blood glucose, and decrease bone density. In growing children, cortisol excess also decreases linear growth by direct effects at the growth plate and reduction in growth hormone secretion. (4) We present a 2-year-old boy with poor growth in head circumference and length who was found to have a benign cortisol-secreting adrenal adenoma.