Clinical features: typical signs and symptoms of Cushing’s syndrome, including full-moon face, buffy back, polycythemia, purple striae, hirsutism, hypertension, and centripetal obesity; secondary manifestations are primary amenorrhea or hypogonadism and developmental delay. Cushing’s disease in children is easily misdiagnosed, with decreased levels of free insulin-like growth factor (IGF-1) and/or direct negative feedback from cortisol on the growth cycle resulting in a significant period of developmental delay, with the child often being suspected of dwarfism or being seen for short stature alone. As the disease progresses, it manifests as a disorder of glucose metabolism (but diabetes is not common). Excess androgens in the body can cause acne and hirsutism, or precocious puberty in children under 10 years of age. Cushing’s disease in children can present with neuropsychiatric symptoms that are distinct from those of adults, often manifesting as obsessive-compulsive disorder or extreme expressiveness at school. Differential diagnosis: Cushing’s disease in children needs to be differentiated from adrenal tumors, ectopic ACTH-secreting tumors (rare in children), and ectopic CRH-secreting tumors. Diagnosis: For patients with suspected childhood Cushing’s disease, the standard diagnostic procedures include blood cortisol rhythm and ACTH, measurement of 24-hour urinary free cortisol, major and minor dexamethasone suppression tests, and pterionic saddle enhancement or dynamic enhancement MRI. because ACTH-secreting pituitary adenomas are mostly microadenomas, sometimes even high-resolution MRI fails to detect the tumor, and the diagnosis of the disease then relies on clinical and The diagnosis of the disease depends on clinical and endocrine examination. Treatment: Transsphenoidal pituitary adenomectomy is the treatment of choice for Cushing’s disease in children, with a postoperative cure rate of 60%. Successful surgery is usually followed by adrenal hypofunction, and patients require glucocorticoid replacement therapy for six months to one year. As the cortisol levels normalize, the child will develop normally. Generally, after cure the child will be lower in height than children of the same age, with a few reaching the level of children of the same age.