CUSHINGS SYNDROME

PREPARED BY: FUENTES, MAILA JOY P. LEVEL IV BSN II

CUSHINGS SYNDROME excessive adrenocortical activity sometimes called hypercortisolism

Cause: use of corticosteroid medications and is frequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal gland

 primary hyperplasia is less common ectopic production of ACTH bronchogenic carcinoma = most common type Signs and symptoms of Cushings syndrome are primarily a result of oversecretion of glucocorticoids and androgens although mineralocorticoid may also be affected

RISK FACTORS

rare condition common to adults Type 2 diabetes aged 20 to 50 years poorly controlled old blood glucose also obese called blood sugar women ages 20 to and high blood pressure 40 are five times more likely to develop this

SYMPTOMS

 Classic picture in the adult: central type obesity buffalo hump heavy trunk relatively thin extremities

OPHTALMIC Cataracts glaucoma CARDIOVASCULAR hypertension heart failure

ENDOCRINE truncal obesity moon face buffalo hump sodium retention hypokalemia metabolic alkalosis

hyperglycemia menstrual irregularities impotence negative nitrogen balance altered calcium metabolism adrenal

suppression IMMUNE FUNCTION decreased inflammatory responses impaired wound healing

 increased susceptibility to infections

SKELETAL osteoporosis spontaneous fractures aseptic necrosis of

femur vertebral compression fractures GI Peptic ulcer pancreatitis

MUSCULAR ecchymoses Myopathy striae muscle weakness acne PSYCHIATRIC DERMATOLOGIC mood alterations thinning of skin psychoses petechiae

 in females of all ages: o Virilization may occur o hirsutism o breasts atrophy o menses cease o Clitoris enlarges o voice deepens

COMPLICATIONS

Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet High blood pressure (hypertension) Diabetes Frequent or unusual infections Loss of muscle mass and strength

ASSESSMENT AND DIAGNOSTIC FINDINGS

 Dexamethasone suppression test increase in serum sodium and blood glucose levels decrease in serum potassium reduction in the number of eosinophils disappearance of lymphoid tissue measrements of plasma and urinary cortisols level are obtained blood samples

 24 hour urinary free cortisol level low dose dexamethasone suppression test radioimmuno assay elevation of both ACTH and cortisol a low ACTH with a high cotisol level CT scan UTZ MRI

MEDICAL MANAGEMENT

 Treatment is directed to pituitary gland transsphenoidal hypophysectomy radiation of the pituitary gland adrenalectomy temporary replacement therapy with hydrocortisone may be necessary for several months

 bilateral adrenalectomy-lifetime replacement of adrenal cortex hormones is necessary adrenal enzyme inhibitors to reduce hyperadrenalism taper the medication dosage

NURSING DIAGNOSES

 risk for injury r/t weakness risk for infection r/t altered protein metabolism and inflammation response self-care deficit r/t weakness, fatigue, muscle wasting and altered sleep patterns

 impaired skin integrity r/t edema, impaired healing, and thin and fragile skin disturbed body image r/t altered physical appearance, impaired sexual functioning and decreased activity level disturbed thought processes r/t mood swings, irritability, and depression

NURSING MANAGEMENT

 decreasing risk of injury decreasing risk of infection preparing the patient for surgery encouraging rest and activity promoting skin integrity improving body image

improving thought processes monitoring and managing complications Addisonian crisis adverse effects of adrenocortical activity promoting home and community based care