Cushings Syndrome

Prepared by: Aquino, Erica Bianca Rivera, Annie Christine

What is Cushings Syndrome? A syndrome caused by an increased production of ACTH from a tumor of the adrenal cortex or of the anterior lobe of the pituitary gland, or by excessive intake of glucocorticoids.

Risk Factors

Women ages 20-40 years old

Patients with corticosteroids medication Patients with Pituitary Gland Tumor Excessive adrenocortical production

 Ophthalmic Glaucoma Cataract Cardiovascular Hypertension Heart failure

Immune Function Decreased inflammatory responses Impaired wound healing Increased susceptibility to infection
Skeletal Fracture Osteoporosis Muscular Myopathy Muscle weakness

Signs and Symptoms

Endocrine/Metabolic Trunchal obesity Moon face Buffalo hump Sodium retention Hypokalemia Virilization Hirsutism Psychiatric Mood alterations Psychosis

Dermatologic Thinning of skin Ecchymoses Striae

Pathophysiolog y

Tumor of the Pituitary gland

Excessive Adrenocortical production

Excessive Corticosteroid medication

Increase ACTH production Increase secretion of hormones from adrenal cortex

Increased (Glucocorticoids)

Increase Aldosterone (Mineralocorticoids)

Increase Androgen

Increase inhibition of inflammatory response

Increase cortisol production

Increase sodium and water retention

Increase rate of elimination of Potassium

Exagerated male characteristics

Increase inhibition of inflammatory response

Increase cortisol production

Breakdown of protein and fat

Increase sodium and water retention

Increase rate of elimination of Potassium

Exagerated male characteristics

VIRILIZATION EDEMA Increase blood vessel constriction Decrease potassium in the body HIRSUTISM

Increase susceptibility to infection

MOON FACE FACIES Increase blood volume

HYPOKALEMIA

excessive protein catabolism

HYPERTENSION Increase conversion of amino acids to glucose

Muscle wasting High risk for osteoporosis

HYPERGLYCEMIA

Diagnostic Procedures
Overnight Dexamethasone Suppresion Test

- A test to determine the cause of Cushings syndrome - I mg of Dexamethasone administered orally at 11 pm and plsama cortisol is obtained at 8 am in the morning - False results may occur in some medications such as Estrogen, Antiseizre and Rifampin Plasma ACTH level - ACTH and cortisol level: Pituitary disease - ACTH cortisol level: Adrenal Disease

 24-hour Urinary Free Cortisol Level CT-scan & MRI - To localize sdrenal tissue and detect tumors

Medical management
Restriction

- Minimum dosage of corticosteroids Radiation Therapy of the Pituitary Gland

Removal of Adrenal Gland (Adrenalectomy)

Replacement of Adrenal Hormones Transsphenoidal hypophysectomy - removal of the pituitary gland tumors

Pharmacologic Management

Adrenal Enzyme Inhibitor (Ex. Metopirone, Cytadren, Lysodren) - To reduced hyperadrenalism by inhibiting cortisol synthesis - Administered with meals Hydrocortisone - Post-op: temporary replacement therapy after surgery

Nursing Management
Establish protective environment Encourage high protein, calcium and vitamin D foods to avoid muscle wasting and osteoporosis Low sodium diet

Frequently assess the patient for signs of infection

Encourage moderate activities to prevent

 Avoid direct application of adhesive tape to the skin and skin care is necessary Encourage the patient and the family to verbalize feelings and concerns Monitor fos signs and symptoms of Addisonian crisis