ATI Unit 12 Cushings Disease/Syndrome Flashcards Preview

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Flashcards in ATI Unit 12 Cushings Disease/Syndrome Deck (9):
1

What is Cushing's disease/syndrome

oversecretion of adrenal hormones by the cortex
1. can be pituitary (oversecretion of adrenocorticotropic hormone) or adrenal (oversecretion by cortex)
2. Cushing's syndrome: long-term use of glucocorticoids such as in asthma or rheumatoid arthritis

2

what hormones does the adrenal cortex produce?

1. mineralocorticoids: alodersterone, increases water and sodium reuptake and K+ and Ca+ secretion in kidney
2. glucocorticoids: cortisol, (affects metabolism like fat storage, glucose production as well as immune responses decreases macrophages and eosinophils)
3. sex hormones: androgens and estrogen

3

what are three things to advise someone with Cushing's off the bat for health promotion?

1. diet: eat high in calcium and Vitamin D, no alcohol or caffeine b/c look out for gastric bleeding = black tarry stools, coffe-ground emesis
2. infection prevention, wash hands
3. monitor weight

4

Manifestatoins of Cushing's

1. fatigue, weakness, insomnia
2. decreased immune function without inflammatory response (no infection symptoms like redness, swelling, fever)
3. bruising, petechiae, thing fragile skin
4. hypertension (Na+ H2O retention)
5. tachycardia
6. weight gain/edema
7. gastric ulcers
8. moon face
9. truncal obesity
10. fractures (osteoporosis)
11. hirsutism/acne
12. muscle wasting
13. striae (reddened lines on abdomen and thighs)
14. hyperglycemia

5

are cortisol levels elevated or depressed in Cushing's?

elevated

6

lab values of Cushing's

glucose: elevated
calcium: decreased
potassium: decreased
sodium: elevated
lymphocytes: decreased

7

what is done to measure cortisol production

dexamethasone suppression tests, cortisol will be suppressed after admin if don't have Cushing's

8

Medications for Cushing's

1. aminoglutethimide (Cytadren)
- adrenal corticosteroid inhibitor
- don't use longer than 3 months
(so think opposite, monitor hypotension and electrolyte opposite imbalances, gastric stuff)

2. ketoconazole (Nizoral)
- antifungal agent that in high doses inhibits adrenal corticosteroid synthesis
- liver toxicity, gastric effects

3. mitotane (Lysodren)
- suppresses action of adrenal cortex
- monitor for indications of schock and hepatotoxicity
- used to reduce size of tumor

4. spironolactone (Lasix)
- aldosterone antagonist
- K+-sparing
- used when bilateral adrenal hyperplasia is cause

consideration = hyperkalemia (nausea, diarrhea, muscle weakness, numbness/tingling in extremities and around mouth)

9

what are complications of cushing's disease

1. perforated GI lining/ulceration due to increase in cortisol
- look for tarry, blackk stool and coffee-ground emesis

2. risk for bone fractures/osteoporosis from hypocalcemia
- caution when ambulating
- fall risk

3. risk for infection from decreased macrophages/eosinophils
- also reduced inflammatory response
- acoid ill people and crowds

4. risk for adrenal crisis/addisonian crisis
- sudden withdrawal of meds or tumor
- hypotension, hyperkalemia, hypoglycemia, hypercalcemia, hyponatremia,