ATI Unit 12 Cushings Disease/Syndrome Flashcards Preview

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

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


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


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


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


are cortisol levels elevated or depressed in Cushing's?



lab values of Cushing's

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


what is done to measure cortisol production

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


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)


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,