Cushing Syndrome

Question 1

Adrenal Cortex

Answer 1

• Produce life sustaining hormoneS
  — Steroid hormones
• Mineralocorticoids- a class of corticosteroids (which are a class of steroid hormones) regulate blood volume & blood pressure
• Primary mineral corticosteroid= aldosterone

Question 2

Aldosterone

Answer 2

• Regulates the balance of water and electrolytes such as sodium & potassium
• Helps control BP by maintaining salt and water balance in the body

Question 3

Other hormones produced by the Adrenal Cortex

Answer 3

• Glucocorticoids- regulate the activation of immune cells
  — Example= cortisol (natural hormone), cortisone (man-made)
• Adrenal Androgens- sex hormones
  — Example= DHEA male sex hormone
• Epinephrine & norepinephrine

Question 4

Adrenal Glands

Answer 4

• Attached to the upper portion of each kidney. Each adrenal gland is two endocrine glands with separate independent functions.
• Adrenal Medulla – Center of the gland and secretes catecholamines.
• Adrenal Cortex – function is necessary for life; the adrenocortical secretions make it possible for the body to adapt to stress of all kinds. Hormones secreted; Glucocorticoids (cortisol), mineralocorticoids (aldosterone) and sex hormones (androgens).

Question 5

Cushing’s Disease

Answer 5

• a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the pituitary gland

Question 6

Cushing’s Disease Assessment & Interventions
Disregard “this card may be wrong. Waiting on confirmation”

Answer 6

• Assess for lethargy, fatigue, GI disturbances, weight loss, hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia, hypotension, hyperpigmentation of skin.
• Monitor vital signs, I & O, daily weights, lab values (WBC, serum glucose, sodium, potassium and calcium levels)

Question 7

Cushing’s syndrome

Answer 7

• A metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or from the administration of glucocorticoids in large doses for several weeks or longer.
• If caused by pituitary tumors rather than tumors of the adrenal cortex, treatment is directed at the pituitary gland. Possible surgical removal – transsphenoidal hypophysectomy is the treatment of choice.

Question 8

Cushing Syndrome

Answer 8

• HYPERsecretion of the adrenal cortex hormone, cortisol
• Increased cortisol levels
• Cortisol increases blood glucose levels
• Commonly caused by use of corticosteroid medications
• “cushy”
• Signs & symptoms= steroid side effects

Question 9

Cushing Syndrome S/S

Answer 9

• *Classic “moon face”
• *Classic “buffalo hump”
• Central obesity (round body)
  — Men-gynecomastia (breast development)
• Thin limbs
  — Atrophy of leg & arm muscles
• Hirsutism- excessive hair growth on unexpected areas
• Thin fragile skin, ecchymosis, striae
• Irritable, depressed
• Increased sodium & water retention= hypertension
• Increased glucose levels
• Decreased potassium levels watch for hypoK
• Immunosuppressed
  — These pts have excess cortisol
  — Cortisol inhibits the effects of the immune system
  — At risk for infections!
• hypersecretion of cortisol
• Increased Na & water
• Increased BP
• Increased blood glucose
• Decreased potassium

Question 10

Cushing Syndrome Nursing Care

Answer 10

• Prevent infection, there will be slow healing of even minor cuts
• Ensure safety (decrease risk of injury) due to muscle wasting & osteoporosis & promote skin integrity (fragile skin)
• Body image disturbance
• Assure pts that most psychical changes are reversible with treatment
• Fluid restriction- observe for fluid volume overload (monitor I&Os)
• Diet: high protein, low sodium, high potassium
• Monitor glucose levels, anticipate insulin
• Sleep disturbance from altered secretion of cortisol
• Administer meds to decrease cortisol production

Question 11

Treatment of Cushing Syndrome- depends on cause

Answer 11

• If caused by too much corticosteroid medications (common cause)
  — Reduce/taper corticosteroid meds to minimum dose; alternate day therapy
• If caused by unilateral primary adrenal hypertrophy-
  — Adrenalectomy is treatment of choice
• If caused by pituitary tumor (rather than tumor of adrenal cortex), then treatment is directed at pituitary gland
  — Transsphenoidal hypophysectomy -80% success rate
  — Radiation of pituitary gland may help but control of symptoms may take up to several months to control.

Question 12

Nursing care post- adrenalectomy

Answer 12

• Flank incision painful to breath so encourage TCDB (turn, cough, deep breath)
• Monitor for infection due to increased risk of infection
• Ensure safety to decrease risk of fractures
• Symptoms of adrenal insufficiency may begin to appear 12-48hrs after surgery because of reduction of high levels of circulating adrenal hormones.
• Educate patients that it may take even up to a year or more for the body to adjust

Question 13

Nursing post-op General Care

Answer 13

• Watch for symptoms of hormone insufficiency.
• Watch for addisonian crisis
• a life-threatening condition: severe abdominal and lower back pain, severe headache, severe hypotension, tachycardia, generalized weakness and shock
• Temporary replacement therapy with hydrocortisone may be needed for several months until adrenal glands begin to respond normally to body’s needs.