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Flashcards in Cushing Syndrome Deck (26)
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1

Adrenal glands

-triangular-shaped organs, found above the kidneys

-endocrine glands that produce a variety of hormones

2

Adrenal glands are made up of...

two distinct parts:

1. adrenal cortex
2. adrenal medulla

3

adrenal cortex

secretes glucocorticoids and androgen sex steroids

4

adrenal medulla

-epi/norepi

5

Cushings Syndrome

overproduction of cortisol, evaluate cause

-endogenous (made within body)

-formation of a pituitary microadenoma

6

Addison's Dz

failure to produce enough cortisol and aldosterone

7

Cortisol

glucocorticoid hormone made from cholesterol

8

Cortisol function

-increase BS

-inhibits protein synthesis

-increases protein breakdown

-breaks down amino acids in bone collagen

-decreases inflammatory immune response

-regulates electrolytes

-lipolysis

-produces adrenal androgen

9

Cushing Syndrome: Tumor produces...

adrenocorticotropic hormone (ACTH)

-this leads to hyperplasia of the adrenal glands and the result is excess production of cortisol

10

Cushing Syndrome is induced by...

chronic exposure to excess glucocorticoids

11

Endogenous vs. Exogenous Cushing Syndrome

Endo: excessive cortisol production from an adrenal gland adenoma

Exo: cause outside of the body. Excess long term steroid use for tx of an inflammatory or autoimmune dz

12

Possible causes of Endogenous Cushing Syndrome

-Pituitary tumor (70 percent)

-Adrenal tumor (15 percent)

-other or unknown causes (15 percent)

13

adrenalectomy

surgical removal of the adrenal gland if there is a tumor

-patient will require steroid replacement therapy for life

14

24 hour urine for free cortisol

-gold standard

-over 300 mcg is diagnostic for Cushings

-low and high dexamethasone suppression test

15

MRI

detects pituitary microadenomas

16

CT

detect enlargement of adrenal glands due to hyperplasia

17

Transsphenoidal hypophysectomy

removal of pituitary adnemona via the sphenoid sinus.

18

Pre and Post op Teaching

-nasal cavity packed up to 3 days

-labs to reflect: hyperglycemia, hypernatermia, hypokalemia, hypocalcemia

-safety issues, fall risk, fractures

-anxiety and depression r/t cortisol levels

-oral care (gentle), may not use toothbrush for up to 10 days after procedure

-breathe through mouth due to nasal packing

-HOB at least 30 degrees

-LOC changes

-avoid straining with BM, coughing, and sneezing (decreases ICP)

-strict I and O's

-daily wts

-do not abruptly stop steroid

19

Possible complications

-bleeding from incision
-infection of brain
-increased ICP
-cerebral spinal fluid leak
-fluid imbalance r/t transient diabetes insipidus
-persistent HAs unrelieved by mild analgesics

20

persistent HAs unrelieved by mild analgesics may indicate....

increase in ICP

21

If pituitary gland is removed....

hormone replacement therapy for life

22

If surgery is contraindicated...

-radiation
-drug therapy

23

Drug Therapy if no sz

-Aminglutethimide
-Ketoconzole

24

Aminglutethimide

-anti steroid drug

-blocks production of steroids derived by cholesterol

25

Ketoconzole

may inhibit adrenal function

-use cautiously because these drugs are toxic levels required to decrease the synthesis of cortisol

26

Adrenalectomy Post op

-may have NG, foley, IVF

-SCDs

-HIgh dose of steroids administered

-risk of hemorrhage

-Monitor VS and Fluid/Electrolyte status

-morning urine samples for cortisol measurement to eval sx effectiveness