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Cushings

SyndromePrepared by:

Aquino, Erica BiancaRivera, Annie Christine

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What is Cushings Syndrome?

A syndrome caused by anincreased production of ACTH from atumor of the adrenal cortex or of theanterior lobe of the pituitary gland, orby excessive intake of glucocorticoids.

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Risk Factors

Women ages 20-40 years old

Patients with corticosteroids

medication

Patients with Pituitary Gland Tumor

Excessive adrenocortical production

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OphthalmicGlaucomaCataract

CardiovascularHypertensionHeart failure

Endocrine/Metabolic

Trunchal obesityMoon faceBuffalo humpSodium retentionHypokalemia

VirilizationHirsutism

PsychiatricMood alterationsPsychosis

Immune FunctionDecreased inflammatory

responsesImpaired wound healingIncreased susceptibility to

infection

Skeletal

FractureOsteoporosisMuscularMyopathyMuscle weakness

DermatologicThinning of skinEcchymosesStriae

S

igns

and

S

ymp

toms

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Pathophysiolog

y

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Tumor of thePituitary gland

ExcessiveAdrenocortical

production

ExcessiveCorticosteroid

medication

Increase ACTH production

Increase secretion of hormonesfrom adrenal cortex

Increased(Glucocorticoids)

Increase Aldosterone(Mineralocorticoids)

Increase Androgen

Increaseinhibition ofinflammatoryresponse

Increasecortisol

production

Increasesodium and

water retention

Increase rate ofelimination of

Potassium

Exagerated

malecharacteristics

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Increaseinhibition ofinflammatoryresponse

Increasecortisol

production

Increasesodium and

water retention

Increase rate ofelimination of

Potassium

Exageratedmale

characteristics

Increasesusceptibilityto infection

Breakdown ofprotein and fat

EDEMA Increase bloodvessel

constriction

MOON FACE

FACIES

Increase bloodvolume

HYPERTENSIONexcessive

proteincatabolism

Increase

conversion ofamino acids to

glucose

Muscle wasting

High risk forosteoporosis

HYPERGLYCEMIA

Decreasepotassium in

the body

HYPOKALEMIA

VIRILIZATION

HIRSUTISM

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Diagnostic Procedures

Overnight Dexamethasone Suppresion Test

-A test to determine the cause of Cushingssyndrome

- I mg of Dexamethasone administered orally at

11 pm and plsama cortisol is obtained at 8 am in themorning

- False results may occur in some medicationssuch as Estrogen, Antiseizre and Rifampin

Plasma ACTH level- ACTH and cortisol level: Pituitary disease- ACTH cortisol level: Adrenal Disease

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24-hour Urinary Free Cortisol Level

CT-scan & MRI

- To localize sdrenal tissue and detecttumors

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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

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Pharmacologic Management

Adrenal Enzyme Inhibitor(Ex. Metopirone, Cytadren, Lysodren)

- To reduced hyperadrenalism byinhibiting cortisol synthesis- Administered with meals

Hydrocortisone- Post-op: temporary replacement

therapy after surgery

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Nursing Management

Establish protective environment

Encourage high protein, calcium andvitamin D foods to avoid muscle wasting and

osteoporosis

Low sodium diet

Frequently assess the patient for signs ofinfection

Encourage moderate activities to prevent

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Avoid direct application of adhesive tape tothe skin and skin care is necessary

Encourage the patient and the family toverbalize feelings and concerns

Monitor fos signs and symptoms of

Addisonian crisis