Modifiable
Non-modifiable
Age: 20-50 years Sex: female (much more common in women)
Chronic use of corticosteroid medicines Pituitary micro adenoma Tumor in the adrenal Multiple endocrine neoplasia type 1 Ectopic ACTH secreting tumore Irregular sleep pattern Asthma Rheumatoid arthritis Depression, alcoholism, and malnutrition Trained athletes
Growth of ACTH secreting tumor
Synthesis and increase secretions of ACTH
ACTH stimulate adrenal cortex to secrete cortisol
Synthesis and secretion of cortisol
Increase cortisol level
Suppression of CR and ACTH secretion
Low level of ACTH
Atrophy of remaining adrenal cortex
Alteration of cortisol secreting activity
Prolonged and excessive cortisol level
CUSHING SYNDROME
Surgical /Medical Management Stereotactic radio surgery Transphenoidal adenomectomy Removal of piyuitary gland Radiation chemotheraphy gradual discontinuance of corticosteroids
Medications Ketoconazole Aminoglutethimide Mitotane Metyrapone Cortisol-inhibiting drugs Potassium supplement Hydrocortisone
Diagnostic test -Serum cortisol levels -Salivary cortisol levels -Dexamethasone suppression test -24-hour urine for cortisol and creatinine -ACTH level ACTH (cosyntropin) stimulation test -Abdominal CT -ACTH test -Pituitary MRI -Dual x-ray absorptiometry (DEXA) -Chest x-ray -CT scan -Examination of visual field -Complete blood count
Signs and Symptoms Trunk obesity Moon face Pendulous abdomen Hyperpigmentation Facial flush Acne and Hirsutism Polyuria and polydipsia Muscle weakness Fatigue Back pain and kyphosis Purple striae and easy bruising Psychosis and mood swings Oligomenorrhea High blood sugar and blood pressure Osteoporosis Skeletal delayed growth Buffalo hump Unexplained hypokalemia
Legend:
Factors
Disease process
di
Disease
Nursing Diagnosis Imbalance nutrition: less than body requirement Disturbed body image Self-care deficit Sexual dysfunction Risk for excess fluid volume Risk for trauma Disturbed self-esteem Impaired skin integrity Risk for infection
Medications
Diagnostic Test
Surgical and Medical Management
Signs and Symptoms
Nursing Diagnosis
Cushings syndrome results from chronic exposure to excessive circulating
levels of glucocorticoids. Several conditions can cause Cushing Syndrome. The most common cause is iatrogenic administration of exogenous corticosteroids. Approximately 85% of the cases of endogenous Cushing syndrome are due to an adrenocorticotropic hormone (ACTH)-secreting pituitary tumor. Other causes of Cushing syndrome include adrenal tumors and ectopic ACTH production by tumors outside of the hypothalamic pituitary adrenal access. Cushings disease are primary adrenal tumors are more common in women 20-50 year old age group; ectopic ACTH production is more common in men.
Pathophysiology although the origin of Cushing disease incompletely
understood, the vast majority of individual with Cushing disease have the pituitary microadenoma, which secrets ACTH. Ectopic ACTH- secreting tumors are non pituitary tumors that synthesized and hyper secrete ACTH, leading to hypercortisolism. Some tumors may hyper secrete CRH, which results in over secretion of ACTH from tha pituitary. Tumors associated with episodic secretion of ACTH and hypercortisolisn include small cell carcinomas of the lung, thymoma, pancreatic cell tumors, carcinoid tumors, medullary carcinoma of the thyroid, and pheochromocytoma tumors. Eventhough the secretion of ectopic ACTH from rhe neoplasm is not under hypothalamic-pituitary control, the normal pituitary release of ACTH is inhibit by elevated levels of cortisol. However cortisol fails to inhibit the release if CRH from the ectopic source. Autonomous secretion of cortisol can be the results of either an adrenal adenoma or, less commonly, adrenal cortical carcinomas. Elevated cortisol levels suppress CRH and ACTH release secretion from the hypothalamus and anterior pituitary, respectively, which leads to low levels of ACTH. Low levels of ACRTH cause atrophy of the remaining normal portions of the adrenal cortex, which over time will alter the cortisol-secreting activity of normal cells. The normal diurnal variations in cortisol secretions is lost in individual with hyper cortisolism regardless of the underlying cause.
Reference: Lewis, S.L., Heitkemper, M., Dirksen, S., OBrien, P. Bucher, L.(2007). Medical-surgical nursing. [Link]: Mosby McCance K., Huether S., Brashers V.,Rote N.(2010). Pathophysiology. Singapore: Mosby
Results from chronic exposure to excessive circulating levels of glucocorticoids.
Medical-Sugical Nursing
Jonah Mae S. Malazarte March 22, 2012
