4. Cushing syndrome by Dr Iqra Osman.pptx

Cushing syndrome

1. Disease/Syndrome Dr.Iqra Osman Abdullahi

2. Cushing's Disease/ Cushing's Syndrome: Cushing's is a hormonal disorder caused by prolonged e x posu r e o f th e b o d y' s t i ssues t o hi g h le v els o f the hormo n e c or t iso l . Y o u r ad r enal g la n d s , w hi c h a r e r i g h t above your kidneys, release cortisol when they receive a chemical message from your pituitary gland. The message c omes in th e f orm o f ad r eno c or t i c ot r ophic hormo n e (ACTH), which travels through the bloodstream. The pituitary gland is known as the “Master gland of the body”. Introduction

3. Pituitary Hormones and Adrenals

4. Definition It is a condition in which the plasma cortisol level is elevated, causing signs and symptoms of Hypercortisolism.

5. Causes of Cushing’s A benign tumor of the adrenal gland A benign tumor of the pituitary gland A benign tumor of the lung or other organ Extensive use of cortisone medication Administration of ACTH or Corticosteroids. Primary hyperplasia of both adrenal gland. Excessive secretion of adrenal androgen. Exogenous Glucocorticoid administration.

6. Cushing’s at it’s worst M oon fa c e L a r g er t orso and fa c e

7. Pathophysiology: Due t o etiol o gi c al fac t or Normal feedback mechanisms that control adreno cortical function are ineffective. Resulting in excess secretion of adrenal cortical hormones Inadequate amount of adrenal cortical hormones in secretion Hypercortisolism

8. Symptoms of Cushing’s Disease Excess Glucocorticoids: W ei g ht g ai n / o be s i t y Heavy trunk and thin extremities Buffalo hump in neck Thin skin Rounded face/moon face M u scle s w a s t ed Osteoporosis Mental Disturbance Increased susceptibility to infection. Excess Mineralo-corticoids: Hypertension Hypernatremia Hypokalemia W ei g ht g ain Expanded blood volume Edema E x c ess Ant r o g en: Women- Hirsutism B r ea s t a t r o p y Cli t ori s enl a r g e m ent Voice masculine Men- Loss of Libido Gastro Intestinal: Peptic Ulcer Pancreatitis Gastritis and Duodenitis Opht h l m ic: Cataracts Glau c o m a Others Tachycardia Fatty Liver Mild slowing on EEG Pituitary Adenoma Migraines Syncope M em o r y and c o g ni t i v e s k ill s d i min i s hed Superficial skin infections ⚫ ⚫

9. Diagnostic Evaluation History Collection Physical Examination CT Scan and USG Radio-Immuno Assay of plasma ACTH Corticotropin releasing factor (CRF) Stimulation Test. Dexamethasone suppression Test Blood samples X-rays of the skull Reduced eosinophils level Excessive Plasma cortisol level

10. Medical Management Mitotane = An agent toxic to the adrenal cortex. M et r o p i n e = T o c o n t r ol (s t e r o i d h y p er sec r eti o n ) w ho do not respond to mitotane therapy. Amino-glutethimide = Effectively Blocking cortisol production P r o t ein anab o llic s t e r o i d s m a y b e g i v en t o fac i lita t e i s required (protein and potassium replacement)

11. Surgical Mgt: Trans sphenoidal adenomectomy or Hypophysectomy: = R em o v al of p i t u ita r y g la n d Transfrontal Carinotomy: = It is necessary when pituitary tumor is enlarge. Bilateral Adrenalectomy: = H y p erpl a sia of ad r enals

12. Complication: Adrenal Carcinoma Addisonian crisis Adverse effects of Adreno – cortical activity.

13. Nursing Diagnosis Impaired skin integrity r/t altered healing and edema. Self care deficit r/t muscle wasting and fatigue. Anxiety r/t surgery Ris k f or Inju r y t o su r gi c al p r o c edu r e. Self – Es t eem distu r ban c e r ela t ed t o al t e r ed p h y sic a l appearance.

14. The End