Cushing Syndrome

Cushing's syndrome is the collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol

1. SUBJECT : CLINICAL SPECIALITY-I TOPIC : CUSHING’S SYNDROMES PREPARED BY, J.G SAMBAD M.SC. NURSING CUSHING’S SYNDROME/DISEASE

2.   CUSHING’S SYNDROME/DISEASE): DEFINITION :  Cushing’s syndrome is a metabolic disorder resulting from the chronic & excessive production of cortisol by the adrenal cortex or by the administration of gluco -corticoids in large doses for several weeks or longer.

3. Cushing’s = Hypercortisolism Cushing's Syndrome- Clinical effects of increased glucocorticoid hormone- all causes or excess cortisol Cushing's Disease- ACTH producing pituitary adenoma

4. RISK FACTORS: Adrenal tumours are responsible for about 30% of cases of Cushing’s syndrome. Most 85% are benign, but 15% are malignant

5. CAUSES: Frequent therapeutic use of high- doses cause by a cortisol- secreting adrenal tumour or adrenal hyperplasia.

6. CONT… Over production of ACTH. Pituitary hypersecretion & pituitary tumours, which cause about 70% of cases of Cushing’s syndrome.

7. PATHOPHYSIOLOGY BY POSTER PRESENTATION

8. Signs and symptoms of Cushing’s syndrome Weight gain, especially in the upper body Rounded face and extra fat on the upper back and above the collarbones

9. Continue…. High blood sugar (diabetes) High blood pressure (hypertension) Thin bones (osteoporosis) Muscle loss and weakness Thin, fragile skin that bruises easily

10. Continue…… Purple-red stretch marks (usually over the abdomen and under the arms) Depression and difficulties thinking clearly Too much thinner hair in women

11. Continue… Irregular or absent menstrual periods and infertility Reduced sex drive Poor height growth and obesity in children

12. Symptoms of Excess Cortisol Truncal obesity Moon face Fat deposits supraclavicular fossa and posterior neck- buffalo hump HTN Hirsutism Amenorrhea or impotence Depression Thin skin Easy bruising Purplish abdominal striae Proximal muscle weakness Osteoporosis Diabetes Mellitus Avascular necrosis Wound healing impaired Pysch symptoms Hyperpigmentation Hypokalemic alkalosis

13. How is Cushing’s syndrome diagnosed? The most sensitive and specific diagnostic test measures cortisol levels in the saliva between 11:00 p.m. and midnight. A sample of saliva is collected in a small plastic container and sent to the laboratory for analysis.

14. How is Cushing’s syndrome diagnosed? In healthy people,cortisol levels are very low during this period of time. In contrast, patients with Cushing’s syndrome have high levels. Cortisol levels can also be measured in urine that has been collected over a 24-hour period.

15. How is Cushing’s syndrome diagnosed? In another screening test, people with suspected Cushing’s syndrome have their cortisol levels measured the morning after taking a late-night dose of dexamethasone , a laboratory-made steroid. Normally, dexamethasone causes cortisol to drop to a very low level, but in people with Cushing’s syndrome, this doesn’t happen.

16. COMPLICATION:- - BONE LOSS -BONE FRACTURES -MUSCLE LOSS -KIDNEY STONE

17. MANAGEMENT: MEDICAL MANAGEMENT:

18. Pharmacological therapy : ADMINISTER ANTIBIOTICS. Administer antipyretics.

19. SURGICAL MANAGEMENT:

20. SURGICAL MANAGEMENT: For Cushing's syndrome due to adrenal tumor an adrenalec­tomy can be performed to remove the gland containing the tumor.

21. NURSING MANAGEMENT

22. NURSING DIAGNOSIS: Risk for injury related to weakness Risk for infection related to altered protein metabolism and inflammatory response

23. CONT… Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns Impaired skin integrity related to oedema, impaired healing, and thin and fragile skin

24. CONT… Disturbed body image related to altered physical appearance, impaired sexual functioning, and decreased activity level Disturbed thought processes related to mood swings, irritability, and depression

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