cushing syndrome.pptx which steroid abuse

Introduction
Etiology
Pathophysiology
Signs and symptoms
Diagnosis
Complications
Treatment with patient counseling.

1. Cushing syndrome By P.Jyothi Pharm D Geethanjali college of pharmacy.

2. Introduction Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the same way as cortisol. Too much cortisol can cause some of the main symptoms of Cushing syndrome — a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin. Cushing syndrome also can cause high blood pressure or bone loss. Sometimes, it can cause type 2 diabetes.

3. Etiology Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland. Cushing syndrome is caused by having too much cortisol in the body. Cortisol is a hormone that is made in the adrenal glands. It helps the body respond to stress and plays many other important roles, including:

Controlling blood pressure.
Reducing inflammation.
Helping the heart and blood vessels work correctly.
Controlling blood sugar.
Helping the body use food for energy.

4. Pathophysiology Cushing disease the frequency of ACTH production remains the same, but the normal circadian rhythm is lost. The increased plasma ACTH causes bilateral adrenal hyperplasia and a consequent increase in the production of cortisol. Therefore, the normal circadian rhythm of cortisol is also lost. Cortisol functions primarily as a glucocorticoid; however, in high concentrations, cortisol can also exhibit mineralocorticoid activity, leading to hypertension and hypokalaemia through the renin-angiotensin-aldosterone system (RAAS).The RAAS hormone system regulates plasma sodium concentrations as well as arterial blood pressure, which can indirectly lead to hypokal aemia.

5. Signs and Symptoms Common symptoms of Cushing syndrome Weight gain in the trunk, with thin arms and legs.
Weight gain in the face. This is sometimes called moon face.
A fatty lump between the shoulders. This may be referred to as a buffalo hump.
Pink or purple stretch marks on the stomach, hips, thighs, breasts and underarms.
Thin, frail skin that bruises easily.
Slow wound healing.
Acne. Symptoms women with Cushing syndrome Thick, dark hair on the face and body. This condition is called hirsutism.
Periods that are irregular or that stop. Symptoms men with Cushing syndrome Lower sex drive.
Reduced fertility.
Problems getting an erection.

6. Other possible symptoms of Cushing syndrome Extreme tiredness.
Muscle weakness.
Depression, anxiety and irritability.
Emotions that are hard to control.
Trouble concentrating or remembering.
Sleeplessness.
High blood pressure.
Headache.
Infections.
Skin darkening.
Bone loss, which can lead to broken bones.
Stunted growth in children.

7. Diagnosis Urine and blood tests . These tests measure hormone levels and show if the body is making too much cortisol. For the urine test, you may be asked to collect your urine over a 24-hour period. Cortisol, ACTH and other hormones are be measured in urine and blood samples. Saliva test. Cortisol levels typically rise and fall during the day. In people without Cushing syndrome, cortisol drops in the evening. By looking at cortisol levels from a small sample of saliva collected at night, the health care team can see if cortisol levels are too high. Imaging tests. CT or MRI scans can take pictures of the pituitary and adrenal glands to see if anything shows up, such as tumors.
Inferior petrosal sinus sampling. This test can help decide if Cushing syndrome is caused by an ACTH-producing pituitary adenoma, or ACTH-producing tumor in another organ. For the test, blood samples are taken from the veins that drain the pituitary gland, called the inferior petrosal sinuses.

8. Complications

9. Treatment Medicines to control cortisol production at the adrenal gland include ketoconazole, osilodrostat (Isturisa), mitotane (Lysodren), levoketoconazole (Recorlev), and metyrapone (Metopirone). Exogenous corticosteroid use Taper steroid dose down and wean patient off Pituitary tumor Resection of the tumor (transsphenoidal resection) Adrenal tumor Partial or total adrenal resection (adrenalectomy )

Chemotherapy, radiation, etc. If malignant

Ectopic ACTH-producing tumor Resection depending on the site Chemotherapy, radiation, etc. If malignant

10. Patient counselling

11. Patient counselling Reduce sodium intake - excess sodium can worsen symptoms of the syndrome by increasing BP and cusging weight gain. Increasing calcium intake and vit d3 – which strengthen the bones include kale, cheese and broccoli, milk and beverages fortified with vit D Reducing cholesterol- avoid fatty foods and eat more fibrous foods. Reducing or eliminating tobacco – tobacco increase the risk of complications. The exercises like swimming and bicycling which is not stress full to Skeletal muscles. Maintaining the muscle with high protein – beans, lean meat, etc... Foods rich in magnesium which increases the cortisol level like processed meats, high sugar foods and caffeine and alcohol. Do not stop the corticosteroid use abruptly and without medical supervision. Relaxing in quiet environment for rest and sleep. Use meticulous skin care to avoid traumatized fragile skin. Avoid adhesive tape, which can tear and irritate the skin.

12. Reference https://www.medlineplus.in https://www.pubmed.in https://www.NIH.gov.in .

13. Thank you