Cushing's Disease

"Moon Face & Buffalo Hump"

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Pathophysiology

Cushing's Disease/Syndrome is caused by excessive adrenocortical activity, unlike Addison's disease where there is an underproduction of corticosteroids.

 

Etiology

Causes of Cushing's Disease include:​​

  • A tumor of the pituitary gland that produces ACTH and stimulates the adrenal cortex to increase hormone production.

  • The ectopic production of ACTH by malignancies (bronchogenic carcinoma is the most common) 

 

Lab & Diagnostics

​Labs and diagnostics for Cushing's  include:

  • Serum cortisol (normally higher in the AM and lower in the PM)

  • Urinary cortisol (acquired by 24 hr collection (Cushing's is assumed when the levels are 3 times the normal limit)

  • Low-dose dexamethasone (Decadron) suppression Test (these are used to diagnose pituitary and adrenal causes of Cushing syndrome)

 

Signs & Symptoms

The primary S/S are mostly the result of increased glucocorticoids and androgens.

  • Buffalo hump in the neck

  • Heavy trunk with thin arms and legs

  • Easily bruising skin, with slow-healing wounds

  • Kyphosis with backache

  • Moon face appearance

  • Weight gain

 

Risk Factors

While none of the below factors are direct causes, they are more prevalent if you fall into each category:

  • Women between 20-40

  • Obesity

  • Type 2 Diabetes

  • Poorly controlled blood sugar levels

  • High blood pressure​

 

Treatment

Medical: If caused by a tumor, surgical removal is recommended. Adrenalectomy (removal of the adrenal gland) is recommended for unilateral adrenal hypertrophy.

 

Pharmacologic: Adrenal enzyme inhibitors (metyrapone, aminoglutethimide, mitotane, ketoconazole) may be used to reduce hyperadrenalism if the syndrome is caused by ectopic ACTH secretion by a tumor that cannot be eradicated.

 

If Cushing s is caused by the admin of corticosteroid therapy, a reduction may be made and an eventual taper off to treat other diseases.

 

Nursing

Interventions

Assessment: Health and History with the focus on the S/S of high concentrations of adrenal cortex hormones. Get the patient's level of activity, and ability to carry out self-care. Also, check the patient s mental status (depression), mood, etc.

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The nurse is responsible for decreasing the risk of injury (impaired healing ability), risk of infection. The nurse assists in preparing the patient for surgery if a tumor or adrenal gland is to be removed.

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Monitor blood glucose before, during, and after surgery as diabetes is common in patients with Cushing syndrome.

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Encourage rest but at the same time, you must encourage activity to avoid complications of immobility (skin breakdown) as well as after surgery to prevent blood clots.

 

Addisonian Crisis: Withdrawal of corticosteroids by adrenalectomy, or by pituitary tumor removal are at risk for adrenal hypofunction and should be monitored as such.

 

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