Cushing's Disease
"Moon Face & Buffalo Hump"
Osmosis
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:​​
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A tumor of the pituitary gland that produces ACTH and stimulates the adrenal cortex to increase hormone production.
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The ectopic production of ACTH by malignancies (bronchogenic carcinoma is the most common)
Lab & Diagnostics
​Labs and diagnostics for Cushing's include:
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Serum cortisol (normally higher in the AM and lower in the PM)
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Urinary cortisol (acquired by 24 hr collection (Cushing's is assumed when the levels are 3 times the normal limit)
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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.
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Buffalo hump in the neck
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Heavy trunk with thin arms and legs
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Easily bruising skin, with slow-healing wounds
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Kyphosis with backache
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Moon face appearance
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Weight gain
Risk Factors
While none of the below factors are direct causes, they are more prevalent if you fall into each category:
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Women between 20-40
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Obesity
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Type 2 Diabetes
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Poorly controlled blood sugar levels
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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.