Cushing's Disease

"Moon Face & Buffalo Hump"

Pathophysiology

Etiology

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Nursing Interventions

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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.

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.

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

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.