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Questions and Answers
What is the main cause of Cushing's syndrome?
Which of the following is NOT a clinical manifestation of Cushing's syndrome?
What is the most common cause of ACTH-dependent Cushing's syndrome?
What is the purpose of administering alpha-adrenergic blockers prior to pheochromocytoma surgery?
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Which of the following is a common complication of pheochromocytoma adrenalectomy?
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Which of the following tests is used to diagnose pheochromocytoma?
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What is the main function of mineralocorticoids in the body?
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Which of the following is NOT a characteristic of the pheochromocytoma triad?
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What is the purpose of administering beta-adrenergic blockers in the management of pheochromocytoma?
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Which of the following is a common clinical feature of Cushing's syndrome?
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Study Notes
Cushing's Syndrome
- A clinical condition resulting from chronic exposure to excessive cortisol
- Affects women more than men
- Causes: • Steroid use (Exogenous source) • Cushing’s Disease (ACTH-producing pituitary adenoma) • Adrenal hyperplasia • Malignancies
- Clinical manifestations: • Central obesity with pendulous abdomen • Skinny arms and legs • Hirsutism (not in males) • Acne • Amenorrhea • Depression • Infections (often recurrent) • Purpura • Peptic ulcers • Osteoporosis • "Lemon on stick" Appearance • Non-healing wounds
Diagnostic Tests
- Dexamethasone Suppression Test: • Low-dose suppression (1mg): Screening test for Cushing's Syndrome • High-dose suppression (8mg): Determines etiology
- Interpretation: • Low plasma cortisol: Normal • Normal/High plasma cortisol: Cushing's Syndrome • High-dose suppression: • Low plasma cortisol: Cushing's Disease • Normal/High plasma cortisol: - ACTH is low: Adrenal Cushing - ACTH is high: Ectopic ACTH source
Medical and Surgical Management
- Transsphenoidal hypophysectomy: For pituitary tumors
- Adrenalectomy (Laparoscopic): For adrenal hyperplasia
- Key nursing interventions: • Institute safety/fall precautions • Adhere to infection prevention and control measures • Provide meticulous skin and wound care • Encourage verbalization of concerns
Adrenal Glands
- Functions: • Produces glucocorticoids (cortisol) • Produces mineralocorticoids (aldosterone) • Produces sex hormones (androgen)
- Effects of glucocorticoid excess: • Increased metabolism • Glucose elevation • Adipose redistribution • Immunosuppression • Norepinephrine sensitizer • Increased bone demineralization • Secretion of gastric acid
Pheochromocytoma
- A tumor of the chromaffin cells of the adrenal medulla
- Peak incidence at 40-50 years old
- Affects men and women equally
- Clinical manifestations: • Palpitation • Headache • Episodic sweating • Sustained or paroxysmal hypertension
- Diagnostic test: • Vanillylmandelic Acid (VMA) Test: Measures urinary excretion of catecholamine metabolite • Normal: 1.4-6.5mg/24 hours
- Treatment: • Adrenalectomy
- Pre-operative preparation: • Control blood pressure using alpha-adrenergic blockers, beta-adrenergic blockers, and calcium-channel blockers
- Complication: • Hypertensive crisis (Intra/Post-Op) • Mgt: Sodium nitroprusside and Phentolamine
- Nursing management: • Institute bed rest with HOB elevated • Monitor vital signs, ECG, fluid and electrolytes, and blood glucose levels
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Description
Test your knowledge on the clinical manifestations of Cushing’s syndrome, including physical characteristics and associated symptoms. Learn about the diagnostic test used to assess adrenal gland function in this condition.
