_Cushing’s syndrome .pdf

Cushing’s syndrome ⩥ Excess secretion of the adrenal cortex hormones Etiology ⩥ Iatrogenic causes: excessive cortisol levels from chronic therapy with glucocorticoids ⩥ Primary cause: excessive cortisol production from adrenal neoplasms such as adenomas or carcinomas ⩥ Secondary cause: excessive pro...

Cushing’s syndrome ⩥ Excess secretion of the adrenal cortex hormones Etiology ⩥ Iatrogenic causes: excessive cortisol levels from chronic therapy with glucocorticoids ⩥ Primary cause: excessive cortisol production from adrenal neoplasms such as adenomas or carcinomas ⩥ Secondary cause: excessive production of ACTH from the anterior PG due to pituitary carcinoma or ectopic ACTH secretion by neoplasm of the lungs, kidneys, etc. 18 Increased glucocorticoids ⩥ Increased blood glucose ⩥ Fat catabolism ⊳ Increased blood cholesterol ⊳ Acne, oily skin ⩥ Protein catabolism ⊳ Muscle wasting ⊳ Osteoporosis ⩥ Decreased immunity ⊳ Slow wound healing ⊳ infection 19 Increased mineralocorticoids ⩥ Na retention- lead to imbalance of Na-K pump ⊳ CNS instability ⩥ Water is reabsorbed ⩥ Weight gain, obesity, lethargy ⩥ Hypertension, heart failure 20 Increased androgens ⩥ ⩥ ⩥ ⩥ ⩥ Voice deepens Hirsutism Amenorrhea Breast atrophy Loss of libido 21 22 Diagnostic findings ⩥ Serum cortisol ⩥ Urinary cortisol ⩥ Low-dose dexamethasone (Decadron) suppression test ⩥ Hypernatremia, hypokalemia, hyperglycemia, hypercholesterolemia 23 Imaging studies ⩥ CT scan or MRI of adrenal glands ⩥ MRI of pituitary gland 24 Medical management ⩥ Treatment depends on the cause ⩥ Pituitary adenoma ⊳ Transsphenoidal hypophysectomy ⊳ Pituitary irradiation ⊳ Stereotactic radiotherapy (gamma knife) 25 Medical management ⩥ Adrenal neoplasm ⊳ Surgical resection of the affected adrenal gland ⊳ Glucocorticoid replacement for approximately 9 to 12 months after surgery to allow time for the contralateral adrenal gland to recover from its prolonged suppression. ⩥ Ectopic ACTH ⊳ Surgical resection of the ACTH-secreting neoplasm 26 Nursing management ⩥ Encourage foods high in protein, calcium and vitamin D; low ⩥ ⩥ ⩥ ⩥ ⩥ ⩥ ⩥ in sodium and calories Instruct patient to avoid persons with current infection Frequently assess patient for signs of infection Help patient to plan rest periods and activity Teach the patient meticulous skin care Avoid use of adhesive tape Change position frequently Encourage the patient and family to verbalize their feelings and concerns 27 Nursing management ⩥ Instruct the patient not to stop corticosteroid use abruptly. ⩥ Regularly monitor blood pressure, blood glucose levels and weight ⩥ Instruct patient to wear a medical alert bracelet 28