Cushing Syndrome

Medical Lifestyle
September 03, 2021

 

CUSHING SYNDROME

DEFINITION:-

It resuls from excessive adrenocortical activity which leads to excess secretion of glucocorticoid hormones.






CAUSES:-

  • Excessive corticosteroids medications.
  • Tumour of pituitary gland which results excessive production of ACTH.
  • ACTH stimulate adrenal cortex and produce excessive cortisone.
  • Tumour in adrenal cortex.

CLINICAL MANIFESTATION:-

  • Arrested growth
  • Weight gain
  • Obesity
  • Acne
  • Hypertension
  • Diabetes
  • Osteoporosis
  • Weakness
  • Moon face appearance (dusky face like mental retardation)
  • Increased susceptibility to infection, slow healing of minor cuts and bruise.
  • Virilization in female (due to excessive androgen).
  • Khyposis
  • Bruising
  • Polyuria
  • Purple striae on abdomen thigh, breast.

DIAGNOSTIC EVALUATION:-

  • Overnight dexamethasone suppression test to measure plasma cortisol level.
  • Laboratory studies (e.g.,serum sodium, blood glucose, serum potassium, plasma, urine test).
  • CT scan.
  • MRI and ultrasound.

COMPLICATIONS:-

  • Possibility of recurrence in patients with adrenal carcinoma.
  • fractures
  • Gastric ulcer
  • Renal colic
  • Pancreatitis
  • Infections.

MEDICAL MANAGEMENT:-

  • Surgical removal of tumour by trans-sphenoidal hypophysectomy is the treatment of choice.
  • Adrenalectomy (removal of adrenal glands).
  • Postoperatively, temporary replacement therapy with hydrocortisone.
  • Adrenal enzymes inhibitors, e.g., Action:They interferes with the production of hormones (cortisol and aldosterones.)
    - Metyrapone
    - Mitotane
    - Ketoconazole
    May be used with ectopic ACTH secreting tumours that cannot be totally removed.

Nursing Diagnosis:-

  1. Risk for infection related to decrease immunity.
  2. Self care deficits related to weakness, fatigue, muscles wasting.
  3. Impaired skin integrity related to edema, impiared healing.
  4. Disturbed though process related to mood swings, irritability and depression.
  5. Disturbed body image related to altered appearance, Impaired sexual functioning and decrease activity level.