Cushing Syndrome.pptx lecture slide for nursing students
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Cushing's syndrome is caused by excess cortisol secretion, often linked to pituitary adenomas or adrenal tumors, leading to symptoms like weight gain, muscle wasting, and increased infection risk. Diagnosis involves multiple tests including urine and blood tests to measure cortisol and ACTH levels, while management may include surgery, medication, and lifestyle modifications. Nursing care focuses on infection risk management, promoting skin integrity, and addressing altered body image.
Cushing Syndrome.pptx lecture slide for nursing students
- 1. Cushing Syndrome Mr Yogendra Mehta Lecturer, HOD(AHD) BRNC
- 2. Functions of Cortisol • Control blood pressure. • Reducing inflammation. • Helping heart and blood vessels work correctly. • Controlling blood sugar. • Helping the body use food for energy.
- 3. Introduction • It is characterized by excess cortisol secretion resulting from too much ACTH by pituitary. • Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. • It can happen from talking glucocorticoid medicines. • A hormone made in the pituitary gland controls how much cortisol the body makes.i.e ACTH. • More in women of 20- 40 yrs
- 4. Causes Hypersecretion of ACTH.(disease) Pituitary adenomas: Hypersecretion of ACTH by the anterior pituitary-causes increased release of both cortisol and androgenic hormones Ectopic ACTH- producing tumor: Tumor makes too much ACTH grows in an organ that usually doesnot make ACTH.like; lungs, pancrease, thyroid and thymus gland cancer Adrenal Gland tumors or disease: like; Adrenal Adenomas, Adrenal Carcinomas: Hypersecretion of Cortisol by the adrenal cortex organ itself. Family Cushing Syndrome
- 5. Clinical Features • serum glucose levels increased ….(gluconeogenesis) eventually the islet cells of the pancreas cannot produce enough insulin and DM results. • Loss of protein stores occurs, muscle wasting • Humoral immunity is reduced, decreasing the threshold to infection. • Skin tissues lose collagen, and become very thin: tearing and bruising easily.
- 6. Contd…… • Wt. gain • Thin arm and legs . • Moon face –deposit of adipose tissue at these sites. • Kyphosis- backpain, compression fracture of vertebra • Visual disturbance
- 8. Excess body and facial hair growth in women (from excess androgen secretion) Mood swings and psychosis may occur as the effect of excess cortisol on cognitive function. Truncal obesity: results from the mobilization of fat in the lower parts of the body, to the trunk causing the abdomen to become protuberant as the extremities become thin and wasted.
- 9. Purple striae: appear on the abdomen as a result of the stretching of the abdominal skin. They’re purple due to the collagen deficit in the tissues. Round facial features: fat accumulation around the neck and cervical area is termed the buffalo hump.
- 11. Diagnosis • 24 hrs urine test: – for Unbound cortisol • Mid night salivary cortisol test: cortisol levels are very low at late night. This test check cortisol level between 11pm -12 am. Cortisol level shows high. • Low dose Dexamethasone suppression test : Dexamethasone (1 mg) is administered orally at night and then measure cortisole level between 8am – 9am. High Cortisol level shows cushing syndrome. • Blood Test: Measure the ACTHLevel. If ACTH level is low Adrenal tumor might be there. If normal or high, pituitary tumor might be there.
- 12. Diagnosis • High Dose Dexamethasone suppression test: 8 mgdexamethasone is given at night and measure the ACTH level and shows high. • Bilateral inferior petrosal sinus sampling(BIPPS): this test finds the source of ACTH secretion. ACTH and other hormones enter into the blood stream from pituitary gland. • This test has a 95%- 98% accuracy rate. • CT Scan chest: Shows Ectopic tumor
- 13. Management Radiation of the pituitary gland also has been successful, although it may take several months for control of symptoms. Adrenalectomy is the treatment of choice in patients with primary adrenal hypertrophy. Potassium supplement
- 14. Adrenal enzyme inhibitors (eg, metyrapone, aminoglutethimide, mitotane, ketoconazole) may be used to reduce hyperadrenalism. In general, ketoconazole is the best tolerated of these agents and is effective as monotherapy in about 70% of patients. • Surgical removal of pituitary gland . • If due to steroid therapy – taper the dosage • New Treatment: The U.S. Food and Drug Administration approved Isturisa (osilodrostat) oral tablets for adults with Cushing's disease who either cannot undergo pituitary gland surgery or have undergone the surgery but still have the disease.
- 15. Nursing Diagnoses • Risk for Infection R/T impaired immune response and tissue repair • Risk of Altered Health Maintenance R/T insufficient knowledge of disease process • Disturbed body image related to altered physical appearance, impaired sexual functioning, and decreased activity level • Risk for Fluid and Electrolyte imbalance
- 16. • DECREASING RISK FOR INJURY • Establishing a protective environment will help to prevent falls, fractures, and other injuries to bones and soft tissues. • DECREASING RISK FOR INFECTION • The nurse frequently assesses the patient for subtle signs of infection because the anti-inflammatory effects of corticosteroids may mask the common signs of inflammation and infection. Therefore, insulin therapy and medication to treat peptic ulcer may be initiated if needed.
- 17. • ENCORAGE REST AND ACTIVITY • the nurse should encourage moderate activity to prevent complications • of immobility and promote increased self-esteem
- 18. • PROMOTING SKIN INTEGRITY • The nurse frequently assesses the skin and bony prominences and encourages and assists the patient to change positions frequently to prevent skin breakdown.
- 19. • IMPROVE BODY IMAGE • Weight gain and edema may be modified by a low- carbohydrate, low-sodium diet, and a high-protein intake may reduce some of the other bothersome symptoms.
- 20. Pheochromocytoma • Most of the chromaffin cells are in Adrenal Gland. • Small clusters of chromaffin cells also present in the heart , head, neck, bladder, stomach & along the spine. • Chromaffin cell tumors located outside the gland is known paragangliomas. • Pheochromacytoma is a catecholamine secreting tumor of the cromaffin cells of the sympathetic nervous system it is usually found in the adrenal medulla. • Peak at 40 – 50 yrs
- 22. •Pathophysiology • The tumor secrete epinephrine and nor epinephrine in excess amount – leads to life threatening arrhythmia and hypertension. • Increased gluconeogenesis. • Relaxes the bowel.
- 24. Diagnosis • Adrenal biopsy • Catecholamines blood test • Glucose test • MRI of abdomen- to detect adrenal massess • Urine catecholamines • Test for metanephrine – metabolite formed frombreakdown of catecholamines.
- 25. Management • Treatment involves removing the tumor with surgery. • It is important to stabilize blood pressure and pulse with medication before surgery. • Phenoxybenzamine (Dibenzyline), a long-acting alpha-blocker, may be used when the blood pressure is stable to prepare the patient for surgery. • Beta-adrenergic blocking agents, such as propranolol (Inderal), may be used in patients with cardiac dysrhythmias
- 26. • The definitive treatment is Bilateral adrenalectomy. • IV administration of corticosteroid . • The nurse instructs the patient about their purpose, the medication schedule, and the risks of skipping doses or stopping their administration abruptly. • Monitor for hypertensive crisis. • IV lines .
Editor's Notes
- #7: Hyper function of adrenal gland cortex causing elevated serum cortisol or ACTH levels. Elevated serum cortisol cause life-threatening changes in physiological, psychological, and metabolic functioning. Tumorof adrenal cortex is first cause of Cushing’s syndrome. More in women 30-40 years old. Also caused by long-term use of glucocorticoid (steroid). S/s: weakness, thin skin and bruise easily, mood swing (emotional lability), skin infection, hypertension, fluid overload, weight gain, (abnormal fat deposits, amenorrhea, impotence or decreased libido, hirsutism (hairs, Women who have hirsutism usually have irregular menstrual cycles. They sometimes have small breasts and deep voices, and their muscles and genitals may become larger than women without the condition.)