Sunday, May 17, 2009

Cushing’s syndrome (Hypercortisolism) from NLE Review Bullets

Cleansweep RN

A. General Information

  • Characterized by hyper secretion of glucocorticoids from adrenal cortex

  • Occurs mostly in females ages 30 – 60

  • Primary Cushing’s syndrome caused by adrenocortical tumors or hyperplasia

  • Secondary Cushing’s syndrome or Cushing’s disease is caused by functioning pituitary or non-pituitary neoplasm secreting ACTH, causing increased secretion of glucocorticoids
    Iatrogenic is caused by prolonged use of corticosteroids

B. Assessment Findings:

  • General muscle weakness, fatigue, truncal obesity with thin arms and legs, muscle wasting
  • Irritability, depression, frequent mood swings
  • Moon face, buffalo hump, pendulous abdomen and weight gain
  • Reddish-purple striae on trunk and upper thighs, acne, thin skin
  • Hirsutism (signs of masculinization in woman), menstrual dysfunction and decreased libido
  • Osteoporosis, decreased resistance to infection
  • Fragile skin that easily bruises
  • Mental changes include memory loss, poor
    concentration and cognition, euphoria, and depression (steroid
  • Hypertension and edema
  • Diagnostic test: increased cortisol levels, slight
    hypernatremia, hypokalemia, hyperglycemia, hypocalcemia

C. Nursing Interventions:

  • Monitor vital signs especially blood pressure
  • Monitor intake and output and weight
  • Monitor laboratory values, particularly the white cell count and serum glucose, sodium, potassium and calcium levels
  • Provide meticulous skin care
  • Protect skin from exposure of infection
  • Provide diet low in calories and sodium, and high in protein, potassium, calcium and vitamin D
  • Monitor urine for glucose and acetone, administer insulin if ordered
  • Allow client to discuss feelings related to body appearance

D. Medical and Surgical management:

  • Radiation therapy to treat primary pituitary tumors and other ACTH-secreting adenomas
  • Adrenal Blocking Agents such as Mitotane (Lysodren) drug that inhibits corticosteroid synthesis without destroying cortical cells, Aminoglutherthimide (Cytadren) and trilostane (Modrastane) other drug that block the synthesis of glucocorticoids and adrenal steroids
  • ACTH-Reducing Agents such as Cyproheptadine (Periactin), bromocriptine or somatostatin to treat hypersecretion caused by pituitary abnormalities.
  • Adrenalectomy for benign unilateral tumor


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