This document discusses Cushing syndrome, which is caused by excess corticosteroids in the body. It can be due to primary conditions of the adrenal glands or secondary conditions of the pituitary gland. Symptoms include central obesity, high blood pressure, muscle wasting, and impaired wound healing. Diagnostic tests include urine and blood tests and imaging tests. Treatment depends on the underlying cause but may include surgery, radiation, or medication. Nursing care focuses on monitoring for infection, managing nutrition and weight, addressing body image issues, and skin integrity.

1. ADRENOCORTICAL
OVERACTIVITY
Sasha Bondi

2. Objectives
• Discuss anatomy in brief
• Discuss Cushings
Cause
Treatment
Nursing management

4. Cushing syndrome
• Due to excess corticosteroids, particularly
glucocorticoids
- androgens, mineralocorticoids to a lesser extent
• Alterations in – protein, fat, and CHO metabolism
- inflammatory and immune response
- Emotional stability
- Water and electrolyte metabolism
- RBC and platelet levels

5. Causes
• PRIMARY- high doses corticosteroids e.g.
predinisolone (iatrogenic)
-Adrenal tumours – Ca or adenoma →
excessive cortisol production
• SECONDARY - ACTH secreting pituitary tumour
(Cushing`s disease, → ↑ACTH production)
- Ectopic ACTH production by bronchogenic Ca
or pancreatic tumours

7. Assessment
• History- PH
Eating and drinking
-Weight gain (most common feature) –
accumulation of adipose tissue in trunk, face &
cervical area, Na⁺ and H₂O retention
- Anorexia
- Use of corticosteroids
-Usual 24 hr food intake

8. Mobilising
Mobilising
-Back and joint pain
-awkward gait
Working and playing
•Weakness due to muscle wasting (catabolic
effect of cortisol)
•fatigue

9. Sleeping
• Insomnia – altered diurnal secretion of
cortisol
Cleansing and dressing
• Slow healing of minor cuts (altered protein
metabolism)
• Bruises

10. Communicating
• Poor concentration and memory
• Anxiety , psychosis, depression
• Euphoria
Sexuality
• ↓libido
• Impotence
• Amenorrhoea

11. Physical examination
General appearance
-Central obesity
-Buffalo hump (fat deposits)
-Moon face
- Thin extremities
Vital signs
↑BP (Na⁺ and water retention, effects of
aldosterone)
- Weight ↑

12. Integumentary
• Hirsutism of face (in women)
• Thin friable skin, easily traumatised (loss of
collagen support)
• Ecchymosis, petechiae, (blood vessel fragility)
• Striae on breasts, buttocks, abdomen
• Acne (↑androgens)

14. Musculoskeletal
• Muscle wasting ( ↑ catabolism of protein)
• Oesteoporosis
• Kyphosis
• Backache
• Fractures
CVS – heart failure
- Oedema of lower extremities
- Jugular vein distension

15. Reproductive( androgenic effects)
• Gynaecomastia
• breasts atrophy
• Enlarged clitoris (virilisation in women)

16. Diagnostic studies
•24 hr urine collection for free cortisol-may be ↑
•CT scanning and MRI – tumour localisation in
adrenal or pituitary glands, lung, GIT.
•Bloods show -↑cortisol level
-FBC shows leucocytosis, lymphopenia, eosinophilia
(↓ immune and inflammatory response)
-↑ Blood sugar - glycogenolysis and
gluconeogenesis

17. Diagnostic studies
• Urine –glycosuria, ↑calcium
-17 ketosteroids elevated (adrenal
metabolites
of cortisol and androgens)
• ↑ ACTH & ↑ cortisol – in pituitary or
hypothalamic disease
- ↓ ACTH & ↑ cortisol - in adrenal disease
• U&Es - ↑Na , hypokalaemia
• X-ray –osteoporosis(↓ protein- ↓bone matrix

18. Collaborative care
• Treatment depends on underlying cause e.g. -
pituitary adenoma:- surgical removal or
radiation if surgery is not possible.
- Primary adrenal hypertrophy:-
adrenalectomy
- Ectopic ACTH secreting tumours- treatment
of primary neoplasm or drugs to decrease
cortisol production

19. Drug therapy
• when surgery is contraindicated in ectopic
ACTH secretion
• to suppress cortisol production e.g. mitotane
(cytotoxic) with meals, ketoconazole
• If due to prolonged administration of steroids,
-gradual discontinuance of the drug ( to avoid
adrenal insufficiency)
- Conversion to an alternate-day regimen

20. Nursing Care Plan
• Risk for infection RT altered protein metabolism, ↓
resistance to stress and suppression of immune
system
-assess for poor wound healing, proteinuria as
indicators of risk for infection
- 4 hourly temperature
-assess urinary and respiratory tracts, skin, IV
lines to detect infection early

21. Risk for infection (cont’d)
- provide private room if possible, maintain
asepsis to ↓risk of cross contamination.
- instruct on hand washing to avoid infection
- oral care with a soft toothbrush, 2hourly deep
breathing and coughing

22. Nursing Care cont.
• Altered nutrition more than body requirements RT
to increased appetite and inactivity
- low calorie, ↑ protein, calcium, Vit. D to ↓ weight,
replace protein and calcium + low calorie, high
vitamin snacks
-weigh daily to maintain body weight (not to loose
more than 1kg per week)
-diet low in Na⁺ as necessary
-↑ intake of food high in K⁺.
-blood glucose level monitored 4-8hourly.

23. Nursing Care cont.
• Body image disturbance RT truncal obesity, buffalo
hump, moon face, hirsutism in women, gynaecomastia
in men, impaired sexual activity
-explain that changes are due to hormone imbalance and
that most will disappear with treatment.
-encourage use of attractive attire to improve appearance
and self-esteem
-provide emotional support and unconditional acceptance.

31. Nursing Care cont.
• Impaired skin integrity RT immobility, altered
skin fragility, oedema
-assess skin to detect trauma early
-prevent injury by avoiding bumping into hard objects,
avoid adhesive tape
-change position frequently to ↓pressure and improve
circulation
-provide good skin care to oedematous areas & over bony
prominences.

32. Discharge Teaching
• To monitor BP, blood sugar & weight
• Medic Alert at all times
• To avoid extremes of temperature, infections
and stress as much as possible
• Not to stop steroids abruptly without medical
supervision