cushing syndrome

1. TIPS FOR YOUR
HEALTH CARE
CUSHING
SYNDROME
BY GROUP 4

2. A 30-year-old woman complains of
thinning of the skin, excessive hair
growth and weight gain. She is on
chronic oral prednisone for treatment of
bronchial asthma. On examination, her
face is round and flushed, and there’s
central obesity with wide purple striae
on the abdominal area.
CASE 4

3. PATHOPHYSIOLOGY

4. MEDICAL HISTORY
01
CORTICOSTEROID
PREDNISONE

5. LABORATORY
levels above 80 - 120 mcg / day
24 HOUR URINE FREE
CORTISOL
01
LOW DOSE DEXAMETHASONE
SUPPRESSION TEST
02
03
PLASMA ACTH
(ADRENOCORTICOTROPIC
HORMONE)
20 pg/mL (4.4 pmol/L)
04
LATE NIGHT SALIVARY
CORTISOL

6. IMAGING TESTS
01
COMPUTER
TOMOGRAPHY SCAN
MAGNETIC RESONANCE IMAGING
02

7. TREATMENT
PHARMACOLOGIC
Corticosteroids
to control cortisol production
ketoconazole
levoketoconazole
metyrapone
osilodrostat
mitotane

8. TREATMENT
TAPERING OR GRADUALLY DISCONTINUE GLUCOCORTICOID
adrenal insufficiency
TREAT OTHER COMORBIDITIES
Mifepristone
PHARMACOLOGIC

9. TREATMENT
Bilateral Adrenelectomy
A surgical procedure that involves the removal of both adrenal glands.
It is considered as the last resort for the treatment of severe and
uncontrolled cushing syndrome.
Radiation Therapy
in the context of cushing syndrome, it is typically used when other
treatment options such as medication and surgery are not feasible or
successfu. It targets and shrinks pituitary tumor causing excessive
cortisol.
SURGICAL

10. TREATMENT
Transphenoidal surgical excision
A common procedure removing a tumor of the pituitary gland
Intraoperative ultrasonography
Adjunct in identifying tumors
Reserve bilateral adrenalectomy
For cases when radiotherapy and mitotane therapy do not cure the
patient or when mitotane therapy is not tolerate.
SURGICAL

11. NURSING DIAGNOSIS
ALTERED BODY IMAGE RELATED TO
CORTICOSTEROIDS THERAPY AS
EVIDENCED BY COMPLAINTS OF
THINNING OF THE SKIN, EXCESSIVE
HAIR GROWTH AND WEIGHT GAIN.

12. NURSING INTERVENTIONS
1. Determine whether the condition is permanent with no expectation for resolution. There is always something
that can be done to enhance acceptance, and it is important to hold out the possibility of living a good life with
the condition.
2. Assess mental and physical influence of illness or condition on the client’s emotional state (e.g., diseases of the
endocrine system or use of steroid therapy). Some diseases or condi- tions can have a profound effect on one’s
emotions and need to be considered in the evaluation and treatment of the individual’s behavior and reaction to
the current situation.
3. Evaluate the level of the client’s knowledge of and anxi- ety related to the situation. Observe emotional
changes, which may indicate acceptance or nonacceptance of the situation.
4. Recognize behavior indicative of over concern with the body and its processes. May interfere with ability to
engage.
5. Have the client describe self, noting what is positive and what is negative. Be aware of how the client believes
others see self. Identifies self-image and whether there is a discrep- ancy between own view, how client’s view is
affected by social media, or how client believes others see him or her, which may have an effect on how client
perceives changes that have occurred.
INDEPENDENT INTERVENTIONS

13. NURSING INTERVENTIONS
6. Discuss the meaning of change to the client. A small change may have a big impact. The change
could be devastating (e.g., per- manent facial scarring of child).
7. Observe interaction of client with significant other (SOs). Distortions in body image may be
unconsciously rein- forced by family members, and/or secondary gain issues may interfere with
progress.
8. Listen to the client’s comments and responses to the situation. Different situations are upsetting
to different people, depending on individual coping skills and past experiences.
9. Work with the client’s self-concept, avoiding moral judg- ments regarding client’s efforts or
progress (e.g., “You should be progressing faster”; “You’re weak or not trying hard enough”).
Positive reinforcement encourages the client to continue efforts and strive for improvement.
10. Alert the staff to monitor their own facial expressions and other nonverbal behaviors, because
they need to convey acceptance and not revulsion when the client’s appearance is affected.
INDEPENDENT INTERVENTIONS

14. NURSING INTERVENTIONS
1. Proper corticosteroids management according to the physician’s
prescription. To limit/manage side effects
2. Implement contraptions that solves precipitating symptoms such as
nasogastric tube, urinary catheter, IV therapy, CVP monitoring, leg
compression devices.
DEPENDENT INTERVENTIONS

15. NURSING INTERVENTIONS
1. Determine individual/family/community resources available to the
client.
2. Discuss the availability of prosthetics, reconstructive surgery, and
physical/occupational therapy or other referrals as dictated by the
individual situation. Provides hope that situation is not impossible and
the future does not look so bleak.
3. Begin counseling/other therapies (e.g., biofeedback or relax- ation) as
soon as possible to provide early/ongoing sources of support.
4. Refer to appropriate support groups.
COLLABORATIV INTERVENTIONS

16. THANK YOU!!