Cushing disease is caused by a benign tumor in the pituitary gland that produces excess ACTH, causing the adrenal glands to overproduce cortisol. Symptoms include fatigue, weakness, depression, weight gain, and fragile skin that bruises easily. Treatment may include medications to reduce cortisol production, pituitary surgery to remove tumors, or adrenal gland removal with lifelong hormone replacement therapy. Nursing care focuses on preventing injury and infection due to weakened state, improving skin integrity and self-care abilities, and addressing changes in body image and mental health.

1. Chusing Disease
Cushing Disease:
● Cushing disease is a form of Cushing syndrome.
Cushing disease occurs when a benign tumor in the
pituitary gland causes the pituitary gland to produce
too much ACTH, the hormone responsible for cortisol
production. Too much ACTH in the body causes the
adrenal glands to produce cortisol in high levels.

4. Causes....
Cushing disease is caused by a tumor or excess growth
(hyperplasia) of the pituitary gland. The pituitary gland is
located just below the base of the brain. A type of pituitary
tumor called an adenoma is the most common cause. An
adenoma is a benign tumor.
●Endogenous (from within the body): Cushing syndrome
happens because of cortisol produced by your body.
●Exogenous (from outside sources): Cushing syndrome happens
because of the side effects of certain medications taken to treat
other conditions.

5. Continu.....
●Vitamin D Deficiency.
●Cushing disease may be caused by an overuse of
corticosteroids, such as prednisone.
●Chronic stress and poor stress management can
cause Cushing disease, as cortisol is the hormone we
produce when we're stressed.

6. Continue....
●The
most common cause of Cushing's syndrome is the
long-term, high-dose use of the cortisol-like
glucocorticoids. These medicines are used to treat
other medical conditions, such as asthma link,
rheumatoid arthritis link, and lupus link.
●People who are obese and have type 2 diabetes
have a higher risk of developing Cushing's syndrome.

7. Complications...
●Diabetes mellitus.
●High blood pressure.
●Derious infections.
●Fractures due to osteoporosis.
●Kidney stones.
●Enlargement of pituitary tumor..

8. Clinical Manifistations.
●Severe fatigue.
●Muscle weakness.
●Depression, anxiety and irritability.
●Loss of emotional control.
●Cognitive difficulties.
● High blood pressure.
●Headache.
●Infections.

9. Continue...
●Weight gain and fatty tissue deposits, particularly around
the midsection and upper back, in the face (moon face),
and between the shoulders (buffalo hump)
●Pink or purple stretch marks (striae) on the skin of the
abdomen, thighs, breasts and arms
●Thinning, fragile skin that bruises easily
●Slow healing of cuts, insect bites and infections
●Acne.

12. Pathophysiology..
Pathophysiology
⚫ Normally, the production and release of cortisol follows a
precise chain of events. Corticotropin-releasing hormone (CRH)
released from the hypothalamus causes the pituitary gland to
secrete ACTH, which in turn results in the production of cortisol
from the adrenal glands (located just above the kidneys).

13. Continue...
⚫ In healthy people, cortisol begins to rise between 3 and
4 am, reaches a peak between 7 and 9 am, and then falls
for the rest of the day to the lowest levels when the
person is unstressed and asleep at midnight.
⚫ Cortisol controls its own production and release by
switching off the hormones CRH and ACTH, a form of
hormonal regulation known as "negative feedback".
ACTH and cortisol become elevated in response to stress,
such as surgery, trauma, infection or other medical
illnesses. i.e. Stress response

16. Medical management.
Medications to control excessive production of
cortisol at the adrenal gland include
●ketoconazole, mitotane (Lysodren)
●metyrapone (Metopirone).
●Mifepristone (Korlym, Mifeprex) is approved for
people with Cushing syndrome who have type 2
diabetes or glucose intolerance.

17. Continue...
Mifepristone does not decrease cortisol production, but it
blocks the effect of cortisol on your tissues.
●New medications include pasireotide (Signifor), given as a
twice-daily injection, and osilodrostat (Isturisa), a pill. Other
medications are being developed.

18. Side effects..
●Side effects from these medications may include fatigue,
nausea, vomiting, headaches, muscle aches, high blood
pressure, low potassium and swelling. Some have more-serious
side effects, such as neurological side effects and liver toxicity..

19. Surgical Management.
● If none of these treatment options is appropriate or
effective, your doctor may recommend surgical
removal of your adrenal glands (bilateral
adrenalectomy). This procedure will cure excess
production of cortisol but will require lifelong
replacement medications.

20. Continue..
●In some cases, the tumor or its treatment will cause
the pituitary or adrenal gland to produce not enough
of other hormones, and your doctor will recommend
hormone replacement medications..

21. Radiation Theraphy
●If the surgeon can't totally remove a pituitary tumor, he
or she will usually prescribe radiation therapy as well as
surgery. Additionally, radiation may be used for people
who aren't suitable candidates for surgery.
Radiation can be given in small doses over a six-week
period, or with a technique called stereotactic
radiosurgery. In the latter procedure, a large, one-time
dose of radiation is delivered to the tumor, and the
radiation exposure to surrounding tissues is minimized

22. Nursing Diagnose.
●Risk for injury related to weakness.
●Risk for infection related to altered protein
metabolism and inflammatory response.
●Self care deficit related to weakness, fatigue, muscle
wasting, and altered sleep patterns.
●Impaired skin integrity related to edema, ●impaired
healing, and thin and fragile skin.
●RISK for infection.

23. Nursing Diagnose..
●Impaired skin integrity related to edema, impaired
healing, and thin and fragile skin.
●Disturbed body image related to altered physical
appearance, impaired sexual functioning, and
decreased activity level.

24. Nursing interventation
●Decrease risk of injury(Provide protective environment to
prevent falls,fractures & bone injury..
Decrease risk of infection(follow hygiene)as well
demonstrate the pt;.
●Increase ability to carry out self-care activities.
●Improve skin integrity.
●Improve body image.
●Improve mental function.

26. Raference..
Www.mayoapp.com
Www.sabqfound.com
Www.google.com
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