Cushing's syndrome definition, causes, pathophysiology,c/m, memonic,treatments,complications included in this presentation

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CUSHING’S SYNDROME
BY MEGERSA ALENE REGASSA

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Outline of presentation
Definition
Causes
Pathophysiology
Clinical manifestation
Diagnosis
Management
Complication
Nursing diagnosis of cushing’s syndrome

3. DEFINITION
▪ Cushing's syndrome is a characteristic group of
manifestations caused by excessive circulating
free cortisone
▪ A condition resulting from long term exposure to
excessive glucocorticoids.
▪ The term "Cushing's disease" is reserved for
Cushing's syndrome that is caused by excessive
secretion of adrenocorticotropin hormone
(ACTH) by a pituitary tumor, usually an adenoma
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5. Pathophysiology
▪ When stimulated by ACTH, the adrenal gland
secretes cortisol and other steroid hormones.
▪ The switch that controls the feedback mechanism
is cortisol .
▪ When the levels are low the system turns on and
when high the system turns off.
▪ Excessive use of steroids leads to excess free
circulation of cortisol in the body.
▪ Excess cortisol in the body cause liver to release
more sugar,increase breakdown of muscle and fat
for energy and lowers amount of energy used by
cells,also increase anti inflammatory effects and
lowers the body ability to protect itself. 5

6. Clinical manifestations
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7. Clinical manifestat…
■ Fatigue ,anxiety,irritability
■ Thinning skin that bruises easily
■ Erectile dysfunction,decreased libido,clitoral
enlargement
■ Obesity, increased susceptibility to infection
■ Mental changes,depression,insomnia,psychosis
■ hyperpigmentation,hypokalemia
■ poor wound healing
■ peripheral edema,weight gain
■ hematologic leukocytosis,lymphopenia,bone loss
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9. Diagnosis
■ History and physical examination
■ Blood tests to check ACTH,cortisol and potassium
levels
■ Dexamethasone suppression tests
■ Fasting glucose
■ Eosinophils decreased on complete blood count.
■ 24 hr urinary free cortisol test
■ Skull X-ray, CT scan and ultrasonography
■ ACTH stimulation tests
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10. Medical Management
▪ Treatment depends on the cause
▪ Reducing corticosteroid use
▪ Cortisol inhibiting
medication{ketoconazole,metyrapone}
▪ Surgery -to treat pituitary cushing's syndrome
▫ Transsphenoidal adenomectomy{remove tumor in
pituitary gland}
▪ Bilateral adrenalectomy is used to treat adrenal
causes.
▪ Radiation therapy
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12. Nursing Management
▪ Provide time for discussion of the disease
and treatment; encourage verbalization of
feelings and identify successful coping
mechanisms used in the past.
▪ Encourage turning, coughing, and deep
breathing
▪ Monitor for signs of infection because risk is
high with excess glucocorticoids.
▪ Advise the patient how to recognize signs
and symptoms
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13. Nursing Management
▪ Assess the skin frequently to detect
reddened areas, skin breakdown or tearing,
excoriation, infection or edema.
▪ Handle skin and extremity gently to prevent
trauma; prevent falls by using side rails.
▪ Avoid using adhesive tape on the skin to
reduce trauma on its removal.
▪ Encourage the patient to turn in bed
frequently or ambulate to reduce pressure on
bony prominences and areas of edema.
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14. Complications
➢Infection
➢Hypokalaemia
➢Hypertension
➢Osteoporosis
➢Peptic ulcer disease
➢Retarded linear growth
➢Virilisation[due to excess production of
androgens]
➢diabetes,enlargement of pituitary tumor….
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15. NURSING DIAGNOSIS
▪ Fluid volume excess, related to sodium
retention causing edema and hypertension
▪ Risk for injury, related to generalized fatigue
and weakness
▪ Risk for infection, related to impaired immune
response and oedema
▪ Body image disturbance, related to physical
changes secondary to Cushing’s syndrome
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