PATHOPHYSIOLOGY OF CUSHING’S DISEASE (LEADING TO CUSHING’S SYNDROME)

PRECIPITATING FACTORS LEGEND PREDISPOSING FACTORS

 Anterior Pituitary Adenoma PRECIPITATING DISEASE SURGICAL  Multiple endocrine
FACTORS PROCESS TREATMENT neoplasia type 1 (MEN1
PREDISPOSING DIAGNOSTIC
NURSING
gene)
FACTORS TEST
INTERVENTION  Carney Complex
COMPLICATIONS/ NURSING
SIGNS AND DIAGNOSIS
 Familial Acromegaly
SYMPTOMS  Overweight/Obesity
DISEASE PROCESS W/O TREATMENT  Family History
DISEASE PROCESS W/ TREATMENT  Stress
 Female

HYPOTHALAMUS secretes
Corticotropin Releasing
Hormone (CRH)

CRH stimulates Pituitary Gland

to produce Adrenocorticotropic
hormone (ACTH)

ACTH travels into the Zona

Adrenal Adenoma
Fasciculata is also
of the Adrenal
stimulated and is making
Cortex
excess ACTH

Adrenal Cortex is stimulated to

produce Cortisol
 ACTH Plasma Level Check

Inappropriately High (>10

pg/mL)

Dexamethasone Suppression
Test

Suppression is Present

Cortisol remains in
Supraphysiological levels
Amplify effects of
Catecholamines in blood
vessels + Triggers Elevated High Blood UNTREATED Cortisol receptors in the Cortisol inhibits
mineralocorticoid Glucose brain are overstimulated Prostaglandins and
receptors dampens immune
response
 Complications
DIABETES Worsen
Retention of Sodium and
Water + Vasoconstriction
SHORTENED
High Insulin Levels LIFESPAN

Insulin targets
adipocytes to store
more fat molecules

CENTRAL OBESITY

Disturbed Body
Image

 Monitor vital signs,  Assess for any Selective Adenomectomy  Assess frequently
especially BP and changes in for subtle signs of
HR. personal infections.
 Monitor the client’s appearance  Avoid unnecessary
sodium and caused by the exposure to people
potassium levels. cortisol excess. Eradicates Pituitary with infections.
 Instruct the client to  Assess client’s Adenoma while  Use strict medical
reduce fluid intake feelings about retaining Normal and surgical asepsis
as indicated. their changed Pituitary Function when providing
 Encourage the client appearance and care.