ALMIN, RAZELLE S.

BSN3Y2-2

LABORATORY

WEEK 7. COURSE TASK LEC CU6

NCMB316
DISCUSSION QUESTIONS:
1. DISCUSS THE PROBABLE CAUSES OF THE ALTERATIONS IN T.H.’S LABORATORY RESULTS.
ANSWER: T.H is the affected by the disease of Cushing syndrome. That’s why the all
changes came in his body. Too much of the hormone cortisol in your body causes
Cushing syndrome. Cortisol, which is produced in the adrenal glands, plays a variety of
roles in your body. For example, cortisol helps regulates your blood pressure, reduces
inflammation and keeps your heart and blood vessels functioning normally. Cortisol
helps your body respond to stress. It also regulates the way your body converts
proteins, carbohydrates and fats in your diet into energy. The role of corticosteroid
medications (exogenous Cushing syndrome). Cushing syndrome can develop from taking
oral corticosteroid medications, such as prednisone in high doses over time. Oral
corticosteroid may be necessary to treat inflammatory disease, such as rheumatoid
arthritis, lupus and asthma. They may also be used to prevent your body from rejecting
a transplant organ. It’s also possible to develop Cushing syndrome from injectable
corticosteroids, for example repeated injections for joint pain, bursitis and back pain.
Inhaled steroid medicines for asthma and steroid skin creams used for skin disorders
such as eczema are generally less likely to causes Cushing syndrome than are oral
corticosteroid. But in some individuals these medications may cause Cushing syndrome,
especially if taken high doses.

2. EXPLAIN THE PATHOPHYSIOLOGY OF CUSHING SYNDROME.

ANSWER: When stimulated by ACTH, the adrenal glands secrete cortisol and other
steroid hormones. ACTH is produced by the pituitary gland and released into the
petrosal venous sinuses in response to stimulation by corticotropin-releasing hormone
(CRH) from the hypothalamus. ACTH is released in a diurnal pattern that is independent
of circulating cortisol levels: peak release occurs just before awakening and ACTH levels
then decline throughout the day. Control of CRH and ACTH release is maintained
through negative feedback by cortisol at the hypothalamic and pituitary levels. Neuronal
input at the hypothalamic level can also stimulate CRH release.
Although the adenomas of Cushing’s disease secrete excessive amounts of ACTH,
they generally retain some negative feedback responsiveness to high doses of
glucocorticoids. Ectopic sources of ACTH, usually in the form of extracranial neoplasms,
are generally not responsive to negative feedback with high doses of glucocorticoids.
However, some overlap exists in the response to negative feedback between pituitary
and ectopic sources of excessive ACTH.
3. WHAT DIAGNOSTIC TESTING WOULD IDENTIFY THE CAUSE OF T.H.’S CUSHING
SYNDROME?
ANSWER: This diagnostic test may help pinpoint the cause:
 Urine and Blood test - These test measure hormone levels and show whether T.
H’s body is producing excessive cortisol. For the urine test, T.H may ask to collect
your urine over a 24-hour period. Urine and blood samples will be sent to a
laboratory to be analyzed.
 T. H’s doctor might also recommend other specialized tests that involve
measuring cortisol levels before and after using hormone medications to
stimulate or suppress cortisol.
 Saliva test – Cortisol levels normally rise and fall throughout the day. In people
without Cushing syndrome, levels from a small sample of saliva collected late at
night, doctors can see if cortisol levels are too high.
 Imaging tests - CT or MRI scans can provide images of your pituitary and adrenal
glands to detect abnormalities, such as tumors.
 Petrosal sinus sampling - This test can help determine whether the cause of
Cushing syndrome is rooted in the pituitary or somewhere else. For the test,
blood samples are taken from the veins that drain the pituitary gland (petrosal
sinuses). A thin tube is inserted into your upper thigh or groin area while T. H is
sedated and is threaded to the petrosal sinuses. Levels of ACTH are measured
from the petrosal sinuses and from a blood sample taken from the forearm. If
the ACTH level is higher in the sinus sample, the problem stems from the
pituitary. If the ACTH levels are similar between the sinuses and forearm, the
root of the problem lies outside of the pituitary gland.

4. WHAT IS THE USUAL TREATMENT OF CUSHING SYNDROME?

ANSWER: The overall goal of Cushing’s syndrome treatment is to lower the levels of
cortisol in body. This can be accomplished in several ways. The treatment that receives
will depend on what’s causing condition. T. H's healthcare provider may prescribe a
medication to help manage cortisol levels. Some medications decrease cortisol
production in the adrenal glands or decrease ACTH production in the pituitary gland.
Other medications block the effect of cortisol on tissues. Examples include:
ketoconazole (Nizoral), mitotane (Lysodren), metyrapone (Metopirone), pasireotide
(Signifor), mifepristone (Korlym, Mifeprex) in individuals with type 2 diabetes or glucose
intolerance.
 If T. H use corticosteroids, a change in medication or dosage may be necessary.
Don’t attempt to change the dosage u sh. T. H should do this under close medical
 supervision. Tumors can be malignant, which means cancerous, or benign, which
means noncancerous.

 If T. H's condition is caused by a tumor, your healthcare provider may want to

remove the tumor surgically. If the tumor cannot be removed, your healthcare
provider may also recommend radiation therapy or chemotherapy.

5. WHAT IS MEANT BY A ‘MEDICAL ADRENALECTOMY’?

ANSWER: Medical adrenalectomy - Agents that inhibit steroidogenesis, such as
mitotane, ketoconazole, metyrapone, and etomidate, have been used to cause medical
adrenalectomy. These medications are often are toxic at the doses required to reduce
cortisol secretion. For instance, ketoconazole's prescribing information was revised to
include a black box warning regarding hepatotoxicity, including fatalities and liver
transplantation. Thus, medical treatment should be initiated cautiously and, ideally, in
consultation with a specialist. Efficacy of these medical interventions can be assessed
with serial measurements of 24-hour urinary free cortisol. Patients receiving these
medications may require glucocorticoid replacement to avoid adrenal insufficiency.
Patients should be counseled on the signs and symptoms of adrenal insufficiency when
starting these drugs.
An orally administered steroidogenesis inhibitor, osilodrostat (Isturisa) acts on
11-beta-hydroxylase, an enzyme that catalyzes the last step of cortisol synthesis in the
adrenal cortex. It is indicated for adults with Cushing disease who cannot undergo
pituitary surgery or in whom the operation has not been curative.

6. PRIORITY DECISION: WHAT ARE THE PRIORITY NURSING RESPONSIBILITIES IN THE CARE
OF THIS PATIENT?
ANSWER: The priority nursing responsibility in the care of patient is to Identify nursing
diagnoses, two experts analyzed signs and symptoms registered in medical charts at the
time of risk classification. For priority level I patients, the most frequent nursing
diagnoses were acute pain (65.0%), respiratory insufficiency (45.0%), and impaired gas
exchange (40.0%). Nursing Care Planning & Goals.
The major nursing goals for the patient include:
 Decrease risk of injury.
 Decrease risk of infection.
 Increase ability to carry out self-care activities.
 Improve skin integrity.
 Improve body image.
 Improve mental function.
7. PRIORITY DECISION: BASED ON THE ASSESSMENT DATA PRESENTED, WHAT ARE THE
PRIORITY NURSING DIAGNOSIS? ARE THERE ANY COLLABORATIVE PROBLEM?
ANSWER: Based on the assessment data, the major nursing diagnoses of the patient
with Cushing’s syndrome include:

 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.
 Disturbed body image related to altered physical appearance, impaired sexual
functioning, and decreased activity level.
 Disturbed thought processes related to mood swings, irritability, and depression.
 Yes, it is collaborative problem. the home health nurse needs the patient's
complete medication history but the patient tells the nurse that many changes
were made in the hospital