Emilio

Aguinaldo Start
College

CUSHING'S
Subject : MEDICAL-SURGICAL NURSING Presented by: ANDREA L. MAUNGCA
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DESCRIPTION
Cushing's is a hormonal disorder caused by high levels of the hormone cortisol in your
body over a long period of time. It’s also known as hypercortisolism. It is sometimes
called the “stress hormone” because it helps your body respond to stress. Cortisol also
helps
maintain blood pressure
regulate blood glucose, also called blood sugar
reduce inflammation
turn the food you eat into energy
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ETIOLOGY
(Cushing's Disease)
Endogenous Factor : originating within the body
Pituitary Adenoma
Adrenal Tumors
Ectopic ACTH Syndrome
Adrenal Hyperplasia

(Cushing's Syndrome)
Exogenous Factor : typically from medication
Long-term Use of Corticosteroid Medications
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RISK FACTOR
Several risk factors can increase the likelihood of developing this condition, including:
Long-term use of corticosteroid medications
Pituitary tumors
Ectopic ACTH Syndrome
Adrenal gland tumors
Genetic factors
Age and gender
Obesity
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ANATOMY AND
PHYSIOLOGY
Pituitary Gland
Adrenal Glands
Hypothalamus-Pituitary-Adrenal (HPA)
Axis
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
Pituitary Adenoma Formation: Cushing's disease is
Increased Cortisol Production: Elevated levels
caused by a benign tumor or adenoma in the pituitary
of ACTH stimulate the adrenal cortex to produce and
gland, typically in the anterior portion known as the pars
distalis. adenoma secretes excessive amounts of ACTH.
release cortisol excessively.

Excessive ACTH Production: The pituitary
adenoma produces ACTH in excess, leading to
hyperstimulation of the adrenal glands.
Negative Feedback Mechanism: Normally, high cortisol
levels inhibit the release of CRH and ACTH via a negative
feedback loop. However, in Cushing's disease, the tumor
continues to produce ACTH despite elevated cortisol levels.
 PATHOPHYSIOLOGY
Systemic Effects: Excess cortisol leads to a range of systemic effects, including:

Metabolic Effects: Increased gluconeogenesis

Immunosuppression: Reduced immune function,
(formation of glucose), leading to hyperglycemia.
leading to increased susceptibility to infections and
Lipolysis and proteolysis result in fat redistribution
delayed wound healing.
and muscle wasting.

Cardiovascular Effects: Hypertension due to

Musculoskeletal Effects: Osteoporosis due to
increased sensitivity to catecholamines and
bone resorption and muscle weakness.
mineralocorticoid effects of cortisol.

Psychological Effects: Mood disturbances,

cognitive impairment, and psychiatric symptoms
may occur.
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CLINAL
MANIFESTATION
[ Acronym ]

STRESSED Skin fragile

Truncal obesity
Round face “moon face”, Reproductive issues
Ecchymosis, Elevated blood pressure
Striae on the extremities and abdomen (purplish)
Sugar extremely high (hyperglycemia)
Excessive body hair esp. women “Hirsutism”
Dorsocervical fat pad (Buffalo Hump), Depression
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24-HOUR URINARY FREE CORTISOL LATE-NIGHT SALIVARY CORTISOL

TEST LEVEL

Common test that collects your urine for 24 Measures cortisol in your saliva. As the name
hours to measure how much cortisol is in it suggests, these tests happen at night.

DEXAMETHASONE SUPPRESSION TEST

Take a low-dose steroid pill at night and
LABORATORY & then take a blood test in the morning to see
how much cortisol your body still makes.
DIAGNOSTICS If the ACTH level is high, the next
step is to give an injection of a high dose
of dexamethasone.
Cushing's
MEDICAL MANAGEMENT
TRANSSPHENOIDAL SURGERY
The primary treatment for Cushing's disease involves
removing the pituitary adenoma through the nose or
upper lip,
ENDOSCOPIC PITUITARY SURGERY
A less invasive approach using an endoscope to
access and remove the tumor.
RADIATION THERAPY
Used as an adjunctive or alternative treatment
when surgery is not feasible or unsuccessful.
Techniques include conventional external beam
radiation therapy or stereotactic radiosurgery
(e.g., Gamma Knife).
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MEDICATIONS
Cortisol-lowering medications:
Ketoconazole, metyrapone, and mitotane may be
prescribed to inhibit cortisol synthesis or block its
effects.
Somatostatin analogs: Drugs like pasireotide
can suppress ACTH secretion from the tumor.
Dopamine agonists: Bromocriptine and
cabergoline may help reduce ACTH levels in
some cases.
Glucocorticoid receptor antagonists:
Mifepristone can block the effects of cortisol in
patients with severe symptoms.
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NURSING MANAGEMENT
PATIENT EDUCATION SYMPTOM MANAGEMENT PREOP PREPARATION

Educate patients about their Assist patients in managing Prepare patients for surgery by
condition, treatment options, symptoms such as hypertension, explaining the procedure,
and potential side effects of diabetes, and emotional potential risks, and
medications. disturbances. postoperative care.
Provide information on Monitor for signs of infection Ensure patients understand
lifestyle modifications, such as and provide appropriate nursing preoperative instructions, such
dietary changes and stress care. as fasting and medication
management techniques. management.

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 Cushing's

NURSING MANAGEMENT
POST-OP CARE PSYCHOSOCIAL SUPPORT

Monitor patients closely for complications such
as cerebrospinal fluid leak, nasal packing, or
infection.
Assess for signs of adrenal insufficiency and
provide glucocorticoid replacement therapy as
needed.
Offer emotional support and counseling to
patients and their families, as Cushing's disease
can have a significant impact on quality of life.
Provide resources for support groups or
counseling services.

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COMPLICATION
Cushing’s syndrome can cause health problems such as:
Heart attack and stroke
Blood clots in the legs and lungs
Infections
Bone loss and fractures
High blood pressure
Unhealthy cholesterol levels
Depression or other mood changes
Memory loss or trouble concentrating
Insulin resistance and prediabetes
Type 2 diabetes
Emilio
Aguinaldo Finish
College

THANK YOU!
Subject : MEDICAL-SURGICAL NURSING Presented by: ANDREA L. MAUNGCA