Also known as Hypercortisolism, Itsenko-Cushing syndrome, Hyperadrenocorticism

1. BY RAJEE RAVINDRAN
RN, RM, MSN
CUSHING SYNDROME

2. WHAT IS CUSHING SYNDROME ?
Cushing’s syndrome is a cluster of clinical abnormalities
caused by excessive levels of CORTISOL
Adrenal
HyperfunctionHypercortisolism
Dr. Harvey Cushing

5. ENDOGENOUSEXOGENOUS
ACTH
DEPENDENT
ACTH
INDEPENDENT

6. CUSHING’S DISEASE
VS
CUSHING’S SYNDROME

7. Administration of
high dose steroids
Secretion of excess
ACTH
Excess Cortisol
production
PATHOPHYSIOLOGY

9. CLINICAL MANIFESTATIONS

10. CLINICAL MANIFESTATIONS

11. COMPLICATIONS

12. COMPLICATIONS

13. DIAGNOSIS

14. DIAGNOSIS

16. MEDICAL MANAGEMENT
Somatostatin Analogs: Pasireotide
Adrenal steroid inhibitors: Metyrapone,
Ketoconazole, Etomidate
Glucocorticoid receptor antagonist:
Mifepristone
Adrenolytic agents: Mitotane

17. Intramuscular formulation:
Initial dose: 10 mg intramuscularly every 4 weeks (28
days)
Maximum dose: 40 mg intramuscularly every 4 weeks
(28 days), after 4 months of treatment with 10 mg for
patients without normalized 24-hour urinary free cortisol
(UFC) levels after 4 months treatment who tolerated the
10 mg dose
Subcutaneous formulation:
Initial dose: 0.6 mg or 0.9 mg subcutaneously twice
daily.
Maintenance dose: 0.3 to 0.9 mg subcutaneously twice
daily.
Maximum dose: 0.9 mg subcutaneously twice daily
Duration of therapy: Treatment should be continued as
long as benefit is derived.

18. SURGICAL MANAGEMENT
TRANS SPHENOIDAL HYPOPHYSECTOMY
Surgical removal of the pituitary tumor through
the sphenoid sinus. It has 80% success rate.
ADRENALECTOMY

19. NURSING MANAGEMENT
NURSING ASSESSMENT
Health history- The history includes information about the patient’s level of activity and
ability to carry out routine and self-care activities.
Physical exam- The skin is observed and assessed for trauma, infection, breakdown,
bruising, and edema.
Mental function- The nurse assesses the patient’s mental function including mood,
responses to questions, awareness of environment, and level of depression.

20. NURSING MANAGEMENT
Nursing Diagnosis: Risk for injury related to weakness
Goal: Decrease risk of injury
Interventions:
 Provide a protective environment to prevent falls, fractures, and other injuries
to bones and soft tissues.
 Assist the patient who is weak in ambulating to prevent falls or colliding into
furniture.
 Recommend foods high in protein, calcium, and vitamin D to minimize muscle
wasting and osteoporosis; refer to dietitian for assistance.

21. NURSING MANAGEMENT
Nursing Diagnosis: Risk for infection related to altered protein
metabolism and inflammatory response.
Goal: Decrease risk of infection
Interventions:
 Avoid unnecessary exposure to people with infections.
 Assess frequently for subtle signs of infections (corticosteroids mask
signs of inflammation and infection).

22. NURSING MANAGEMENT
Nursing Diagnosis: Impaired skin integrity related to edema, impaired
healing, and thin and fragile skin.
Goal: Improve skin integrity.
Interventions:
 Use meticulous skin care to avoid traumatizing fragile skin.
 Avoid adhesive tape, which can tear and irritate the skin.
 Assess skin and bony prominences frequently.
 Encourage and assist patient to change positions frequently.

23. NURSING MANAGEMENT
Nursing Diagnosis: Disturbed body image related to altered physical
appearance, impaired sexual functioning, and decreased activity level.
Goal: Improve body image
Interventions:
 Discuss the impact that changes have had on patient’s self-concept and
relationships with others. Major physical changes will disappear in time if the
cause of Cushing syndrome can be treated.
 Weight gain and edema may be modified by a low-carbohydrate, low-sodium
diet; a high-protein intake can reduce some bothersome symptoms.

24. NURSING MANAGEMENT
Nursing Diagnosis: Disturbed thought processes related to mood swings,
irritability, and depression.
Goals: Improve mental function
Interventions:
 Explain to patient and family the cause of emotional instability, and help
them cope with mood swings, irritability, and depression.
 Report any psychotic behavior.
 Encourage patient and family members to verbalize feelings and
concerns.

25. SUMMARY
 Introduction
 Cushing disease vs Cushing's syndrome
 Related anatomy and physiology
 Clinical manifestations
 Complications
 Diagnosis
 Management

26. CONCLUSION
It has a multifactorial pathogenesis and contributes to the increased risk for myocardial infarction,
cardiac failure, or stroke, which are the most common causes of death. Neuropsychiatric disorders
can be responsible for suicide. Immune disorders are common; immunosuppression during active
disease causes susceptibility to infections, possibly complicated by sepsis, an important cause of
death, whereas immune rebound after disease remission can exacerbate underlying autoimmune
diseases.
Prompt treatment of cortisol excess and specific treatments of comorbidities are crucial to prevent
serious clinical complications and reduce the mortality associated with Cushing's syndrome.
Cushing's syndrome is a serious endocrine disease caused by chronic, autonomous, and excessive
secretion of cortisol.

28. EVALUATION

29. BIBLIOGRAPHY
• Black MJ. Management of clients with adrenal and pituitary disorders. In: Carroll GR, Keene MA, Melander S
(eds.) Medical surgical nursing. 8th ed. Missouri, Elsevier; 2009.p1044-1049
• Chintamani. Nursing assessment and management: Endocrine system. In: Mani m(ed). Medical Surgical
Nursing. Elsevier 2011. P1295-1298
• Polaski LA, Tatro ES. Luckmann’s. Nursing care of clients with Adrenal, pituitary and Gonadal disorders. Core
principles of and practices of Medical surgical Nursing. Philadelphia, Saunders; 1996. P1237-1240
• https://nurseslabs.com/cushings-disease-nursing-care-plan
• https://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)00086-3