Disease/Syndrome
Ratheesh.R
SLMGNC

Cushing's Disease/ Cushing's Syndrome:
Cushing's is a hormonal disorder caused by prolonged
exposure of the body's tissues to high levels of the
hormone cortisol. Your adrenal glands, which are right
above your kidneys, release cortisol when they receive a
chemical message from your pituitary gland. The message
comes in the form of adrenocorticotrophic hormone
(ACTH), which travels through the bloodstream.
The pituitary gland is known as the “Master gland of the
body”.
Introduction

Pituitary Hormones and Adrenals

Definition
It is a condition in which the plasma cortisol
level is elevated, causing signs and symptoms
of Hypercortisolism.

Causes of Cushing’s
⚫A benign tumorof theadrenal gland
⚫A benign tumorof the pituitary gland
⚫A benign tumorof the lung orotherorgan
⚫Extensive use of cortisone medication
⚫Administration of ACTH or Corticosteroids.
⚫Primary hyperplasia of both adrenal gland.
⚫Excessive secretion of adrenal androgen.
⚫Exogenous Glucocorticoid administration.

Cushing’s at it’s worst
Moon face Largertorsoand face

Pathophysiology:
Due to etiological factor
Normal feedback mechanisms that control adreno cortical
function are ineffective.
Resulting in excess secretion of adrenal cortical hormones
Inadequate amount of adrenal cortical hormones in
secretion
Hypercortisolism

Symptoms of Cushing’s Disease
Excess Glucocorticoids:
⚫ Weight gain/obesity
⚫ Heavy trunk and thin extremities
⚫ Buffalo hump in neck
⚫ Thin skin
⚫ Rounded face/moon face
⚫ Muscles wasted
⚫ Osteoporosis
⚫ Mental Disturbance
⚫ Increased susceptibility to infection.
Excess Mineralo-corticoids:
⚫ Hypertension
⚫ Hypernatremia
⚫ Hypokalemia
⚫ Weight gain
⚫ Expanded blood volume
⚫ Edema
Excess Antrogen:
⚫ Women- Hirsutism
- Breast atropy
- Clitoris enlargement
- Voice masculine
• Men- Loss of Libido
Gastro Intestinal:
⚫ Peptic Ulcer
⚫ Pancreatitis
⚫ Gastritisand Duodenitis
Ophthlmic:
⚫ Cataracts
⚫ Glaucoma
Others
⚫ Tachycardia
⚫ Fatty Liver
⚫ Mild slowing on EEG
⚫ Pituitary Adenoma
⚫ Migraines
⚫ Syncope
⚫ Memoryand cognitive skillsdiminished
⚫ Superficial skin infections
⚫
⚫

Diagnostic Evaluation
⚫History Collection
⚫Physical Examination
⚫CT Scan and USG
⚫Radio-ImmunoAssayof plasma ACTH
⚫Corticotropin releasing factor (CRF) Stimulation Test.
⚫Dexamethasonesuppression Test
⚫Blood samples
⚫X-raysof the skull
⚫Reduced eosinophils level
⚫Excessive Plasmacortisol level

Medical Management
⚫Mitotane = An agent toxicto theadrenal cortex.
⚫Metropine = Tocontrol (steroid hypersecretion) who
do not respond to mitotanetherapy.
⚫Amino-glutethimide = Effectively Blocking cortisol
production
⚫Protein anabollicsteroids may begiven to facilitate is
required (proteinand potassium replacement)

Surgical Mgt:
i) Trans sphenoidal adenomectomyor Hypophysectomy:
= Removal of pituitarygland
ii) Transfrontal Carinotomy:
= It is necessarywhen pituitary tumor is enlarge.
iii) Bilateral Adrenalectomy:
= Hyperplasiaof adrenals

Complication:
⚫Adrenal Carcinoma
⚫Addisonian crisis
⚫Adverseeffectsof Adreno – cortical activity.

Nursing Diagnosis
⚫Impaired skin integrity r/taltered healing and edema.
⚫Self caredeficit r/t musclewasting and fatigue.
⚫Anxietyr/tsurgery
⚫Risk for Injury tosurgical procedure.
⚫Self – Esteem disturbance related toaltered physical
appearance.

Addison's Disease

Introduction
O Addison's disease (also known as primary adrenal
insufficiency or hypoadrenalism) is a rare disorder of
the adrenal glands. It affects the production of two
hormones - cortisol and aldosterone.
O Cortisol is released in stressful situations and helps to
maintain your energy levels, your blood sugar levels and
carbohydrate metabolism.
O Aldosterone maintains the balance of salt and water in
your body, which helps to control blood pressure.

Definition
O A disease characterized by progressive
anemia, low blood pressure, great weakness,
and bronze discoloration of the skin. It is
caused by inadequate secretion of hormones by
the adrenal cortex.(Gluco-corticoids and
mineralocorticoids)

Etiology
O Auto immune response
O Inadequate secretion of the Adrenal
Hormone
O Infection of the Adrenal gland
O Atrophy of the adrenal cortex.

Pathophysiology
O Due to any factor
Adrenal cortex function is inadequate to meet needs for
cortical hormone
Causes deficiencies of the adrenocortical secretions
(glucocorticoids, sex hormones, and mineral corticoids)
Addison’s disease
Death (if untreated)

CLINICAL FINDINGS
O Fatigue
O Muscle weakness
O Muscle/joint pain
O Increased Insulin
Sensitivity
O Nausea
O Anorexia (decrease in
appetite)
O Irritability
O Depression
O Dehydration
O Hyperpigmentation
O Abnormal Pain
O Hyponatremia
O Hypotension
O Hypoglycemia
O Hyperkalemia
O Hypovolemia
O Vomiting
O Diarrhea
O Constipation
O Mouth lesions
O Decrease in body hair
O Weight Loss
O Low BMR

Diagnostic Findings
O History collection
O Physical examination
O ACTH Stimulating Test
O 24 Hrs urine studies
O Lab studies(Decrease glucose and
sodium level and Increased potassium
and WBC level)
O Blood Chemistry(Plasma cortisol and
aldosterone level)

Medications

Patient Education
O Increase salt intake during hot weather and
heavy exercise
O Never skip a dose. This could lead to an
Addisonian crisis.
O Learn to recognize the symptoms of an
Addisonian crisis. (Ex: pain in lower back,
severe vomiting and diarrhea , extreme
weakness, fainting.-Contact physician
immediately.)
O Wear Med alert tag
O Frequently monitor weight
O Reframe from stressful activities

Nursing Consideration
O Monitor BP and weight
O 2hr postprandial glucose test.
O Chest x-ray if prolonged tx.
O Electrolytes (k+); I&O ratio (decreasing
output and increasing edema).
O Plasma cortisol levels (norm: 6-
23mcg/dL); signs of infection cardiac
symptoms (edema, HTN)

Cont….
O Monitor patient frequently for
dysrhythmias
O Administer NaCl IV to increase sodium
O Administer Insulin
O Administer an antiemetic as tolerated
by the patient
O Provide high calorie snacks and finger
foods
O Daily weight
O Nutritional supplements

Complication
O Hypotension
O Nausea and Vommiting
O Weakness
O Coma
O Psychological Stress

Nursing Diagnosis
O Electrolyte Imbalance r/t vomiting, diarrhea
hyperkalemia and hyponatremia
O Imbalanced nutrition: less than body
requirements r/t anorexia, decrease in weight
and inadequate food intake.
O Fluid volume deficit r/t renal loss of sodium
and water.
O Activity intolerance r/t decreased cortisol
production and fatigue.

Thank you