ATI Unit 12 Cushings Disease/Syndrome

Question 1

What is Cushing’s disease/syndrome

Answer 1

oversecretion of adrenal hormones by the cortex

1. can be pituitary (oversecretion of adrenocorticotropic hormone) or adrenal (oversecretion by cortex)
2. Cushing’s syndrome: long-term use of glucocorticoids such as in asthma or rheumatoid arthritis

Question 2

what hormones does the adrenal cortex produce?

Answer 2

1. mineralocorticoids: alodersterone, increases water and sodium reuptake and K+ and Ca+ secretion in kidney
2. glucocorticoids: cortisol, (affects metabolism like fat storage, glucose production as well as immune responses decreases macrophages and eosinophils)
3. sex hormones: androgens and estrogen

Question 3

what are three things to advise someone with Cushing’s off the bat for health promotion?

Answer 3

1. diet: eat high in calcium and Vitamin D, no alcohol or caffeine b/c look out for gastric bleeding = black tarry stools, coffe-ground emesis
2. infection prevention, wash hands
3. monitor weight

Question 4

Manifestatoins of Cushing’s

Answer 4

1. fatigue, weakness, insomnia
2. decreased immune function without inflammatory response (no infection symptoms like redness, swelling, fever)
3. bruising, petechiae, thing fragile skin
4. hypertension (Na+ H2O retention)
5. tachycardia
6. weight gain/edema
7. gastric ulcers
8. moon face
9. truncal obesity
10. fractures (osteoporosis)
11. hirsutism/acne
12. muscle wasting
13. striae (reddened lines on abdomen and thighs)
14. hyperglycemia

Question 5

are cortisol levels elevated or depressed in Cushing’s?

Answer 5

elevated

Question 6

lab values of Cushing’s

Answer 6

glucose: elevated
calcium: decreased
potassium: decreased
sodium: elevated
lymphocytes: decreased

Question 7

what is done to measure cortisol production

Answer 7

dexamethasone suppression tests, cortisol will be suppressed after admin if don’t have Cushing’s

Question 8

Medications for Cushing’s

Answer 8

1. aminoglutethimide (Cytadren)
   - adrenal corticosteroid inhibitor
   - don’t use longer than 3 months
   (so think opposite, monitor hypotension and electrolyte opposite imbalances, gastric stuff)
2. ketoconazole (Nizoral)
   - antifungal agent that in high doses inhibits adrenal corticosteroid synthesis
   - liver toxicity, gastric effects
3. mitotane (Lysodren)
   - suppresses action of adrenal cortex
   - monitor for indications of schock and hepatotoxicity
   - used to reduce size of tumor
4. spironolactone (Lasix)
   - aldosterone antagonist
   - K+-sparing
   - used when bilateral adrenal hyperplasia is cause

consideration = hyperkalemia (nausea, diarrhea, muscle weakness, numbness/tingling in extremities and around mouth)

Question 9

what are complications of cushing’s disease

Answer 9

1. perforated GI lining/ulceration due to increase in cortisol
   - look for tarry, blackk stool and coffee-ground emesis
2. risk for bone fractures/osteoporosis from hypocalcemia
   - caution when ambulating
   - fall risk
3. risk for infection from decreased macrophages/eosinophils
   - also reduced inflammatory response
   - acoid ill people and crowds
4. risk for adrenal crisis/addisonian crisis
   - sudden withdrawal of meds or tumor
   - hypotension, hyperkalemia, hypoglycemia, hypercalcemia, hyponatremia,