Cushing Syndrome

Question 1

Adrenal glands

Answer 1

• triangular-shaped organs, found above the kidneys

- endocrine glands that produce a variety of hormones

Question 2

Adrenal glands are made up of…

Answer 2

two distinct parts:

1. adrenal cortex
2. adrenal medulla

Question 3

adrenal cortex

Answer 3

secretes glucocorticoids and androgen sex steroids

Question 4

adrenal medulla

Answer 4

-epi/norepi

Question 5

Cushings Syndrome

Answer 5

overproduction of cortisol, evaluate cause

• endogenous (made within body)
• formation of a pituitary microadenoma

Question 6

Addison’s Dz

Answer 6

failure to produce enough cortisol and aldosterone

Question 7

Cortisol

Answer 7

glucocorticoid hormone made from cholesterol

Question 8

Cortisol function

Answer 8

• increase BS
• inhibits protein synthesis
• increases protein breakdown
• breaks down amino acids in bone collagen
• decreases inflammatory immune response
• regulates electrolytes
• lipolysis
• produces adrenal androgen

Question 9

Cushing Syndrome: Tumor produces…

Answer 9

adrenocorticotropic hormone (ACTH)

-this leads to hyperplasia of the adrenal glands and the result is excess production of cortisol

Question 10

Cushing Syndrome is induced by…

Answer 10

chronic exposure to excess glucocorticoids

Question 11

Endogenous vs. Exogenous Cushing Syndrome

Answer 11

Endo: excessive cortisol production from an adrenal gland adenoma

Exo: cause outside of the body. Excess long term steroid use for tx of an inflammatory or autoimmune dz

Question 12

Possible causes of Endogenous Cushing Syndrome

Answer 12

• Pituitary tumor (70 percent)
• Adrenal tumor (15 percent)
• other or unknown causes (15 percent)

Question 13

adrenalectomy

Answer 13

surgical removal of the adrenal gland if there is a tumor

-patient will require steroid replacement therapy for life

Question 14

24 hour urine for free cortisol

Answer 14

• gold standard
• over 300 mcg is diagnostic for Cushings
• low and high dexamethasone suppression test

Question 15

MRI

Answer 15

detects pituitary microadenomas

Question 16

CT

Answer 16

detect enlargement of adrenal glands due to hyperplasia

Question 17

Transsphenoidal hypophysectomy

Answer 17

removal of pituitary adnemona via the sphenoid sinus.

Question 18

Pre and Post op Teaching

Answer 18

• nasal cavity packed up to 3 days
• labs to reflect: hyperglycemia, hypernatermia, hypokalemia, hypocalcemia
• safety issues, fall risk, fractures
• anxiety and depression r/t cortisol levels
• oral care (gentle), may not use toothbrush for up to 10 days after procedure
• breathe through mouth due to nasal packing
• HOB at least 30 degrees
• LOC changes
• avoid straining with BM, coughing, and sneezing (decreases ICP)
• strict I and O’s
• daily wts
• do not abruptly stop steroid

Question 19

Possible complications

Answer 19

• bleeding from incision
• infection of brain
• increased ICP
• cerebral spinal fluid leak
• fluid imbalance r/t transient diabetes insipidus
• persistent HAs unrelieved by mild analgesics

Question 20

persistent HAs unrelieved by mild analgesics may indicate….

Answer 20

increase in ICP

Question 21

If pituitary gland is removed….

Answer 21

hormone replacement therapy for life

Question 22

If surgery is contraindicated…

Answer 22

• radiation

- drug therapy

Question 23

Drug Therapy if no sz

Answer 23

• Aminglutethimide

- Ketoconzole

Question 24

Aminglutethimide

Answer 24

• anti steroid drug

- blocks production of steroids derived by cholesterol

Question 25

Ketoconzole

Answer 25

may inhibit adrenal function

-use cautiously because these drugs are toxic levels required to decrease the synthesis of cortisol

Question 26

Adrenalectomy Post op

Answer 26

• may have NG, foley, IVF
• SCDs
• HIgh dose of steroids administered
• risk of hemorrhage
• Monitor VS and Fluid/Electrolyte status
• morning urine samples for cortisol measurement to eval sx effectiveness