Cushing Syndrome Flashcards
Adrenal glands
- triangular-shaped organs, found above the kidneys
- endocrine glands that produce a variety of hormones
Adrenal glands are made up of…
two distinct parts:
- adrenal cortex
- adrenal medulla
adrenal cortex
secretes glucocorticoids and androgen sex steroids
adrenal medulla
-epi/norepi
Cushings Syndrome
overproduction of cortisol, evaluate cause
- endogenous (made within body)
- formation of a pituitary microadenoma
Addison’s Dz
failure to produce enough cortisol and aldosterone
Cortisol
glucocorticoid hormone made from cholesterol
Cortisol function
- 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
Cushing Syndrome: Tumor produces…
adrenocorticotropic hormone (ACTH)
-this leads to hyperplasia of the adrenal glands and the result is excess production of cortisol
Cushing Syndrome is induced by…
chronic exposure to excess glucocorticoids
Endogenous vs. Exogenous Cushing Syndrome
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
Possible causes of Endogenous Cushing Syndrome
- Pituitary tumor (70 percent)
- Adrenal tumor (15 percent)
- other or unknown causes (15 percent)
adrenalectomy
surgical removal of the adrenal gland if there is a tumor
-patient will require steroid replacement therapy for life
24 hour urine for free cortisol
- gold standard
- over 300 mcg is diagnostic for Cushings
- low and high dexamethasone suppression test
MRI
detects pituitary microadenomas
CT
detect enlargement of adrenal glands due to hyperplasia
Transsphenoidal hypophysectomy
removal of pituitary adnemona via the sphenoid sinus.
Pre and Post op Teaching
- 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
Possible complications
- 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
persistent HAs unrelieved by mild analgesics may indicate….
increase in ICP
If pituitary gland is removed….
hormone replacement therapy for life
If surgery is contraindicated…
- radiation
- drug therapy
Drug Therapy if no sz
- Aminglutethimide
- Ketoconzole
Aminglutethimide
- anti steroid drug
- blocks production of steroids derived by cholesterol
Ketoconzole
may inhibit adrenal function
-use cautiously because these drugs are toxic levels required to decrease the synthesis of cortisol
Adrenalectomy Post op
- 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
