cushing syndrome /disease Flashcards
DISORDERS/DISEASES OF ADRENALS:
- cushing’s syndrome - overproduction of cortisol, evaluate cause
- Addison’s disease- failure to produce enough cortisol and aldosterone
- adrenal cancer
- congenital adrenal hyperplasia
WHAT IS CORTISOL
-glucorticoid hormone made from cholesterol
function
- increase blood sugar
- inhibits protein synthesis
- increases protein breakdown
- breaks down amino acids in bone collagen
- decreases inflammatory immune response
- regulates electrolytes,lipolysis,
- produces adrenal androgen
-excess =clinical manifestations
ADRENAL GLANDS
- triangular shaped organs,found above the kidneys
- endocrine glands that produce a variety of hormones
- made up of two distinct parts:
adrenal cortex: secretes glucocorticoids and androfen sex steroids (can cause androgen in women
adrenal medulla: epi/norepinephrine
CUSHING DISEASE
- endogenous (made within the body )
- formation of a pituitary micro adenoma (tumor less than 10mm in size)
- tumor produces adrenocorticotrophic hormone (ACTH) this leads to hyperplasia of the adrenal glands and the result is EXCESSIVE PRODUCTION OF CORTISOL
CUSHING SYNDROME
- induced by chronic exposure to excess glucocorticoids
- endogenous caused by Cushing disease (70%)
- endogenous=excessive cortisol production from an adrenal gland adenoma
- exogenous= excess long term steroid use or treatment of an inflammatory or autoimmune disease (ex.prednisone, hydrocortisone,dexamethasone)
-
POSSIBLE CAUSES OF SYNDROME
endogenous=overproduction of cortisol caused by
- pituitary tumor
- adrenal tumor
- other or unknown causes
exogenous=
taking medicines containing glucocorticoids, such as hydrocortisone
TRANSSPHENOIDAL HYPOPHYSECTOMY
removal of pituitary adenoma via the sphenoid sinus
-surgical treatment of cushing’s disease
CUSHING’S SYNDROME NURSING CARE
- assess for history of steroid use
- if possible try to wean patient off steroids
- approximately 20-25% of the endogenous causes due to adrenocortical adenomas
- if tumor, surgical removal of the adrenal gland(adrenalectomy)
- patient will require steroid replacement therapy for life
POST-OP CARE/PRE-OP TEACHING
-nasal cavity packed up to 3 days
- labs to reflect
1. hyperglycemia
2. hypernatremia
3. hypokalemia
4. hypocalcemia - safety issues- fall risk -fractures
- anxiety and depression r/t cortisol levels
- oral care (gentle) patient may not use toothbrush for up to 10 days after procedure - what are alternatives (spongy swabs)
POST- OP CARE/PRE-OP TEACHING
- instruct pt to breathe through mouth due to nasal packing
- keep HOB elevated at least 30 degrees
- monitor patient’s neurological status for changes in LOC and pupillary response
- teach pt to avoid straining with BM, coughing and sneezing(decrease ICP)
- strict intake/ output records and daily wts.
- teach patient no to abruptly stop steroid therapy (steroid therapy
POSSIBLE COMPLICATIONS
- bleeding from incision
- infection of brain (LOC)
- increased intracranial pressure (ICP)
- cerebral spinal fluid leak
- fluid imbalance r/t transient diabetes insipidus
- persisitent headaches- unrelieved by mild analgesics may indicate an increase inICP
- remember if pituitary gland was removed patient may require hormone replacement therapy for the rest of their lives
ADRENALECTOMY POST-OP
- patient may have NG tube, foley , IV therapy
- SCDS
- high does of corticosteroids administered watch for signs of infection and delayed wound healing
- risk for hemorrhage due to highly vascular area of adrenal glands
- monitor vital signs/fluid and electrolyte status
- obtain morning urine samples for cortisol measurement to evaluate effectiveness of surgery
DRUG THERAPY
AMINOGLUTETHIMIDE - anti-steroid drug, blocks production of steroids derived by cholesterol
KETOCONZOLE- (anti-fungal) may inhibit adrenal function , use cautiously because these drugs are toxic at levels required to decrease the synthesis of cortisol
