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endocrine > Cushing Syndrome/Disease > Flashcards

Cushing Syndrome/Disease Flashcards

1
Q

Adrenal gland

A

Medulla ( inner portion of Adrenal gland)
- Catecholamine: epinephrine & norepinephrine
Cortex (outer portion of Adrenal gland)
- Glucocorticoid: Cortisol
- Mineralocorticoids: Aldosterone
- Androgens

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2
Q

What is Cushing Syndrome?

A

A condition of Chronic exposure to excessive corticosteroids, particularly Glucocorticoids.

  • Cushing has to do with glucose metabolism
  • holding onto water & sodium = ⬆️ volume & thickness
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3
Q

What causes Cushing syndrome.

Etiology

A

Most common cause!

  1. Iatrogenic administration of exogenous corticosteroids
    - Prednisone: Asthma, autoimmune, etc. patients
  2. ACTH secreting pituitary tumor: stimulates production of cortisol
  3. Adrenal Cortisol secreting tumor: from kidney
  4. excess secretion of ACTH from carcinoma (usually lungs & pancreas) outside of Hypothalamic-pituitary-adrenal a is.
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4
Q

Clinical manifestations of Cushing Syndrome II

A
  • Protein wasting -Muscle weakness
  • Muscle weakness - Osteoporosis
  • pathologically FX - Bone & Back pain
  • HTN 2/2 Hypervolemia - inhibition of immune system
  • Na+ & water retention -Edema
  • Hirsutism - Thin limbs & Thin skin - Menstrual irregularities
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5
Q

CLASSIC Cushing Syndrome clinical manifestations

A
  • Weight gain: accumulation of adipose tissue in trunk, face, & cervical area
  • Moon face
  • Buffalo hump
  • Hyperglycemia: Cortisol induced Insulin Resistance
  • Purple Striae: Worst stretch marks ever!
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6
Q

Diagnostic testing for Cushing Syndrome

A
  • 24 hour Urine Cortisol: book urine cortisol levels higher than 80-120/ 24hr indicate Cushing.
  • Plasma ACTH levels: from kidneys to pituitary OR pituitary to kidneys?
  • Plasma cortisol
  • CT scan, MRI: looking for tumor(s)
  • CBC, electrolytes: glucose, potassium, sodium
  • eye exam
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7
Q

Dexamethasone Suppression Test

Diagnostic testing

A

Give 2-4 mg of Dexamethasone to lower ACTH that the pituitary is secreting

Normal person: ⬇️Cortisol levels (depressed)
Cushing person: Cortisol levels stay ⬆️ ( no effect)

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8
Q

Surgery for Cushing Syndrome

A

-TransSphenoidal for Pituitary Tumor: up nose to pituitary gland

-Adrenalectomy for malignant tumors: remove medulla & cortex of adrenal gland from 1 kidney.
If B/L removal is required they’ll require hormone replacement tx

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9
Q

Radiation for Cushing Syndrome

A

Killing off/ destroying the tissue

Hopefully only has to be done on 1 kidney (one medulla & cortex)

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10
Q

Monitor Post Op for Cushing Syndrome

A
  • Post Op hemorrhage
  • BP, fluid balance, I&O, & electrolytes
  • Infection
  • Urine cortisol levels
  • High dose of Corticosteroids (SoluCortef): ⬆️doses given intraop & postop to respond to stress. 24-48 hrs postop IV cortisol given to adjust patient. Cannot abruptly stop even after surgery, so you ween them off.
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11
Q

Pharmacological management of Cushing Syndrome I

A

Mitotane “Medical Adrenalectomy”
- suppresses cortisol production , alters peripheral metabolism of cortisol, & ⬇️ plasma & urine corticosteroids. DESTROY medulla & cortex.
Ketoconazole, Metyrapone, Cytadren
- inhibits cortisol synthesis

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12
Q

Pharmacological management of Cushing Syndrome II

A
  • Gradual d/c of corticosteroids
  • Reductions of the corticosteroid dose:still need to treat comorbidity. Gradually taper off to avoid life threatening adrenal insuff.
  • Conversion to an alternate-day regime: BID doses of short-acting corticosteroids given in morning
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13
Q

Cardiovascular complications of Cushing Syndrome

A 
⬆️ water (holding onto)
⬆️ glucose  (holding onto)
                                           High Risk for :
- CAD
- HF
- CHF
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14
Q

Diabetes Mellitus complication of Cushing Syndrome

A

Steroid Induced Diabetes

  • you have to do all the teaching you’d do for a DM patient*
  • Diabetic foot
  • Finger Stick
  • Monitor/ control Diet
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15
Q

Infections complication of Cushing Syndrome

A

Steroids DEPRESS immune system

  • ⬆️ risk for infection
  • Monitor WBC
  • Hand hygiene
  • Flu vaccine (Flu season)
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16
Q

Thromboembolic Phenomena (polycythemia)

A

google
Increases frequency due to predisposing factors
- obesity
- HTN
- ⬆️ haematocrit
- major surgery AND “ hypercoaguable state”

17
Q

Changes in appearance of Cushing Syndrome

A
  • Hirsutism

- Gynecomastia

18
Q

Interventions for Cushing Syndrome

A
  • Monitor VS
  • Daily Weights
  • Monitor Glucose
  • Emotional Support: d/c steroids may cause depression
  • Control HTN, hyperglycemia, hypokalemia
  • Diet (⬆️Protein): you want them to break down protein NOT glucose. They need to have sufficient protein in order to do that.
19
Q

Education for Cushing Syndrome

A
  • Medical alert bracelet
  • Avoid exposure to extreme Temperatures, infections, and emotional disturbances
  • Adjustment corticosteroid replacement therapy
  • Life replacement

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