Cushing Syndrome/Disease Flashcards
Adrenal gland
Medulla ( inner portion of Adrenal gland)
- Catecholamine: epinephrine & norepinephrine
Cortex (outer portion of Adrenal gland)
- Glucocorticoid: Cortisol
- Mineralocorticoids: Aldosterone
- Androgens
What is Cushing Syndrome?
A condition of Chronic exposure to excessive corticosteroids, particularly Glucocorticoids.
- Cushing has to do with glucose metabolism
- holding onto water & sodium = ⬆️ volume & thickness
What causes Cushing syndrome.
Etiology
Most common cause!
- Iatrogenic administration of exogenous corticosteroids
- Prednisone: Asthma, autoimmune, etc. patients - ACTH secreting pituitary tumor: stimulates production of cortisol
- Adrenal Cortisol secreting tumor: from kidney
- excess secretion of ACTH from carcinoma (usually lungs & pancreas) outside of Hypothalamic-pituitary-adrenal a is.
Clinical manifestations of Cushing Syndrome II
- 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
CLASSIC Cushing Syndrome clinical manifestations
- 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!
Diagnostic testing for Cushing Syndrome
- 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
Dexamethasone Suppression Test
Diagnostic testing
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)
Surgery for Cushing Syndrome
-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
Radiation for Cushing Syndrome
Killing off/ destroying the tissue
Hopefully only has to be done on 1 kidney (one medulla & cortex)
Monitor Post Op for Cushing Syndrome
- 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.
Pharmacological management of Cushing Syndrome I
Mitotane “Medical Adrenalectomy”
- suppresses cortisol production , alters peripheral metabolism of cortisol, & ⬇️ plasma & urine corticosteroids. DESTROY medulla & cortex.
Ketoconazole, Metyrapone, Cytadren
- inhibits cortisol synthesis
Pharmacological management of Cushing Syndrome II
- 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
Cardiovascular complications of Cushing Syndrome
⬆️ water (holding onto) ⬆️ glucose (holding onto) High Risk for : - CAD - HF - CHF
Diabetes Mellitus complication of Cushing Syndrome
Steroid Induced Diabetes
- you have to do all the teaching you’d do for a DM patient*
- Diabetic foot
- Finger Stick
- Monitor/ control Diet
Infections complication of Cushing Syndrome
Steroids DEPRESS immune system
- ⬆️ risk for infection
- Monitor WBC
- Hand hygiene
- Flu vaccine (Flu season)