Week 13 - Cushing's Syndrome

Question 1

What does Cushing’s look like in a patient?

Answer 1

Question 2

Clinical Manifestations of Cushing’s Diagram

Answer 2

Cortisol (4)
Androgen (2)

Question 4

Which tests are used to diagnose Cushing’s? (3)

Answer 4

• 24 hour urine for free cortisol
• Low dose dexamethasone suppression test
• CT or MRI of pituitary and/or adrenals for tumour localization

Question 5

How does the 24 hour urine for free cortisol test work?

Answer 5

• Cortisol release follows a circulation rhythm so this will catch it at different times of day
  elevated = cushings

Question 6

In lecture, what is primary cushing’s? (2)

Answer 6

Body creates tumour cells that release ACTH hormone
- cause adrenal cortex to release more and more hormones

Question 7

In lecture, how does the low dose dexamthasone suppression test work? (2)

Answer 7

• Normally cortisol decreases after getting dexamethasone
• Dexamethasone tells brain to stop making cortisol

Question 8

What is the treatment to Cushing’s? (3)

Answer 8

• If due to corticosteroid use (most common), gradually taper off or switch to alternate-day regimen
• BUT NEVER DISCONTINUE CORTICOSTEROIDS ABRUPTLY
• If tumour is the culprit, surgically remove gland or tumour

Question 9

What are the nursing assessments for Cushing’s? (6)

Answer 9

Monitor:
- vitals
- daily weight
- blood glucose
- Signs and sx of infection (redness, fever, may be minimal)
- Signs and sx of thromboembolic phenomena (cortisol increases hypercoag. state)
- Do not forget emotional support bc mood swings