Patho; Cushing's Syndrome
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Transcript of Patho; Cushing's Syndrome
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Cushings
SyndromePrepared by:
Aquino, Erica BiancaRivera, Annie Christine
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What is Cushings Syndrome?
A syndrome caused by anincreased production of ACTH from atumor of the adrenal cortex or of theanterior lobe of the pituitary gland, orby excessive intake of glucocorticoids.
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Risk Factors
Women ages 20-40 years old
Patients with corticosteroids
medication
Patients with Pituitary Gland Tumor
Excessive adrenocortical production
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OphthalmicGlaucomaCataract
CardiovascularHypertensionHeart failure
Endocrine/Metabolic
Trunchal obesityMoon faceBuffalo humpSodium retentionHypokalemia
VirilizationHirsutism
PsychiatricMood alterationsPsychosis
Immune FunctionDecreased inflammatory
responsesImpaired wound healingIncreased susceptibility to
infection
Skeletal
FractureOsteoporosisMuscularMyopathyMuscle weakness
DermatologicThinning of skinEcchymosesStriae
S
igns
and
S
ymp
toms
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Pathophysiolog
y
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Tumor of thePituitary gland
ExcessiveAdrenocortical
production
ExcessiveCorticosteroid
medication
Increase ACTH production
Increase secretion of hormonesfrom adrenal cortex
Increased(Glucocorticoids)
Increase Aldosterone(Mineralocorticoids)
Increase Androgen
Increaseinhibition ofinflammatoryresponse
Increasecortisol
production
Increasesodium and
water retention
Increase rate ofelimination of
Potassium
Exagerated
malecharacteristics
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Increaseinhibition ofinflammatoryresponse
Increasecortisol
production
Increasesodium and
water retention
Increase rate ofelimination of
Potassium
Exageratedmale
characteristics
Increasesusceptibilityto infection
Breakdown ofprotein and fat
EDEMA Increase bloodvessel
constriction
MOON FACE
FACIES
Increase bloodvolume
HYPERTENSIONexcessive
proteincatabolism
Increase
conversion ofamino acids to
glucose
Muscle wasting
High risk forosteoporosis
HYPERGLYCEMIA
Decreasepotassium in
the body
HYPOKALEMIA
VIRILIZATION
HIRSUTISM
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Diagnostic Procedures
Overnight Dexamethasone Suppresion Test
-A test to determine the cause of Cushingssyndrome
- I mg of Dexamethasone administered orally at
11 pm and plsama cortisol is obtained at 8 am in themorning
- False results may occur in some medicationssuch as Estrogen, Antiseizre and Rifampin
Plasma ACTH level- ACTH and cortisol level: Pituitary disease- ACTH cortisol level: Adrenal Disease
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24-hour Urinary Free Cortisol Level
CT-scan & MRI
- To localize sdrenal tissue and detecttumors
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Medical management
Restriction- Minimum dosage of corticosteroids
Radiation Therapy of the Pituitary Gland
Removal of Adrenal Gland(Adrenalectomy)
Replacement of Adrenal Hormones
Transsphenoidal hypophysectomy
- removal of the pituitary gland tumors
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Pharmacologic Management
Adrenal Enzyme Inhibitor(Ex. Metopirone, Cytadren, Lysodren)
- To reduced hyperadrenalism byinhibiting cortisol synthesis- Administered with meals
Hydrocortisone- Post-op: temporary replacement
therapy after surgery
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Nursing Management
Establish protective environment
Encourage high protein, calcium andvitamin D foods to avoid muscle wasting and
osteoporosis
Low sodium diet
Frequently assess the patient for signs ofinfection
Encourage moderate activities to prevent
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Avoid direct application of adhesive tape tothe skin and skin care is necessary
Encourage the patient and the family toverbalize feelings and concerns
Monitor fos signs and symptoms of
Addisonian crisis