CUSHING’S

SYNDROME

Female Ward Staff

NAFH Programme
January 31, 2011
Introduction

Harvey William
Cushing
Definition
• Cushing’s
Syndrome is
caused by chronic
excess of cortisol,
the condition is
then, in essence
called
Hypercortisolism.
 Incidence and Prevalence

Approx. 1 in 100,000 or 0.00% or

2,720 people in US develop Cushing’s
syndrome each year
Commonly affects female adults aged
20-50
Extrapolated incidence in Saudi
Arabia is 257 in every 25,795,938
Patients Profile
A 36-year-old female, Saudi Arabian
Admitted on Nov. 23, 2010
@ 2010H from ED
Presenting complaints of generalized
bodyache one month prior to admission
A known case of DM type II.
Assessment
Anatomy & Physiology

ENDOCRINE SYSTEM
Signs and Symptoms Endogenous
Exogenous Cushing’s
Cushing’s Syndrome
Syndrome
Paraneoplastic, small cells, bronchogenic
Caner or other nonendocrine cancer
ACTH receptor antibodies

Steroids
Cushing’s Disease Tumor Hyperplasia
Corticotroph Adenoma

ACTH
cortisol
ACTH
ACTH
Clinical manifestations
Cortical
Hyperplasia

cortisol
cortisol
Cushing’s
Syndrome
Complications
High Blood Pressure
Diabetes Mellitus
Obesity
High cholesterol and Triglycerides
Excess clotting of the blood
Osteoporosis
Psychological and Physical Changes
Diagnostic Tests
24-hour urinary free cortisol level
Midnight plasma cortisol and late-
night salivary cortisol measurements
Low-dose dexamethasone
suppression test (LDDST)
Dexamethasone-corticotropin-
releasing hormone (CRH) test
Management
Management
TREATMENT:

Depends on the specific reason for

excess cortisol and may include
surgery, radiation, chemotherapy, or
the use of cortisol-inhibiting drugs .
Management
SURGICAL Mgt
Transsphenoidal excision of tumors
Subtotal hypophysectomy

RADIATION THERAPY,
STEREOTACTIC RADIOSURGERY OR
GAMMA KNIFE RADIATION
Management
MEDICAL Mgt:
Ketoconazole Therapy

Aminoglutethimide Therapy

Metyrapone Therapy

Etomidate Therapy
Medications
 Tab. Methotrexate 15mg OD
 Tab. Prednisolone 35mg
 Tab. Alendronic Acid 70mg Once
Weekly
 Tab. Calcium Carbonate 600mg OD
 Tab. Naproxen 500mg B.I.D
 Tab. Relaxon 250mg B.I.D
 Tab. Tramadol Hcl 50mg B.I.D
 Tab. Pioglitazone 30mg OD
 Nursing Care Plan 1
Assessment Nursing Plan Intervention Evaluation
Diagnosis

Provide
After11quiet
Subjective:
Alteration
After hour
hourinenvironment
of Nursingand calm
Comfort:
ofNursing
activities
intervention
Verbalizes moderate
the patientto severe
will be body
was
Encourage verbalization of feelings
ache
Pain
relieved
related fromto inflammation
pain as manifested
of smallby
Encourage use of diversional activities
Objective:
joints
by of her
gradual
decreased hands,
decrease
pain both
of
scale
painelbows,
from
from and
9/10
pain
Provide comfort measures
left
to knee.
Facial
scale
4/10ofGrimace
9/10 to 4/10.
Encourage relaxation exercises
Guarding
Instruct Behavior
to report pain as soon as it begins
Administer
Expressive analgesics
behavioras ordered
Pain scale of 9/10
 Nursing Care Plan 2
Assessment Nursing Plan Intervention Evaluation
Diagnosis

Determine individual strength and skills

Establish remotivation
Objective:
Will
Self be
Demonstrated
careable
deficit
to demonstrate
techniques
related to / life style
Allow sufficient time for patient to
techniques/life
generalized
changes
Generalized
accomplish to
tasks
style
meet
weakness
body changes
self
malaise
to fullest care
andof
extent
to
needs.meet
fatigue
ability as
self care
evidenced
Limited
Assist needs.
with ROM
by inability
necessary to complete
adaptations to
accomplish ADLs
or
Performs
performself ADLscare. activities within
Arrange for assistive device
Will
theProvidebe of
level able
own to ability.
perform self care
for communication among those who
activities
are within
involved in level
caring and of own
assisting the client
ability.
 Nursing Care Plan 3
Assessment Nursing Plan Intervention Evaluation
Diagnosis

Assess
Will
Risk skin
Verbalized
befor frequently
able understanding
to verbalize
Impaired skin of
Objective:
Handle skin andof
understanding extremities
therapy. gently
therapy.
Integrity
Avoid use of adhesive tape
related
Encourage
Thin, to
thethin
fragile and
patient
skin fragile
to and
turn in bed
bruises
Will be able to behaviors
Demonstrated demonstrate /
skin.
frequentlyeasily.
behaviors
techniques / to
techniques
prevent to prevent skin
Use meticulous skin careskin
provide food
breakdown.
breakdown.
low in sodium
Conclusion
 The End
Special Thanks to:

Ms. Princess Santos

NURSING DEPARTMENT

Ms. Merlinda Castro

Mr. Abdulhamid Abdulradzak
Ms. Surul Ayn Que
Ms. Xilavi Alinah Mokoena

METD
Dr. Fawaz Al Harbi

DEPARTMENT OF MEDICINE
Dr. Mohammed Farooq
Thank You for Coming!

Have A Nice day …