NCLEX Study Guide: Cushing’s Syndrome



A group of clinical abnormalities known as Cushing's syndrome, also known as Cushing's disease, hypercortisolism, or adrenal hyperfunction, are brought on by excessive levels of adrenocortical hormones, particularly cortisol or related corticosteroids, as well as, to a lesser extent, androgens and aldosterone. 


The prognosis is bad in individuals who are untreated and those who have an incurable ectopic corticotropin-producing cancer, depending on the underlying reason.


Causes


Cushing's syndrome has the following causes:


Excess. Cushing's syndrome is caused by excessive corticotropin synthesis and the subsequent hypertrophy of the adrenal cortex in about 70% of cases.

Tumor. The remaining 30% of patients develop Cushing's disease as a result of a benign cortisol-secreting adrenal tumor.


Clinical Signs and Symptoms


Depending on the adrenocortical hormone involved, Cushing's syndrome alters several bodily systems, similar to other endocrine illnesses.


Muscle weakness. Hypokalemia or a decrease of muscle mass through accelerated catabolism are the causes of muscle weakness. 


Buffalo hump. The Cushing's triad symptoms include the buffalo hump, which are fat patches on the upper back. 


Moon face. The Cushing's triad includes the moon face, which is characterized by excessive facial fat.


Complications


Cushing's syndrome complications include the following:


Addisonian crisis. The addisonian crisis and adrenal hypofunction are risks for the Cushing's syndrome patient whose symptoms are managed by stopping corticosteroids, having an adrenalectomy, or removing a pituitary tumor.


Adverse effects of adrenocortical activity.  By keeping an eye on laboratory results and daily weights, the nurse evaluates the patient's fluid and electrolyte status.


Evaluation and Diagnostic Results


These tests are used to look for Cushing's syndrome:


Low-dose dexamethasone suppression test.  An oral dose of dexamethasone (1 mg) is given at late in the evening and plasma cortisol levels are measured at 8 a.m. the following morning. This procedure typically confirms the diagnosis of Cushing's syndrome.


Stimulation test. In a stimulation test, the administration of metyrapone, which prevents the adrenal glands from producing cortisol, evaluates the hypothalamus' and pituitary gland's capacity to recognize and address low levels of plasma cortisol by increasing corticotropin production.


Imaging studies. Adrenal tumors are localized by ultrasound, CT scan, or angiography, which can also spot pituitary tumors.


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