Analysis of Cushing Syndrome and Gastrointestinal Bleeding

The assignment involves analyzing research papers and studies related to Cushing syndrome and gastrointestinal bleeding. It includes a list of references from various publications, including medical journals and books. The analysis focuses on understanding the symptoms, diagnosis, and treatment of Cushing syndrome, as well as its relationship with gastrointestinal bleeding. The goal is to provide a comprehensive overview of the topic, highlighting key points and findings from existing research.

Running head: CASE STUDY ON CUSHING SYNDROME
CASE STUDY ON CUSHING SYNDROME
Name of the student:
Name of the university:
Author note:

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CASE STUDY ON CUSHING SYNDROME
Question 1:
Researchers are of the opinion that there are two causes of Cushing syndrome in patients.
The first one is the exogenous source where intake of oral corticosteroid medications in
extremely high doses for a large period may result in occurrence of the diseases (Lowitz &
Klein, 2015). Oral corticosteroids like Prednisone are one of the medications that are provided to
individuals when they suffer from rheumatoid arthritis as well as lupus or asthma. In such
conditions, body requires more cortisol than it can actually possess to handle the disorders
(Martinez et al., 2016). In such situations, such medications produce side effects resulting in the
occurrence of Cushing syndrome. In the case study also, Maureen had been suffering from
rheumatoid arthritis from the age 15 and are prescribed to take prednisone for a long period. This
might have caused the disorder in the patient. Besides, in other cases, the body itself may result
in higher secretion of the hormone of cortisol like a noncancerous tumor in the pituitary gland
that results in secretion of high level of adrenocorticotrophic or ACTH hormone (Barber, 2017).
This stimulates the adrenal gland to produce more and more cortisol from the adrenal gland.
Moreover, in other cases tumors develop can develop on the adrenal gland those results in the
higher production of the cortisol in the body. This tumor is called the adrenal adenoma and
occurs on the adrenal cortex.
Researchers are of the opinion that the females who are between the age group of 25 to
40 are most prone to development of the disorder (Maletkovic, 2018). Moreover, obesity, type 2
diabetes as well as poorly controlled glucose levels as well as hypertensions are the main risk
factors that make individuals highly vulnerable to the development of the disease (Lowitz &
Klein, 2015). Moreover, taking of corticosteroid medication is yet another risk factor that
associates with the disease. Primary adrenal gland disorders, nodular enlargements of the adrenal

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glands, pituitary gland tumors and others are highly responsible for the occurrence of the
disorders.
Studies suggest that Cushing syndrome is not treated properly or remains untreated, it
may result in bone loss, muscle loss or weakness, high blood pressure, fracture in bones,
infections, enlargement of the pituitary tumors as well as kidney stones (Yedinac, 2016). All
these will lead to poor quality life of the individuals making them suffer physically as well as
mentally. Such suffering of the patients result their caregivers to face emotional turmoil and they
get depressed to see their suffering and pain. It results in financial flow on the healthcare
expenses that may affect the lives of the family members along with the patients (Maletkovic,
2018).
Question 2:
Weight gains as well as fatty tissue deposits mainly in the midsection, upper back, in the
face like a moon face and between the shoulders like a buffalo hump are seen in individuals who
are affected by the disorders. Researchers are of the opinion that cortisol helps the body to
handle stress. When stress level is high in blood, cortisol level rises up. In such situation, cortisol
helps in the stimulation of the fat as well as carbohydrate metabolism in the stressful situations.
This in turn leads to increased blood sugar level that the body requires for fast energy. Therefore,
this result in stimulation of more insulin releases which increases appetite and results in more
calories intake takes place in terms of food intake (Yedinac, 2016). Even after over of the stress
situation, cortisols linger in the body and try to bring the body in balance. The hormone does this
by increasing appetite for properly replacing the fact and carbohydrate that had been already
usedfor the flight and fight response. Consuming more food results in fat accumulation in the

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body. This causes obesity. Overproduction of the cortisol also results in the liberation of the
amount of amino acids from muscle tissue that accompanies resultant weakening of the protein
structures specifically the elastic and muscle tissue. This results in development of protuberant
abdomen that accompanies the purple striae, poor wound healing, marked osteoporosis and
others. High level of cortisol is also responsible for the distribution of fat to specific regions of
the body like that of the chest, face, stomach and many other regions (Kine et al., 2017). A
buffalo hump like symptom mainly occurs as the accumulation of fat takes place on the neck as
well as shoulders giving the patients a typical symptom of Cushing syndrome. The fourth
symptom is the occurrence of edema as well as water retention that takes place under the skin.
Mineralocorticoid activity of the cortisol results in sodium as well as water retention. This in turn
leads to increase in the hydrostatic capillary pressure. This in turn results in increased leakage of
the fluid through the capillaries all over the body. There is also increased weakness of the
muscles that mainly takes place due to increase in the catabolism of the proteins for single amino
acids for the process of gluconeogenesis as well as decreased transport of the amino acids into
the different skeletal muscle tissues that occur under the effect of cortisol (Tating et al., 2016).
Question 3;
One of the FDA approved drug is the class of pasireotide. This drug is mainly seen to activate a
broad spectrum of the different receptors of somatostatin. This class of drug is seen to have a
higher binding affinity for somatostatin receptors like those of the receptors 1,3 and 5. It also
provides a comparable binding affinity for somatostatin receptors like receptor 2. This binding as
well as activation may result in inhibiting of the ACTH secretion in the patients who are
suffering from Cushing syndrome (Papaoin et al., 2015). Researchers have also stated that this
class of drug is also more powerful for the inhibition of the releases of the human growth

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hormone, glucagon and insulin. Thereby this drug is seen to promote reduced levels of cortisol
secretion in the patients suffering from Cushing syndrome. However, the professionals have to
be aware of the side effect like that, it causes an increase in the blood sugar level and may cause
diabetes.
Another FDA approved medication is called the mifepristone. This medication is helpful as it
blocks the effect of excessive cortisol in comparison to other drugs that mainly take part in
decreasing the levels of cortisol in the blood. It mainly does so by following the procedure of
antagonizing the cortisol receptors in the body of the patient. Researchers have found that such
medications helps in binding with the glucocorticoid receptor blocker and thereby helps in the
blocking if the action of the cortisol (Langton et al., 2018) Thereby it helps to decrease the
symptoms of the disorder and help in improving the metabolic derangements that remains
intricately associated by the excess amount of cortisol on blood. One of the best advantages of
using this medication is the improvement of blood sugar and development of the physical
features in the patients. However, nausea, low potassium level as well as headaches are common
side effects of the disorder. In the case of Maureen, it can be seen that se as high level of cortisol
and high level of blood glucose levels. Therefore, this medication would prove to be suitable for
her.
Question 4;
Gastrointestinal bleeding may be of various reasons out of which use of corticosteroids so
one of the factor. Various randomize control trail had assured of the fact and hence in the case of
Maureen, the excessive use of corticosteroids can be considered as the main factor for the
development of gastrointestinal bleeding. Attending to this acute situation would be the first

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priority of the healthcare professionals. For assessing the signs of GI bleed, the healthcare
professionals should first confirm the color of the stool and the vomit to ensure the presence of
blood signs in them. The professional should also assess the blood pressure of the patient, her
urine output and ere art rate for understanding the extent of the blood loss. If the patients shows
drop in blood pressure, time output as well as increased heart rate, then the professional can be
sure that extensive blood loss had taken place. This is the assessment phase (Abraham et al.,
2015). This will be followed by the diagnostic procedures. Here, the physician would need to
determine the exact site of the GI bleeding. These procedures would mainly be including the
endoscopy, sigmoidoscopy, colonoscopy and barium studies. Nursing professionals should
ensure that they are assisting the physicians properly and helping them with every procedure.
The third step would be mainly administering fluids and other treatments. The nurse should be
mainly providing importance to the administration of the blood, blood products, fluids,
electrolytes, vitamins and well as other medications. The nurse would mainly provide importance
to the replacements of the blood loss, prevent any further loss of blood hereby preventing
anemia. In case of very severe situations, the doctors may need to resuscitate the patient with
fluids and blood transfusion (Brown et al., 2017). In some cases, the patient may need surgery. In
other cases, the patients may be needed to give IV proton pump inhibitors (PPIs) such
as omeprazole (Prilosec) for suppressing acid. The nurse may also give prokinetics such as
erythromycin and metoclopramide. This helps in clearing the stomach from blood clots or any
food reside before endoscopy. The nurse should also be careful that she does not give any
medication to the patient that may cause further bleeding. The last step in the emergency ward
that should be conducted before transferring her to the general ward is proper evaluation. The
nurse had to make sure that the interventions that they have taken are successful or not.

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Reassessment would mainly include checking of the vital signs, inspecting the patient’s stool as
well as vomit. If the patient’s blood pressure, urine output and heart rate are normal, then the
interventions taken can be evaluated to be correct. (Jairath et al., 2015).

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References:
Abraham, N. S., Singh, S., Alexander, G. C., Heien, H., Haas, L. R., Crown, W., & Shah, N. D.
(2015). Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and
warfarin: population based cohort study. bmj, 350, h1857.
Barber, C. (2017). Rare health conditions, 5: haemochromatosis, Cushing's syndrome,
conversion disorder. British Journal of Healthcare Assistants, 11(10), 488-491.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing:
Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Jairath, V., Kahan, B. C., Gray, A., Doré, C. J., Mora, A., James, M. W., ... & Greenaway, J.
(2015). Restrictive versus liberal blood transfusion for acute upper gastrointestinal
bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. The
Lancet, 386(9989), 137-144.
Kline, G. A., Buse, J. D., Van Der Gugten, J. G., Holmes, D. T., Chin, A. C., & Sadrzadeh, S. M.
H. (2017). Factitious ACTH‐dependent, apparent hypercortisolism: The problem with
late‐night salivary cortisol measurements collected at home. Clinical
endocrinology, 87(6), 882-885.
Langton, K., Gruber, M., Masjkur, J., Steenblock, C., Peitzsch, M., Meinel, J., ... & Eisenhofer,
G. (2018). Hypertensive crisis in pregnancy due to a metamorphosing
pheochromocytoma with postdelivery Cushing's syndrome. Gynecological
Endocrinology, 34(1), 20-24.

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CASE STUDY ON CUSHING SYNDROME
Lowitz, J., & Keil, M. F. (2015). Cushing Syndrome: Establishing a Timely Diagnosis. Journal
of Pediatric Nursing: Nursing Care of Children and Families, 30(3), 528-530.
Maletkovic, J. (2018). A Case of Severe Iatrogenic Cushing’s Syndrome Followed by Adrenal
Crisis, Multifocal Pneumonia, Sepsis, Pulmonary Embolism and Prolonged Adrenal
Insufficiency. World Academy of Science, Engineering and Technology, International
Journal of Medical and Health Sciences, 5(2).
Martínez-Momblán, M. A., Gómez, C., Santos, A., Porta, N., Esteve, J., Ubeda, I., ... & Resmini,
E. (2016). A specific nursing educational program in patients with Cushing’s
syndrome. Endocrine, 53(1), 199-209.
Papoian, V., Biller, B. M., Webb, S. M., Campbell, K. K., Hodin, R. A., & Phitayakorn, R.
(2015). Patients'perception On Clinical Outcome And Quality Of Life After A Diagnosis
Of Cushing Syndrome. Endocrine Practice, 22(1), 51-67.
Tating, D. L., Montevirgen, N. D., & Cajucom, L. (2016, March). Cushing's Syndrome From
Pituitary Microadenoma and Pulmonary Nodules. In Oncology nursing forum (Vol. 43,
No. 2, pp. 136-140).
Yedinak, C. G. (2016). Development of a screening tool differentiating patient symptoms in
Cushing's, polycystic ovarian and metabolic syndromes.