Cushing syndrome Assignment pdf
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Added on 2021-04-17
Cushing syndrome Assignment pdf
Added on 2021-04-17
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Running head: NURSING Nursing Name of the StudentName of the UniversityAuthor note
1NURSINGCASE STUDY 2- MS MAUREEN SMITH Answer to question- 1Cushing syndrome is caused by the excess level of the hormone called Cortisol,responsible for regulating blood pressure and cardiovascular function. Excess release of theadrenocorticotropic hormone or ACTH by the pituitary gland due to tumor, is the other cause ofthe disease. The ACTH hormone stimulates the adrenal glands to release more Cortisol. It is thecause of the Cushing syndrome in 70% of the cases. Perforation in the descending colon leads tothe gastrointestinal discomfort. It is also the cause of gastric ulcer, due to the stimulation of vagalnuclei. It is attributed to the increased intracranial pressure. It results in increased gastricsecretion via hydrogen potassium ATPase pathway. In case of the patient Ms Maureen Smith, theCushing syndrome may be due to the “iatrogenic”form as she is under medication for rheumatoidarthritis (RA). This form is the side effect of the steroid hormone called glucocorticoids used intreatment of RA and many other illnesses. Other causes of the disease are malnutrition (Lacroix etal., 2015). In Australia, the incidence of the disease is 1-2 cases per million populations. It is found ion60% of the cases of hypercortisolism. The prevalence of the disease is 40 per million (SteffensenET AL., 2010). The risk factors associated with the Cushing syndrome are the type 2 diabetes, obesity,poor regulation of blood glucose level, corticosteroid medications, and adrenal glands containingbenign nodular enlargements. Age and gender are the other risk factors. Cushing syndrome ismost common in females than males. It is commonly diagnosed in the age group of 25 to 40. MsMaureen Smith is a 24 year old female and is suffering from type 2 diabetes. Her BMI is 28kg/m2
2NURSINGindicating overweight and high BGL (14.0mmol/L). Ms. Smith works in Pizza restaurant and mayhave been on high calorie and fat diet, which may have caused her vulnerable to the disease (Raff &Carroll, 2015). The patient may experience social isolation due to the symptoms such as gastrointestinalbleeding, muscle weakness and fatigue. It impacts the activities of daily living and occupation due tolack of energy. The disease also alters the personality owing to the personality changes (moon face),metabolic changes and impaired adjustment. It also alters the mood and may lead to depression andanxiety as side effects and endocrine disorder. The overall quality of life is poor when the disease isuntreated. The illness may also affect the family members emotionally and financially. Lack ofawareness of medical jargons and diseases management strategies may add to stress (Siegel et al.,2016). Answer to question- 2The five common signs and symptoms of the disease are given below withpathophysiology –Signs and symptomsPathophysiology1.Fatigue and weaknessHormonal imbalance and diabetes both resultsin weakness and fatigue. The hypothalamus-pituitary-adrenal (HPA) axisin the brainregulates sleep and stress. ACTH hormone stimulates the adrenal glandsto release more Cortisol resulting in diabetesand weakness as well as fatigue. High blood glucose can cause inflammation ofblood vessels and increase monocytesconcentration in brain, causing fatigue. It is also the side effects of medication forchronic illness such as rheumatoid arthritis(Lacroix et al., 2015)2.Weight gainIncreased Cortisol increases weight by fat
3NURSINGaccumulation in various body parts, bystimulating the fat metabolism during stress. It increases blood sugar and insulin resistanceleading to high appetitite. Excess glucose is converted to fat resulting inweight (Bizarro et al., 2015). Medicines likeprednisone for rheumatoid arthritis also causesweight gain as side effect. 3.Moon face and hump-Round shape of the face due to specific patternof fat distribution such as on sides of face. Fat deposition such as on shoulders mayappear as hump. It is attributed to increase fat metabolismstimulated by cortisol and obesity (Nieman,2015). Prednisone also causes increase in fatdistribution and swelling in face and neck.4.DiabetesHigh glucose level due to elevated Cortisol thatimpairs the glucose metabolism. Excess glucocorticoid stimulatesgluconeogenesis in the liver,inhibist insulinsensitivity, and increases glucose production. Consequently the insulin sensitivity is impairedand manifested as diabetes (Karaman et al.,2017)5.High blood pressureIncreased Cortisol leads to mineralocorticoidactivity in high concentration. It worsens the hypertension as excessglucocorticoids results in high plasma volume,peripheral vascular resistance and cardiacoutput. Glucocorticoids also exert hypertensiveeffects on cardiovascular regulation. This happens through central nervous systemvia mineralocorticoid receptors andglucocorticoid receptors. Glucocorticoidsincreases cardiac output. It also elevatesrenovascular resistance and peripheralresistance and ultimately results inhypertension (Pivonello et al., 2016).
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