Cushing's Syndrome: Causes, Symptoms, Treatment and Nursing Care Strategies

Cushing's Syndrome is a metabolic disorder caused by excess production of corticosteroid hormones. It can be caused by a tumor or medication, prolonged exposure to cortisol, inherited disorders, or the body's overproduction of cortisol. The condition can cause psychological and physiological effects, including cognitive dysfunction, depression, muscle weakness, and cardiovascular events. Treatment options include ketoconazole, mitotane, and pasireotide. Nursing care strategies include assessment, nursing diagnosis, healthcare plan, nursing prescription, nursing evaluation, and prognosis.

1
CUSHING’S SYNDROME
University URL;
Student ID: password:
Course Name/Code:
Assessment Number:
Word Count:

2
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact
on the patient and family (400 words).
Cushing syndrome is a metabolic disorder resulting from excess production of corticosteroid hormones
by the adrenal cortex is involves obesity and high blood pressure(Guaraldi, &Salvatori2012). The
common causes of Cushing Syndrome include the following;
 Cushing syndrome can be caused by a tumor or by medication. Adrenal gland may develop a
tumor that makes too much cortisol. A tumor in the pituitary gland also causes Cushing
syndrome by some pituitary glands producing a hormone known as adrenocorticotrophic
hormone (ACTH), leading to the production of excess cortisol by stimulated adrenal
glands(Kamenický et al., 2011).
 Prolonged exposure to cortisol which generally is very useful to human life and is produced by
adrenal glands. Cortisol level increases naturally to health people during their stressful
situations, and when it is too high (hypercortisolism)for a long time, it causes negative effects
(Cushing syndrome). Cortisol causes structures and functions of the brain and this is a very
normal condition in people with Cushing syndrome as they complain about the loss of
memory(Andela et al., 2015).
 Inherited disorders also cause Cushing syndrome and they include multiple endocrine neoplasia
type 1 and Carney complex (Carroll, Raff &Findling 2009).
Cushing syndrome may also be due to your body’s on overproduction of cortisol also known as
(endogenous Cushing syndrome) occurring as a result of excess production by one or both adrenal
glands. Other times overproduction of the adrenocorticotropic hormone (ACTH) causes the condition.
Cushing syndrome may be related to:

3
 A pituitary gland tumor (pituitary adenoma). This is a non-cancerous (benign) tumor of the
pituitary gland that secretes an excess amount of ACTH, located at the lower side of the brain,
which prompts the adrenal glands to produce more cortisol. This form of the syndrome is called
Cushing disease and it occurs much more often in women than in men (Kamenický et al., 2011).
 An ectopic ACTH-secreting tumor. A growth in an organ that does not produce
adrenocorticotropic hormone (ACTH) will exact a force in it and start producing it in excess and
result in a Cushing syndrome. The growth could be non-cancerous are found in organs such as
lungs, Pancreas, thyroid or thymus gland (Kamenický et al., 2011).
 Cancerous tumors of the adrenal cortex (adrenocortical carcinomas) are also causative Cushing
syndrome(Öberg et al., Guidelines Working Group. 2010).
 Familial Cushing syndrome. This is very rare since it is an inheritable tendency that develops
tumors in one or more of their endocrine glands, and mostly affect cortisol levels and causes
Cushing syndrome.
Effects to patient and family
Psychological effects are common in patients and their families and they include; Cognitive dysfunction,
Depression, Hatred and low self-esteem and Anxiety disorder. In addition to psychological effects are
bodily pain experiences, role limitation as a result of emotional and mental health especially to the
parents and family caregivers.
Cushing syndrome also comes about with Physiological effects such as muscle weakness, fracture,
cardiovascular events, which may adversely affect the survival of the patient.
List five (5) common signs and symptoms of the identified condition; for each provide a link to the
underlying pathophysiology (350 words)

4
Cushing syndrome has different effects in men and women though there are share signs and symptoms
(Nieman et al 2015).
Women with Cushing syndrome may experience:
Thicker or more visible body and facial hair (hirsutism) are experienced in women especially in form of
upper body obesity, rounded face, increased fat around the neck, legs, and arms become slender and
this is as a result of cortisol causing fat redistribution to those areas (Baid et al., 2009).This
redistribution causes the central obesity where legs and arms become thinner. There is the
development of moon face or rounded face, lumpy fat deposit between shoulder blades.
Irregular or absent Menstrual Periods. Reproduction problems could be experienced by victims of
cushion disease and syndrome. Women experience a condition known as amenorrhea, a total lack of
menstrual period and at times an irregular menstrual cycle.Hormones that are responsible for
reproductive function pituitary hormones such as luteinizing hormone, follicle stimulating hormone, are
greatly affected and become dysfunctional as a result of high levels of the adrenal hormone.
Men with Cushing syndrome may experience:
 In men, Cushing syndrome is also very likely to decrease libido, decreased fertility or complete
impotency and also cause erectile dysfunction. Testosterone which is produced in the testes and
the very important male hormone is directly suppressed by the high levels of adrenal steroids
exposed to tests such as cortisol in Cushing’s syndrome.
Other signs and symptoms include:
 Severe fatigue as a result of the damaged brain which works with the endocrines system made
of glands that produce and secrete hormones which in turn controls and regulate body

5
activities. The pituitary gland is the main controller of this process and if damage its fails to
function causing severe fatigue.
 Cognitive difficulties result due to the damage of the hippocampal volumes of the brain that are
responsible for learning and memory. A test done on victims of Cushing syndrome has proven
that there is a relationship between Cushing syndrome and loss of memory. This study included
verbal memory and the other visual memory. Patients were given and normal were given the
text to memorize and instructed to memorize and repeat, and in visual memory normal and
victims were asked to draw a diagram with and without a diagram in front of them. The result
proved that there was a great loss of memory in Cushing’s syndrome victims(Nieman et al
2015).
Describe two (2) common classes of drugs used for patients with the identified condition including the
physiological effect of each class on the body
Years before 2012, there has not been medication recommended by the United States Food and Drugs
Administration for treating Cushing syndrome. Since then the administration approved two groups of
medications, mifepristone, and pasireotide for treatment of the Cushing syndrome (Karatsoreos et al.,
2010).
In recent, other drugs originally designed for other conditions treatment have been used to
treat Cushing syndrome. This group included ketoconazole, mitotane, and metyrapone.
Antibiotics, Ketoconazole

6
This is the most commonly used in this group, to treat fungal infections. Individuals treated with this
drugs and their cortisol normalized represent 50-60%. Despite its effectiveness, it can result in negative
implications such as liver damage. This implication led the FDA to issue a warning against using
ketoconazole with further fear of causing liver injury, raising a need for liver implantation or death. The
side effect of this medication is not limited to a number of times but occurs at any dosage, and damage
caused in the liver may not be reversible even after stopping. For the proper management of the effect,
FDA recommends weekly blood testing to monitor the function of the liver with ketoconazole
treatment(Andela et al., 2015).
Mitotane, Antibiotics been used for treating patients with adrenal gland cancer and lowering of cortisol
levels. It prevents the release of cortisol just like ketoconazole but in a higher dose, it causes the
destruction of adrenal cells. Studies indicate that over 80% of patients have effectively improved but
nearly as many very significant side effects, such as gastrointestinal, problems of confusion and impaired
mental function in taking this drug.
Two drugs, Cabergoline, pasireotide for patients with Cushing syndrome caused by the pituitary disease
have been added for the treatment of prolactin-secreting pituitary growth. Cabergolinemedication has
the low effectiveness of 20-40% and tends to wear off over time and the rise of cortisol levels
continues(Pivonello et al., 2009).
Pasireotide is the other medication in the group and one of the two FDA approved the medication for
treatment of Cushing syndrome. This is an injection given on under the skin and administered twice
daily. Its’ major side effects are increased blood sugars and about 1 in patients are likely to develop
diabetes. It also normalizes cortisol levels to around 25%(Boscaro et al., 2009).

7
Identify and explain, in order of priority the nursing care strategies you, as the registered nurse,
should use within the first 24 hours post admission for this patient (500 words).
According to Horta (1979), nursing process is the dynamics of systemized and interrelated
actions, of helping a human being.
a. Assessment. This is obtaining data through systematic roadmap, by making it easy to
determine the actual problems, the potential of individual family and society. There is a
need to do a thorough assessment before any action is taken to determine the medical
history of the patient to be able to diagnose the patient accurately.
b.Nursing diagnosis. It is the identification of the basic needs of the patient as well as the
determination of the degree of care needed by the individual patient. This is vital because not all
individual patients require similar diagnosis as the disease is in different stages in different
patients.
c. Healthcare plan. The overall determination of healthcare a patient should receive, before
diagnosis administration by the nurse is confirmed. A review of the nursing diagnosis is done as
a result of health care and examination of the issues and requirement of nursing care and the
individual dependency degree. One of the major causes of misdiagnosis is a failure to administer
the right medication due to misdiagnosis. The plan must be considered carefully to avoid
healthcare misdiagnosis (McPhee, Papadakis&Rabow 2010).

8
d. Nursing prescription. The arrangement on how the nurse will be attending to the needs of
the patient to meet their health demand. It is important that as a nurse one do frequent
attendance to the patient to determine whether care given is effective in order to make some
adjustments (Brunner, 2010).
e. Nursing evaluation. This refers to the daily report of successive changes occurring in
individuals. All day evaluation of the improvement on the patient condition on the prescription
implemented. The report should be made after 24 hours showing or indicating the progress of
the patient when using the healthcare medication provided by the healthcare provider.
f.Prognosis. This includes estimation of patients’ capacity to meet the basic needs, after the
implementation of healthcare plan plus nursing evaluation of the data provided.
According to international references, Nursing processes would assessment, diagnosis, planning,
implementation, and evaluation. One of the emphasized in this process is assessment which is
the basis and should be emphasized and carried in a manner believed to be as proper as
possible. If this is done accurate data indicating the state of the patient health will enable the
identification of nursing diagnosis (Brunner, 2010). Data collection is vital and requires specified
tools for a systematic survey of significant data. There should always be the development of
data collection tools to enable nurses’ objective and subjective data that gives practitioners in
outcome identification and nursing care plans.

9
References
Andela, C. D., Van Haalen, F., Ragnarsson, O., Papakokkinou, E., Johannsson, G., Santos, A., ...& Pereira,
A. M. (2015). Mechanisms in endocrinology: Cushing's syndrome causes irreversible effects on
the human brain: a systematic review of structural and functional MRI studies. European journal
of endocrinology, EJE-14.
Baid, S. K., Rubino, D., Sinaii, N., Ramsey, S., Frank, A., &Nieman, L. K. (2009). Specificity of screening
tests for Cushing’s syndrome in an overweight and obese population. The Journal of Clinical
Endocrinology & Metabolism, 94(10), 3857-3864.
Boscaro, M., Ludlam, W. H., Atkinson, B., Glusman, J. E., Petersenn, S., Reincke, M., ...&Melmed, S.
(2009). Treatment of pituitary-dependent Cushing’s disease with the multireceptor ligand
somatostatin analog pasireotide (SOM230): a multicenter, phase II trial. The Journal of Clinical
Endocrinology & Metabolism, 94(1), 115-122.
Brunner, L. S. (2010). Brunner &Suddarth's textbook of medical-surgical nursing (Vol. 1). Lippincott
Williams & Wilkins.
Carroll, T., Raff, H., &Findling, J. (2009). Late-night salivary cortisol for the diagnosis of Cushing
syndrome: a meta-analysis. Endocrine Practice, 15(4), 335-342.
Guaraldi, F., &Salvatori, R. (2012). Cushing syndrome: maybe not so uncommon of an endocrine disease.
The Journal of the American Board of Family Medicine, 25(2), 199-208.
Kamenický, P., Droumaguet, C., Salenave, S., Blanchard, A., Jublanc, C., Gautier, J. F., ...& Chanson, P.
(2011). Mitotane, metyrapone, and ketoconazole combination therapy as an alternative to

10
rescue adrenalectomy for severe ACTH-dependent Cushing's syndrome.The Journal of Clinical
Endocrinology & Metabolism, 96(9), 2796-2804.
Karatsoreos, I. N., Bhagat, S. M., Bowles, N. P., Weil, Z. M., Pfaff, D. W., & McEwen, B. S. (2010).
Endocrine and physiological changes in response to chronic corticosterone: a potential model of
the metabolic syndrome in the mouse. Endocrinology, 151(5), 2117-2127.
McPhee, S. J., Papadakis, M. A., &Rabow, M. W. (Eds.).(2010). Current medical diagnosis & treatment
2010. New York:: McGraw-Hill Medical.
Nieman, L. K., Biller, B. M., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., &Tabarin, A.
(2015). Treatment of Cushing's syndrome: an endocrine society clinical practice guideline. The
Journal of Clinical Endocrinology & Metabolism, 100(8), 2807-2831.
Öberg, K., Hellman, P., Kwekkeboom, D., Jelic, S., & ESMO Guidelines Working Group. (2010).
Neuroendocrine bronchial and thymic tumours: ESMO Clinical Practice Guidelines for diagnosis,
treatment, and follow-up. Annals of Oncology, 21(suppl_5), v220-v222.
Pivonello, R., De Martino, M. C., Cappabianca, P., De Leo, M., Faggiano, A., Lombardi, G., ...&Colao, A.
(2009). The medical treatment of Cushing’s disease: effectiveness of chronic treatment with the
dopamine agonist cabergoline in patients unsuccessfully treated by surgery. The Journal of
Clinical Endocrinology & Metabolism, 94(1), 223-230.