Nursing Care Plan for Exogenous Cushing's Syndrome: Causes, Symptoms, and Incidence

Running head: NURSING CARE PLAN
NURSING CARE PLAN
Name of the Student:
Name of the University:
Author note:

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Question 1
Disease
Maureen has been diagnosed with exogenous Cushing’s syndrome. Cushing’s syndrome
outlines the psychological and physiological changes that accompany as a resultant of
abnormally high circulating levels of the hormone cortisol for prolonged periods of time
(O'brien, DeKlotz&Silverman, 2018).ExogenousCushing’s syndromeoccurs by an interplay of
external mechanisms underlying the increase in the levels cortisol in the blood which in this case,
can be considered as primarily due to consumption of glucocorticoid medications (Özgüç et al.,
2018).Maureen’s diagnosis of exogenous Cushing’s syndrome can be attributed to her
consumption of high dosage of the glucocorticoid medication prednisolone.
Causes
In the case of exogenous type of this disorder, excessive therapeutic consumption of
medications administering glucocorticoids in the body, namely prednisolone, are the primary
causative factor (Morgan, Hassan-Smith & Lavery, 2016). Glucocorticoid medications are
required for the management of autoimmune disorders such as rheumatoid arthritis, lupus,
asthma, dermal disorders, pulmonary disturbances and even tumor associated conditions such as
cancer (Nieman, 2018).Cortisol-like medicines such as glucocorticoids (as observed in
prednisolone medication given to the Maureen) induce functions similar to cortisol in the body
which include regulation of stress response, maintenance of immune status, cardiovascular
functioning and macronutrient metabolism (Paul et al., 2016). However the recommended
dosages outlined for the consumption of these medications often exceed the circulating levels
beyond that tolerated by the human body. Hence, this results in the administration of side effects

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and the resultant physiological complications in the form of development of a moon or round
face, obesity in the trunk, buffalo hump, purple striae and superclavicular fat pads (Wagner-
Bartak et al., 2017). Additional symptoms are fatigue, weakness in the muscles, loss of bone
mass, hypertension, dyslipidemia, weight gain, and aggravated diabetics symptoms such as
hyperglycemia and impairments in cognitive abilities (Pereira et al., 2016).
Maureen’s symptoms have begun to manifest as observed in her feelings of fatigue,
rounding of her face, high LDL levels and accumulation of fat in the trunk and abdominal
regions. If left untreated, as researched by Papachan et al., (2017), the symptomatic effects of
this disease can impact an increase in her hyperglycemic symptoms of diabetes which will
further impair her carbohydrate and lipid metabolic processes resulting in distorted lipid profile.
Hence, a multidisciplinary treatment will be required as to treat her diabetes, rheumatoid arthritis
and Cushing’s syndrome disorder further impacting her family through high medical expenses
(Radhakutty et al., 2016).
Incidence
Approximately 60% of Cushing’s disease cases in Australia are attributed to high cortisol
medication consumption and is more susceptible in females than in males (8:1). Cushing’s
syndrome affects almost 40 million of the global population (Torres et al., 2019). The incidence
of this disease is highest in patients suffering from co-existing autoimmune disorders and
proliferative disorders of the lymph requiring administration of glucocorticoid medications such
as prednisolone, prednisone, betamethasone, dexamethasone, methylprednisolone
andtriamcinolone (Sharma, Nieman& Feelders, 2015).

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Risk factors
While the primary risk factor associated with exogenousCushing’s syndrome, as
observed in Maureen’s case is the excessive consumption of glucocorticoid medications, its
endogenous counterpart can be attributed to various endocrinal and genetic risk factors (Al-Ali et
al., 2016). These include the presence of pituitary adenoma, tumors producing
adenocorticotrophic hormone, diseases in the adrenal glands and a family history of Cushing’s
syndrome (Assié, 2018).
Question 2
Signs, Symptoms and Pathophysiology (As designed by the Author)
Signs and Symptoms Pathophysiology
Dyslipidemia resulting in moon face, obesity,
buffalo hump, subclacicular fat pads
From the case study it can be observed that the
patient in question, Maureen is suffering from
high blood levels of LDL cholesterol coupled
with observable rounding of her face and fat
accumulation in her abdominal and shoulder
regions. Cortisol is a steroid hormone whose
primary functions include regulation of key
macronutrient metabolism of which lipid
metabolism is to be considered here. Cortisol
actively administers the function of
gluconeogenesis, which encompasses
breakdown of non-carbohydrate source such as

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fats into lipids for conductance of
inflammatory responses (Pineyro et al., 2019).
Hence, in exogenous Cushing’s ’s syndrome,
high consumption of cortisol like medications
results in excessive gluconeogenesis, high
mobilization and excessive circulation levels of
lipids and their accumulation in fatty deposits
in the face, shoulders and abdomen as noted in
Muareen (Raff & Carroll, 2015).
Hypertension Maureen has been observed to report high
blood pressure levels which can be associated
with her high consumption of glucocorticoid
medication prednisolone. An additional key
function of cortisols are regulation of the blood
pressure and cardiovascular functioning
performed through influences exerted on the
vasoconstriction functions of catecholamines
like epinephrine, norepinephrine and
dopamione (Isidori et al., 2016). High
circulatory levels of cortisol, as a result of
glucocorticoid medications result in excessive
stimulation of catecholamine functioning
leading to vasoconstriction and high blood

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pressure as observed in Maureen (Lacroix et
al., 2015).Further, an additional method by
which cortisol initiates its regulatory effect on
blood pressure is through aldosterone, which
increases blood pressure through sodium
reuptake and excretion prevention. Hence, such
high levels of sodium uptake mechanisms may
also contribute to the hypertensive symptoms
in Maureen resulting due to excessive
glucocorticoid consumption (Dubrocq et al.,
2017).
Hyperglycemia High levels of fasting blood glucose has been
observed in Maureen. One of the primary
functions of cortisols include the inhibition of
tissue uptake of glucose for nervous tissue
usage and exhibition of the flight or fight
response to stress (Loriaux, 2017). Hence,
excessive glucocorticoid consumption results
in cortisol-like effects of inhibited glucose
uptake by tissues as a result of which high
circulating levels ensue leading to high fasting
blood glucose levels as observed in Maureen
(Kang et al., 2016).