Nursing Case Study: Exogenous Cushing's Syndrome

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student:
Name of the University:
Author note:

1NURSING CASE STUDY
Question 1
Disease
Maureen is suffering ‘Exogenous Cushing’s syndrome. This disease implies the various
physical and mental alterations that occur due to excessive levels of the hormone cortisol
circulating in the body for a long time period (Wagner-Bartak et al., 2017). Exogenous
Cushing’s syndrome is caused due to external factors, such as consuming large dosages of
glucocorticoids, which further leads to abnormally high levels of cortisol in the blood and hence,
the resultant symptoms as evident in Maureen’s scenario. Maureen has been consuming high
amounts of the medicine prednisolone, a glucocorticoid medication, which can be associated
with her present symptoms (Notay, Fazel & Awasthi, 2019).
Cause
The major cause for exogenous Cushing’s syndrome, is the high intake of glucocorticoid
medications in the body like prednisolone, which results in increased circulating levels of the
hormone, cortisol – which in Maureen’s case is the medicine prednisolone. Glucocorticoids are
prescribed for the mitigation of disease of the autoimmune type, such as lupus, rheumatoid
arthritis, chronic lung diseases, disease of the skin and as well as cancerous tumors (Gottiganti et
al., 2017). Glucocorticoid medicines such as prednisolone as prescribed to Maureen exert
cortisol-like effects in the body such as inducing immune responses, stress regulation through
fight or flight modes, metabolism of macronutrients and regulating of cardiovascular functions
(Scherrer et al., 2015). Despite the therapeutic reasons outlining their prescription, consumption
of glucocorticoids result in circulating levels of cortisol in the blood at levels higher than that of
physiological tolerance. Such an excess leads to health implication such as truncal obesity, face

2NURSING CASE STUDY
rounding or ‘moon shaped’ face, purple striae, fat accumulation in the shoulders and buffalo
hump. The patient also suffers from symptoms like muscles weakness, bone loss, fatigue, weight
gain, hypertension, hyperglycemia, cognitive impairment and abnormally high lipid profiles
(Nieman, 2018).
Exogenous Cushing’s syndrome symptoms can be observed in Maureen through her
symptoms of fatigue, development of a moon face, high levels of LDL cholesterol and adiposity
in her abdominal and truncal regions. Further this disease can result in harmful impacts in
Maureen by further increasing her diabetic conditions like hyperglycemia which will also result
in increased levels of her LDL cholesterol, that is, dyslipidemia, by hindering her fat and
carbohydrate metabolism. This may impact her family with huge medical costs since an inter-
disciplinary approach is necessary to treat Maureen’s multiple disease conditions of Cushing’s
syndrome, rheumatoid arthritis and diabetes (Durrani et al., 2017).
Incidence
Exogenous Cushing’s syndrome is more prevalent in females affecting approximately 8
out of 10 Australian women. Excessive dosages of cortisol-like glucocorticoid medications have
been attributed as the primary cause in approximately 50 to 60% of exogenous Cushing’s
syndrome cases in Australia (Aleksova et al., 2016). High risk populations include individuals
suffering from lymphatic or autoimmune diseases which require glucocorticoid prescription like
prednisone, dexamethasone, prednisolone and methyprednisolone (Manubolu & Nwosu, 2017).
Risk Factor
The major risk factor for exogenous Cushing’s syndrome is the intake of high dosages of
cortisol-like glucocorticoid medicines like prednisolone, as observed in Maureen. The risk

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factors for the endogenous disease type include, adrenal glandular diseases, familial history,
adenocorticotrophic hormone producing tumors and adenomas in the pituitary (Pivonello et al.,
2016).
Question 2
Pathophysiology of the Disease (tabulated by the Author)
Disease Symptoms Pathology
Symptoms of dyslipidemia such as abdominal
obesity, moon face, subclavicular fat
deposition, buffalo hump
Maureen has been observed to be suffering
from high LDL cholesterol level along with
developing a moon face and gaining fat in her
abdomen as well as between her shoulders.
The steroid hormone cortisol is responsible for
functions like regulating the metabolism of
macronutrients like fats. Cortisol also
mobilizes of energy and nutrients by
metabolizing non-carbohydrate sources like
lipids and fats, by gluconeogenesis processes
for initiating responses of immunity and
inflammation (Sharma, Nieman & Feelders,
(2015). Thus, excessive intake of
glucocorticoid medications (like prednisolone
by Maureen) in exogenous Cushing’s
syndrome leads to uncontrolled