Case Study: Postoperative Complications in Cushing's Syndrome Patients

This case study focuses on a 40-year-old woman, Susan Summers, suffering from Cushing's syndrome due to a benign tumor in her right adrenal gland, compounded by obesity and diabetes. The study explores the pathophysiology of Cushing's syndrome, which is caused by excessive cortisol exposure, leading to abdominal obesity, hypertension, and type 2 diabetes. It examines the patient's postoperative complications following an adrenalectomy, including elevated respiratory and pulse rates, high blood pressure, and low urine output. The case study details the required interdisciplinary care, including dieticians, endocrinologists, and physiotherapists, to optimize patient recovery. Additionally, it emphasizes the importance of wound management, breathing exercises, medication, and steroid therapy to manage the patient's condition effectively.

0Introduction:
Nursing case study
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction: 2
Aetiology and pathophysiology of the patient: 2
Pathophysiology of the postoperative deteriorations: 4
Interdisciplinary care: 5
Conclusion: 6
Reference: 7

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Introduction:
Cushing syndrome can be defined as hypercorticosolism is a particular health adversity
which is caused by excessive exposure to high levels of cortisol hormone for a prolonged period
of time. On a simpler note, it can be mentioned that this particular disease is facilitated by the
abnormality in the concentration of the hormone cortisol. There are a few hallmark signs of the
Cushing syndrome, some of them can be considered as a fatty hump between the shoulders, a
rounded face, and pink or purple stretch marks on the skin. Other physiological manifestations of
this disease include extreme hypertension, localized obesity mostly abdominal, and weakness in
both the muscles and the bones. Therefore, along with the risk of high blood pressure, weakness
and other related co-morbidities, it has to be mentioned in this context that this particular health
adversity is also associated with body image alterations and facultative mobility restriction (de
Bruin et al., 2012). Therefore, it has to be mentioned that the physical as well as psychological
burden of this diseases is extremely high for this particular disease and hence there is often the
need for surgical intervention like adrenalectomy. However, for extremely obese patients, which
is mostly the case for the Cushing syndrome sufferers, the post operative deterioration can be a
significant health and wellbeing concern for the patients. This assignment will attempt to deal
with the different post operative complications that are common for the adrenalectomy surgery
for Cushing syndrome and the relevant post operative care requirements taking the aid of a case
study.
Aetiology and pathophysiology of the patient:
This case study represents the case of Susan Summers, a 40 years old woman, a victim of
two much related co-morbidities, obesity and diabetes. Along with that the patient had also been

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suffering from excessive obesity at 90kg with a BMI of 35kg/m2. Susan had also had the risk of
mild alcoholism and had a history of drinking a bottle or more of wine every night to cope with
her life. However, her history of having a benign tumor in her right adrenal gland had been the
primary reason behind the overexposure to cortisol enzyme and the resultant abdominal obesity
in the patient due to cushing syndrome. The patient had to undergo an adrenalectomy surgery
attempting for positive changes in her appreacnce nad body image (Dekkers et al., 2013).
Now pathophysiology and aetiology for the disease condition of the present is relative.
Cushing syndrome is facilitated by the overexposure of cortisol hormone and there is an intricate
hormone signalling pathway employed behind this phenomenon. It has to be mentioned that
complementary action of both the corticotrophin releasing hormone and the adrenocorticotropin
facilitates the secretion of the hormone cortisol in the adrenal glands of the human body. It has to
be understood that the increase in the cortisol levels effects the kidney functions and in turn
impacts the blood glucose level in the body (Elliott & Coventry, 2012). This is the pathway
following which the cortisol overexposure leads to type 2 diabetes in the patients. Along with
that it has to be mentioned as well that the cortisol hormone is also associated with the process of
maintaining the functionality of the cardiovascular system and the regulates the fluctuations in
the blood pressure levels, which in turn facilitates the abdominal obesity. Therefore, it can be
concluded that the cortisol releasing adrenal cortex is the primary aetiology of this diseases and
in the case of the patient under consideration as well, the abnormality in the cortisol levels and its
impact on the CRH-ACTH feedback loop results into the obesity, hypertension and type 2
diabetes in the patient (Dimopoulou et al., 2014).

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Pathophysiology of the postoperative deteriorations:
It has to be mentioned in this context that a key requirements for the analysis of the
different post operative deteriorations, there is need for adequate monitoring and analysis of
the vital signs of the patient in the hours following a surgery. It has to be understood that the
different vital signs are indicative of the different life sustaining physiologic and metabolic
function of the body, hence any fluctuations in the vital signs can indicate directly at the
anomaly in the body system facilitated by any post operative deterioration (Tang et al.,
2015). First and foremost, the respiratory rate in the patient had been 30 breaths per minute.
Now it has to be mentioned that the respiratory rate of any normal healthy adult is 12-20
breaths per minute, hence the patients respiratory rate is undoubtedly enhanced. An
underlying cause to this phenomenon can be the pulmonary dysfunction caused by the
tachypnea facilitated by the pulmonary dysfunction due to post anaesthetic effect and the
extra pressure on the thoracic cage due to the extreme abdominal obesity (Guaraldi &
Salvatori, 2012). Along with that, it has t o be mentioned that the pulse rate of the patient
had been 128 beats per minute, where as the normal heart rate for a healthy adult is 80-100
beats per minute. This coupled with the high blood pressure levels of the patient at 160/90
mmHg is the clear indication of the deteriorating health status of the patient. Elaborating
more it has it be mentioned that for the obese and diabetic patients the post anaesthetic period
is associated with many cardiovascular complications. It has to be understood in this context
that the increased insulin resistance in the diabetic patients coupled with the high BMI due to
the high obesity is the primary reason behind the hypertension which is manifested as the
high pulse rate and the blood pressure (Nieman, 2015). Along with that, it also needs to be
mentioned that regular alcohol consumption also can be a major contributing factor behind

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the pathophysiology of hypertension in the patients which is accentuated in the post
anaesthetic period. The temperature of the patient had also been a little reduced from the
normal levels attributing to the effects of anaesthesia. Along with that, it has to be mentioned
that the last vita sign of the patent had been the low urine output at 5ml in the last hour. The
normal urine output is generally is close to 1000-2000 ml on a daily basis and depending on
that calculation; the patient had been suffering from low urine output. It has to be mentioned
that the high abdominal pressure after the surgery can contribute to the low urine output
(Gupta et al., 2011).
As per post operative care that the patient will be requiring, it has to be mentioned that
wound management and surgical site infection control is the most important fact. It has to be
mentioned that wound care needs to be systematic and aseptic at all times. Along with that
the patient would require a few breathing exercises and even airway clearance deepening on
the severity of the need of the patient. Beta blockers will also be needed to be provided to the
patient in an attempt to restore the normal cardiac functions. Following an adrenalectomy
surgery the patient will require the assistance of the steroid therapy to ensure normal adrenal
gland functioning. For increasing the urine output of the patient taking extra fluids, fiber,
along with usage of stool softeners will be beneficial (Hartmann et al., 2016).
Interdisciplinary care:
It has to be mentioned that along with the care provided by the nursing professional and
the health practitioner, the patient in this case study will require the assistance of the different
interdisciplinary health care members in order to have the most optimal and best health
outcomes. First and foremost, the patient will require the assistance dieticians or nutritionist

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who will play a vital role in both the obesity and diabetes management of the patient. It has
to be mentioned that for Susan reducing her weight and better control of the diabetes is very
important in order to attain optimal recovery. The dietician will be responsible for
maintaining a strict and multipurpose diet plan based on whole grains and fluids for the
patient so that she can regain control of her daily calorie intake and can manage her blood
glucose levels effectively (Kiriakopoulos et al., 2011). The assistance of an endocrinologist
will help the patient in maintaining a control on the hormonal imbalance in the body, and
help overcome the impact of the recent adrenalectomy and steroid therapy. Lastly the patient
will also require the assistance of a physiotherapist in order to provide assistance in different
mild gross motor skill exercises that will help the patient control her post operative recovery.
Hence, the interdisciplinary care from the above mentioned 3 care members will optimize the
hospice care after the surgery and will help the patient attain rapid recovery (Manenschijn et
al., 2012).
Conclusion:
On a concluding note, it has to be said that Cushing syndrome is a very common health
adversity and the resultant impact of the different health adversities are also very severe.
However, one of the most impactful and altering effects of this particular disease is the
localised obesity and altered body image which can be a very distressing factor for many.
Hence, the most plausible option for such patients is the adrenalectomy which is also
associated with many post operative complications. Although, as mentioned above an
interdisciplinary care plan can help the patient attain speedy recovery.

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Reference:
de Bruin, C., Hofland, L. J., Nieman, L. K., Van Koetsveld, P. M., Waaijers, A. M., Sprij-
Mooij, D. M., ... & Feelders, R. A. (2012). Mifepristone effects on tumor
somatostatin receptor expression in two patients with Cushing's syndrome due to
ectopic adrenocorticotropin secretion. The Journal of Clinical Endocrinology &
Metabolism, 97(2), 455-462.
Dekkers, O. M., Horváth-Puhó, E., Jørgensen, J. O. L., Cannegieter, S. C., Ehrenstein, V.,
Vandenbroucke, J. P., ... & Sørensen, H. T. (2013). Multisystem morbidity and
mortality in Cushing's syndrome: a cohort study. The Journal of Clinical
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Dimopoulou, C., Schopohl, J., Rachinger, W., Buchfelder, M., Honegger, J., Reincke, M., &
Stalla, G. K. (2014). Long-term remission and recurrence rates after first and second
transsphenoidal surgery for Cushing's disease: care reality in the Munich
Metropolitan Region. European journal of endocrinology, 170(2), 283-292
Elliott, M., & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring.
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Hartmann, K., Koenen, M., Schauer, S., Wittig-Blaich, S., Ahmad, M., Baschant, U., &
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