Do you remember sitting in A&P learning about the endocrine system: the pituitary gland, the hypothalamus, the endocrine organs and allllllll of those hormones?
How could you forget right? You had never been more confused in your entire life!
And then, when you got to nursing school it got…well, worse.
Now, not only do you need to know about what normally happens with all those hormones, but you need to know what to do when things go wrong!
So today you’ll learn just about everything you need to know about one of those endocrine disorders: Cushing Syndrome.
Let’s dive in.
Pathophysiology
We’ve all heard of the so-called “stress hormones.” And honestly, they don’t really sound all that important, do they? I mean, do you realllly want something called a “stress hormone” floating around inside your body? Me neither.
But they actually do a lot of good things for you.
Cortisol, in particular, reduces inflammation and suppresses your immune system so you don’t usually get sick when you’re stressed. That’s a good one, no one wants to get sick, and especially not when we’re stressed!
Cortisol also increases the blood glucose levels in your body and causes protein and fat breakdown. These three things give you necessary energy when you’re in a stressful situation.
Okay, so it doesn’t sound that bad after all! Cortisol actually sounds kind of nice…it helps keep you from getting sick and gives you an extra energy boost when you need it the most!
However, Cushing’s syndrome happens when you have an overproduction of cortisol. Meaning, your body is making a ton of it over and over again, even if it has enough.
And like most everything else, too much of a good thing can be bad. Very bad.
Causes
The most common cause of Cushing Syndrome is the over use of glucocorticoid medication. It can also be caused by a tumor on the adrenal glands (where cortisol is released), or by a tumor somewhere else in the body that releases cortisol inappropriately.
Signs and Symptoms
There are a ton of things to assess with Cushing’s syndrome.
The one’s you’ve probably heard the most about are the stark physical features, such as the “moon face” (meaning they have a more rounded face), “buffalo hump” (they have an accumulation of fat between the shoulders), and excess abdominal fat.
They also may present with increased blood pressure due to excess fluid accumulation in the body, and muscle breakdown because of all of the protein metabolism that is happening.
They may also have thin skin, superficial bruising, and stretch marks because cortisol also breaks down collagen in addition to protein and fat.
Cortisol also stimulates osteoclasts and inhibits osteoblasts, which is just a fancy pants way of saying that it causes your bones to break down. And what happens when you have bone break down? I think I heard you say fractures…and you are RIGHT! 😉
And with cortisol’s role in suppressing the immune system, they may have a decreased white blood cell count.
Interventions
Your priority intervention is to prevent or reverse fluid overload.
Now, I know what you’re thinking…”Why would THAT be my priority intervention? Can’t I just reduce the cortisol and call it a day?”
Well…yes and no.
Yes, because ultimately that is the goal, of course. You want your patient stable after all.
No, because if your patient is in fluid volume overload from retaining too much water, they can die from pulmonary edema or acute heart failure very quickly.
So you should address the fluid overload problem first.
Perform daily weight checks at the same time of day, with the same scale, and with the patient wearing the same clothes.
Keep and accurate record of their intake and output, including any IV fluids they are receiving.
They may also need to be on a low sodium diet and fluid restriction.
Medications
The most common medications to treat Cushing’s syndrome are aminoglutethimide, metyrapone, and mitotane, which reduce cortisol.
And that’s about all you will need to know about Cushing Syndrome in nursing school. Well done, friend!
