Question

Scenario (Page 571)

A 45-year-old woman developed hypertension, a moon-shaped face, and a “buffalo hump” on her upper back. She was diagnosed with Cushing’s syndrome.

Critical thinking Questions

1. Explain the causes of Cushing’s syndrome.

2. What is the treatment for Cushing’s syndrome?

3. What is the expected outcome with treatment.

4. What are some other issues that could be a problem in the future?

Answer 1

Cushing syndrome is due to excessive adrenocortical activity.

1.

It is caused by,

• Overuse of corticosteroid medicine.(common)
• Over production due to hyperplasia of the adrenal cortex.
• Tumor of the pituitary gland.
• Production of adrenocorticotropic hormone due to ectopic malignancy.(less common)

2.

Treatment

• If due to corticosteroid medicine, reduce the dose to minimum level or use alternate- days for treatment.
• If due to tumor in pituitary gland, treatment of choice is surgical removal.
• Radiation to pituitary gland takes several months to resolve symptoms, though it is successful.
• If hypertrophy of adrenal gland , adrenalectomy can perform and after surgery, replacement therapy with hydrocortisone is advisable till adrenal gland works normal.
• If adrenal gland removed fully, lifelong replacement therapy is needed.
• In case of ectopic malignancy, can use adrenal enzyme inhibitors.

3

.Expected outcome

• The main outcome is improve body image,promote skin integrity, mental health and prevent complications.,reduce risk of infection.

4.

Stopping corticosteroid replacement medicine abruptly may result in reappearence of symptoms.

Due to Cushing syndrome patient may become hypertensive, diabetic, may have visual disturbances ,may develop psychosis or depression.