Cushing's Syndrome vs Disease Nursing Pathophysiology, Symptoms, Treatment NCLEX

Summary

This video explains Cushing's disease and syndrome, both related to excessive cortisol levels in the body. The script covers the hormonal pathway involving the hypothalamus, pituitary, and adrenal glands, explaining how cortisol production is regulated. It discusses the signs and symptoms of Cushing’s, including muscle wasting, central obesity, high blood pressure, and glucose intolerance. The difference between Cushing’s disease (pituitary tumors causing excess ACTH) and Cushing’s syndrome (adrenal tumors or corticosteroid overuse) is highlighted. The video also reviews diagnostic labs, treatments, and nursing considerations, including medication options and lifestyle changes for managing the condition.

Takeaways

• 😀 Cushing's disease is caused by excessive levels of cortisol in the body, leading to various physical and hormonal changes.
• 😀 Cortisol, a hormone produced by the adrenal glands, helps the body manage stress by regulating metabolism, glucose, mood, blood pressure, and inflammation.
• 😀 Prolonged high cortisol levels can lead to muscle wasting, abdominal obesity, high blood glucose, anxiety, depression, hypertension, and hypokalemia.
• 😀 Cushing's disease occurs when the pituitary gland releases excess adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce too much cortisol.
• 😀 Cushing's syndrome results from tumors on the adrenal glands or long-term corticosteroid use, leading to excessive cortisol production without the feedback loop regulation.
• 😀 The body has a natural feedback loop to regulate cortisol, but this can be disrupted in Cushing's, leading to either pituitary gland or adrenal gland malfunction.
• 😀 A mnemonic 'STRESS' helps remember the signs of Cushing's: Skin fragility, Truncal obesity, Reproductive issues, Elevated blood pressure, Striae, Excessive body hair, and Decreased potassium/calcium.
• 😀 High cortisol levels can lead to poor skin elasticity, moon face, buffalo hump, and thin extremities, along with other symptoms like excessive body hair and slow wound healing.
• 😀 Lab tests like cortisol, ACTH, glucose, sodium, potassium, and calcium are critical in diagnosing Cushing's disease vs. syndrome.
• 😀 Medications such as steroidogenesis inhibitors, ACTH inhibitors, and glucocorticoid receptor antagonists can help manage Cushing's, along with possible treatments like surgery, radiation, or chemotherapy for tumor removal.

Q & A

What is the primary cause of Cushing's disease?

Cushing's disease is primarily caused by a pituitary tumor that releases excessive ACTH (adrenocorticotropic hormone), which in turn stimulates the adrenal glands to produce excessive cortisol.

How can you differentiate Cushing's disease from Cushing's syndrome based on lab results?

In Cushing's disease, both cortisol and ACTH levels are elevated, indicating the problem originates from the pituitary gland. In Cushing's syndrome, cortisol levels are high, but ACTH levels are low, typically due to adrenal gland tumors or prolonged corticosteroid use.

What is the role of cortisol in the body, and why is it important during stress?

Cortisol is a hormone produced by the adrenal glands and plays a key role in the body's stress response. It helps process fats and proteins, elevates glucose levels, increases hunger, aids in tissue repair, and suppresses inflammation, providing the body with more energy and focus during stressful situations.

What happens when cortisol is excessively produced in the body for a prolonged period?

Chronic excess cortisol leads to muscle wasting, fat redistribution (especially in the trunk and face), high blood glucose levels, mood changes like anxiety or depression, high blood pressure, hypokalemia, and a suppressed immune system, leading to slow wound healing and increased infection risk.

Explain the feedback loop involving cortisol production in the body.

The hypothalamus detects stress and releases CRH (corticotropin-releasing hormone), which stimulates the pituitary gland to release ACTH. ACTH then stimulates the adrenal glands to produce cortisol. Once cortisol levels are adequate, negative feedback reduces CRH and ACTH production, balancing the system.

What is the mnemonic 'STRESS' used for, and what does it stand for in relation to Cushing's disease?

'STRESS' is a mnemonic used to remember the common signs and symptoms of Cushing's disease: S for skin fragility, T for truncal obesity, R for reproductive issues, E for elevated blood pressure, S for striae (stretch marks), S for sugar (high glucose), E for excessive body hair, and D for decreased potassium and calcium levels.

What lab results would you expect in a patient with Cushing's disease?

In Cushing's disease, you would expect high cortisol and high ACTH levels, as well as elevated glucose and sodium. Potassium and calcium levels would be low due to the effects of excess cortisol on the kidneys.

What are the treatment options for Cushing's disease and syndrome?

Treatment options include medications like steroidogenesis inhibitors (e.g., metyrapone), ACTH inhibitors (e.g., pasireotide), and glucocorticoid receptor antagonists (e.g., mifepristone). In more severe cases, surgery may be required to remove pituitary or adrenal tumors, or radiation and chemotherapy could be used.

What are the risks associated with the removal of the adrenal glands in patients with Cushing's disease?

If both adrenal glands are removed, lifelong cortisol replacement therapy is needed. If only part of the adrenal gland is removed, temporary cortisol supplementation is required until the gland recovers its normal function.

What is the role of the ACTH test in diagnosing Cushing's disease or syndrome?

The ACTH test helps determine the source of excess cortisol. In Cushing's disease, both ACTH and cortisol are elevated, suggesting a pituitary issue. In Cushing's syndrome, cortisol is high, but ACTH is low, indicating an issue with the adrenal glands or prolonged corticosteroid use.