U.S. surgeon, 1869-1939.
Cushing syndrome caused by excessive production of adrenocorticotropic hormone.
A reflex due to cerebral ischemia that causes an increase in systemic blood pressure. This maintains cerebral perfusion during increased intracranial pressure.
The symptoms from prolonged exposure to excessive glucocorticoid hormones. Glucocorticoids are naturally excreted by the adrenal glands; however, Cushing syndrome is a side effect of the pharmacological use of steroids in the management of inflammatory illnesses, e.g., reactive airways disease or arthritis. Glucocorticoid excess from pituitary or adrenal adenomas or from the production of excess levels of adrenocorticotropic hormone by lung cancer is exceptionally rare (and is called Cushing disease).
The affected patient may complain of muscular weakness, thinning of the skin, easy bruising due to capillary fragility, weight gain, rounding of facial features (“moon-like” facies), cervicodorsal fat (buffalo hump) on the upper back, poor wound healing related to immunosuppression, decreased sexual drive and function, menstrual irregularities, insomnia, or psychological depression. Symptoms of diabetes mellitus, e.g., thirst, polyuria, and polyphagia, may be present because glucocorticoid hormones oppose the action of insulin. On physical examination, patients may have excessive fat in the face, upper back, and trunk, but none on the limbs. The abdominal skin may be marked by purplish lines (striae). Women may have excessive hair growth on the face and extremities due to increased androgen production. Increased catabolism leads to muscle wasting and osteopenia or osteoporosis. Hypertension is often present.
Cushing's syndrome caused by the chronic use of steroid hormones may improve if steroids can be given every other day or if high doses of these medications can be gradually tapered. When Cushing's disease is present, surgery to remove the causative adenoma is usually needed, sometimes with adjunctive radiation therapy. Before surgery a medication to inhibit cortisol production, e.g., mitotane, may be prescribed along with drugs to reduce blood glucose and blood pressure.
When prolonged administration of therapeutic, as opposed to replacement, doses of adrenocortical hormones is required, the patient is monitored for development of adverse reactions. A diet is provided that is high in protein and potassium but low in calories, carbohydrates, and sodium. The patient is assisted to adjust to changes in body image and strength. Realistic reassurance and emotional support are provided, and the patient is encouraged to verbalize feelings about losses and to develop positive coping strategies. Intermittent rest periods are recommended, and assistance is provided with mobility, esp. with movements requiring arm-shoulder strength. Safety measures are instituted to prevent falls. Instruction to the patient should include information about the risk for the development of diabetes mellitus, cataracts, easy bruising, and infections. For information and support, refer the patient to The National Adrenal Diseases Foundation.
SEE: Nursing Diagnoses Appendix
A stress ulcer in patients with increased intracranial pressure. Cushing ulcer may be caused by increased secretion of gastric acid due to vagus nerve stimulation.
SEE: stress ulcer
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