Similar to Cushing’s syndrome which is much more common, Cushing’s disease is a condition where the pituitary gland secretes too much hormone (ACTH) causing an overproduction of cortisol (stress hormone). It causes weight gain around the trunk and waist with fat loss in the less and arms. Patients may also develop a hump on the upper back that is caused by abnormal fat deposits. This disease weakens the immune system and can cause mood disorders such as anxiety and depression.
Cushing’s disease is caused by a tumor or excess growth (hyperplasia) on the pituitary gland. Cushing’s syndrome is similar in its production of excess cortisol, but is usually a result of other disease processes. As the pituitary secretes more hormone (ACTH), it stimulates the adrenal glands to produce more cortisol (stress hormone). Cortisol controls blood sugar levels, how the body uses carbohydrates, fats and proteins and reduces the immune system’s response to inflammation, therefore making the patient more susceptible to infection.
Manage symptoms, maintain normal blood pressure and a blood glucose level within appropriate range
Assess and monitor cardiac and respiratory status; perform 12-lead EKG to rule out cardiac involvement
Shifts in fluid balance and electrolytes may cause arrhythmias and difficulty breathing.
Monitor fluid and electrolyte balance; I & O, fluid restrictions as necessary
Overproduction of cortisol causes the body to retain sodium and water which can cause cardiac stress and hypokalemia.
Administer medications as appropriate to manage symptoms
Monitor vital signs for hypertension
Excess stress hormone (cortisol) causes an increase in blood pressure. Monitor closely and administer medications as necessary
Manage blood glucose level
Excess cortisol can cause blood sugar to fluctuate. Monitor blood glucose levels regularly and notify MD if outside patient’s target area. Treat hypoglycemia with juice and crackers, but watch for rapid spikes afterwards.
Treat hyperglycemia by having the patient drink water and notify MD if necessary.
Long term stress and elevated cortisol levels can weaken the immune system and increase the risk of developing bacterial infections.
Monitor for signs of infection
Cortisol suppresses the immune system and increases the risk of infection. Obvious signs of infection may be masked, so take note of subtle signs.
Prepare patient for surgery to treat disease
Medication can help manage the symptoms, but there is currently no medication that can fully treat the disease. Surgery to remove the pituitary tumor(s) or adrenal glands is the most common treatment for the disease.
Reduce risk of infections
Avoid unnecessary exposure to people with infections; stress the importance of good hand hygiene to patient and family members / caregivers
Educate and encourage positive body image
Changes in the appearance can give the patient a negative self-image and lead to anxiety and depression. Reassure patient and educate them about the changes in fat distribution associated with the disease. Promote an atmosphere of acceptance and encourage the patient to verbalize feelings.
Nutrition and lifestyle education
Incorporate and educate patient about good dietary and lifestyle choices. Low sodium diet may be supplemented with high potassium foods and low protein to promote a stronger immune system. Encourage exercise as tolerable.
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