Cushing's Syndrome

  1. General information
    1. Condition resulting from excessive secretion of corticosteroids, particularly the glucocorticoid cortisol
    2. Occurs most frequently in females between ages 30-60
    3. Primary Cushing's syndrome caused by adrenocortical tumors or hyperplasia
    4. Secondary Cushing's syndrome (also called Cushing's disease): caused by functioning pituitary or nonpituitary neoplasm secreting ACTH, causing increased secretion of glucocorticoids
    5. Iatrogenic: caused by prolonged use of corticosteroids
  2. Assessment findings
    1. Muscle weakness, fatigue, obese trunk with thin arms and legs, muscle wasting
    2. Irritability, depression, frequent mood swings
    3. Moon face, buffalo hump, pendulous abdomen
    4. Purple striae on trunk, acne, thin skin
    5. Signs of masculinization in women; menstrual dysfunction, decreased libido
    6. Osteoporosis, decreased resistance to infection
    7. Hypertension, edema
    8. Diagnostic tests: cortisol levels increased, slight hypernatremia, hypokalemia, hyperglycemia
  3. Nursing interventions
    1. Maintain muscle tone.
      1. Provide ROM exercises.
      2. Assist with ambulation.
    2. Prevent accidents or falls and provide adequate rest.
    3. Protect client from exposure to infection
    4. Maintain skin integrity.
      1. Provide meticulous skin care.
      2. Prevent tearing of skin: use paper tape if necessary.
    5. Minimize stress in the environment.
    6. Monitor vital signs; observe for hypertension, edema.
    7. Measure I&O and daily weights.
    8. Provide diet low in calories and sodium and high in protein, potassium, calcium, and vitamin D.
    9. Monitor urine for glucose and acetone; administer insulin if ordered.
    10. Provide psychologic support and acceptance.
    11. Prepare client for hypophysectomy or radiation if condition is caused by a pituitary tumor.
    12. Prepare client for an adrenalectomy if condition is caused by an adrenal tumor or hyperplasia.
    13. Provide client teaching and discharge planning concerning
      1. Diet modifications
      2. Importance of adequate rest
      3. Need to avoid stress and infection
      4. Change in medication regimen (alternate day therapy or reduced dosage) if cause of the condition is prolonged corticosteroid therapy