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Causes of Cushing's Syndrome

Discuss about the Problems and Treatment of Cushing Syndrome.

This disorder normally happens when there is high level in the hormone cortisol which is caused by overuse in medication containing high cortisol concentration (Kahn, 2017). From the case study, Maureen is found to use high concentration of corticosteroids which increase the chances of having the disorder. This is why she is undergoing a 24 hour cortisol level measure test to determine the concentration of cortisol in her urine. Other causes of the Cushing’s syndrome may include; depression or high levels of stress and malnutrition.  According to Kahn (2017), a patient suffering from pituitary gland tumor is at a high risk of having this syndrome because the glands release a lot of adrenocorticotropic which causes the syndrome. In women, it may cause irregular or absence in the menstrual cycle and growth of extra body hairs. In men, the disorder may cause erectile dysfunction due to loss of interest in sex and decrease in fertility (Kahn, 2017). Furthermore, the syndrome may cause obesity and slow growth rate in children.

According to Guaraldi (2012), Cushing’s syndrome has a rate of 10-15 patients per million though most patients with hypertension, diabetes and obesity are found to be the most likely victims of this disorder among the population.  From the case study, Maureen is diagnosed with type 2 diabetes which puts her at a high risk of being infected by the disorder. The most common signs and symptoms are fat deposits on the face (round shaped face) and between the shoulder and the upper back side. Maureen’s husband notes that her wife has a round shaped face which is due to fat deposits around her face. Tests done on Maureen also show high levels of low density lipoproteins cholesterol which is a clear sign of fat deposits. She also experiences abdominal pains due to the fat deposits around her abdominal area. Moreover, patients with the disorder tend to develop brain problems which can be partially recovered after biochemical treatment (Andela, 2015).

One of the risk factors of this disorder is that the patient is at a high risk of being obese due to the increase in fat around the abdominal area and poor regulation in the blood glucose levels (Fardet, 2012).  The changes in the blood glucose levels result in gastrointestinal bleeding which is caused by blood loss over a short period of time. Maureen was affected by this due to changing in the menstrual cycle that led to blood loss. The patient is also at a high risk of having bone fracture problems due to the slow healing process of cuts and any other form of injury. Furthermore, the patient is at risk of developing a growth on an organ within the body which normally doesn’t produce ACTH; it’s a hormone that controls cortisol levels (Kahn, 2017). Maureen’s blood is tested and is found to have low cortisol and ACTH levels which is a sign of Cushing syndrome. This disorder is a common risk factor to women compared to men and is among patients who are between 25-40 years of age. This can impact on a patient’s life by affecting the financial state of the patient since a lot of capital is used in the treatment of this disorder. Furthermore, this may also affect the patient’s family in instances where they are the ones catering for the patient. For both the family and the patient, the disorder can be emotionally draining because of the constant medication expense incurred in the welfare of the patient (Lin, 2013).

Symptoms of Cushing's Syndrome

According to Fleseriu (2012), the major sign of this disorder is weight gain where fat is mostly located around the abdominal area. Furthermore, fat is also located on the face resulting to a round-shaped face and fat between upper back and the shoulders (hump). Maureen’s vital signs show fat deposits around her abdominal area and a hump between her shoulders. Moreover, there could be stretch marks on the abdomen, arms and on the breast. Other signs and symptoms include; weakness in the muscles, the rate of urination increases and increase in blood pressure due to irregular blood glucose levels (Kahn, 2017). Other patients may experience fatigue and frequent headaches due to depression and anxiety changes. Maureen experiences fatigue as another symptom which is caused by weakening in of the muscles.

     Common Signs and Symptoms:

·         Round face

·         Fat deposits on the neck

·         Weight gain

·         Fatigue

·         Menstrual absence and irregularity

                          Link:

This is due to fat deposits around the face region.

This is due to fat deposits between the upper back and the shoulder.

This is due to pituitary gland tumor affecting the production of hormones.

This occurs due to weakness in the muscles.

 This occurs due to the change in the blood pressure due to the cortisol production changes.


According to Nieman (2015), the patient may experience bone loss which may lead to bone fracture over time. After the bone mineral density test, Maureen is going to be found positive of loss in bone mineral density level. Another sign and symptom of the Cushing’s syndrome is the thinning of the skin making it more prone to bruises which makes it easy to develop serious injuries that take more time to heal. When injuries take more time to heal it means that the exposed wound is more likely to get infected causing sickness (Nieman, 2015)

There are two classes of drugs that are used in the treatment of the disorder which are somatostatinergic and dopaminergic drugs; they are used in controlling ACTH production (Bertagna, 2013). However, the drugs are not efficient in treating this disorder since they may have adverse effects on a patient. According to Berridge (2013), the use of dopaminergic drugs may result in depression which makes it difficult for a patient to feel happy. The drugs also cause addictive behaviors due to the use of chronic drugs which may result in drug-seeking behaviors. When there is a high level of dopamine in the brain, the patient may not receive sleep since the dopamine increases the feeling of being awake. Therefore, it is essential to reduce dopamine content at night so that the patient can have some sleep (Hussein, 2018).

According to Lin (2013), the somatostatinergic drugs have a direct effect on the behavior and the mood of the patient. The prolonged effect of this drugs result in the emotional and sometimes financial burden on a patient which greatly affects the patient’s family. Research show that the drugs affect different brain systems since it affects the genetic and cellular levels of the brain (Lin, 2013). For instance, the somatostatinergic drugs help the retina in that they regulate and protect neurons against damage. Furthermore, the drugs help in autonomic responses where they control the automatic function of the digestive system and other sensitive systems such as respiration. Maureen used prednisolone which falls in a class of drugs called corticosteroids which lead to the syndrome. The side effects of the drugs can be sleeping problem, abnormal weight gain, sight may be affected, change in moods and abdominal pain (Hatcher, 2018). The stated effects can be related to the signs that Maureen experienced and the effects led to the disorder.

Available Treatments for Cushing's Syndrome

Being a nurse, l should seek information about the history of the patient (Maureen) just to understand whether there have been any past or current injuries (DeWit, 2013). It is essential to acquire relevant information regarding the patient which may include if the patient has any allergy reactions, family history and medication. Maureen is diagnosed with rheumatoid arthritis and type 2 diabetes as her past medical history.

This involves the nurse understanding the emotional, physical and behavior of the patient which will provide a good understanding on what is affecting the patient. This general appearances may include if the patient is pale, body posture and even the movement of the patient. (DeWit, 2013).

This is one of the most important process during assessment of a patient where the nurse is required to check up on the patient after at least every 2 hours so as to make a decision on the vital signs of the patient and what may be affecting him or her. This vital signs may include understanding the body temperature of the patient so as to know whether he or she has a fever or not (DeWit, 2013). Moreover, checking the respiratory rate of the patient is vital in that the nurse is able to know whether the patient is experiencing difficulty in breathing or if it is normal.  Maureen’s body temperature is tested, body mass and breathing rate. Another vital sign is the heart rate where the nurse can check the pulse of the patient so as to determine whether the patient’s heart is functioning normally. The nurse can also conduct a pain assessment check just to know which part of the body may be making the patient to feel unwell (DeWit, 2013). Maureen is found to experience pain on her abdomen.

Physical assessment of the patient

The nurse also conducts a physical assessment on the patient just to have a complete assessment and understanding of the patient (DeWit, 2013).

References

Andela, C. D., Van Haalen, F., Ragnarsson, O., Papakokkinou, E., Johannsson, G., Santos, A., ... & Pereira, A. M. (2015). Mechanisms in endocrinology: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional MRI studies. European journal of endocrinology, EJE-14.

Berridge, K. C., & Kringelbach, M. L. (2013). Neuroscience of affect: brain mechanisms of pleasure and displeasure. Current opinion in neurobiology, 23(3), 294-303.

Bertagna, X., & Guignat, L. (2013). Approach to the Cushing's disease patient with persistent/recurrent hypercortisolism after pituitary surgery. The Journal of Clinical Endocrinology & Metabolism, 98(4), 1307-1318.

Fardet, L., Petersen, I., & Nazareth, I. (2012). Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing’s syndrome: cohort study. Bmj, 345, e4928.

Fleseriu, M., Biller, B. M., Findling, J. W., Molitch, M. E., Schteingart, D. E., Gross, C., ... & SEISMIC Study Investigators include. (2012). Mifepristone, a glucocorticoid receptor antagonist, produces clinical and metabolic benefits in patients with Cushing's syndrome. The Journal of Clinical Endocrinology & Metabolism, 97(6), 2039-2049.

Guaraldi, F., & Salvatori, R. (2012). Cushing syndrome: maybe not so uncommon of an endocrine disease. The Journal of the American Board of Family Medicine, 25(2), 199-208.

Hussein, R. (2018). Functions of Dopamine: What is dopamine and how does it affect you? https://blog.cognifit.com/functions-of-dopamine-serve-you/

Kahn, A. (2017). Cushing Syndrome: Causes and Symptoms. Healthline Media.

 Lin, L. C., & Sibille, E. (2013). Reduced brain somatostatin in mood disorders: a common pathophysiological substrate and drug target?. Frontiers in pharmacology, 4, 110.

Nieman LK. (2015). Overview of the treatment of Cushing's syndrome. https://www.uptodate.com/home.

Hatcher, V. A. (2018). Dermatologists in New York: Prednisone.

 DeWit, S. C., & O'Neill, P. A. (2013). Fundamental concepts and skills for nursing. Elsevier Health Sciences.

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