CUSHING’S
SYNDROME
BY: ALLYANNA NOREEN B. RED
ALEXIS C. MANHIT
CONTENT
- Definition of the Disease
- Pathophysiology
- Diagnostic Examination
- Therapeutic Regimen
- Nursing Interventions
- Diet
- Video Presentation
DEFINITION
Cushing syndrome is a hormonal disorder caused
by prolonged exposure to high levels of cortisol, a
steroid hormone produced by the adrenal glands.
It can result from long-term use of corticosteroid
medications or from the body producing too
much cortisol, often due to tumors in the pituitary
or adrenal glands. The condition leads to
symptoms like weight gain (especially in the face
and abdomen), high blood pressure, muscle
weakness, thinning skin, and mood changes.
Early diagnosis and treatment are essential to
prevent serious complications.
PATHOPHYSIOLOGY
DIAGNOSTIC EXAMINATION
I. Screening Tests
Used to confirm hypercortisolism (excess cortisol production):
1. 24-Hour Urinary Free Cortisol (UFC)
Measures cortisol excreted in urine over 24 hours.
Elevated levels suggest Cushing’s syndrome.
2. Late-Night Salivary Cortisol
Assesses the loss of normal circadian cortisol rhythm.
High levels at night suggest Cushing’s.
3. Low-Dose Dexamethasone Suppression Test (LDDST)
1 mg dexamethasone is taken at 11 p.m., and cortisol is
measured at 8 a.m.
Failure to suppress cortisol suggests Cushing’s
syndrome.
DIAGNOSTIC EXAMINATION
II. Confirmatory & Differential Tests
Used to confirm diagnosis and identify the source of excess cortisol:
1. Plasma ACTH Measurement
Determines if Cushing’s is ACTH-dependent or ACTH-
independent.
Low ACTH → adrenal cause
High/normal ACTH → pituitary or ectopic ACTH source
2. High-Dose Dexamethasone Suppression Test (HDDST)
Differentiates Cushing disease (pituitary) from ectopic ACTH.
Suppression of cortisol → pituitary
No suppression → ectopic
3. CRH Stimulation Test
Measures response to corticotropin-releasing hormone.
Increased ACTH/cortisol → pituitary source
No response → ectopic or adrenal
DIAGNOSTIC EXAMINATION
III. Imaging Studies
Used to locate the source of hormone overproduction:
1. MRI of the Pituitary Gland
Detects pituitary adenomas in Cushing disease
2. CT or MRI of the Adrenal Glands
Detects adrenal tumors (adenoma or carcinoma)
3. CT Scan of Chest/Abdomen/Pelvis
Used to find ectopic ACTH-producing tumors (e.g., small
cell lung cancer)
THERAPEUTIC
REGIMEN
STEP 1: IDENTIFY THE CAUSE
FIRST
TREATMENT DEPENDS ON WHETHER
IT’S DUE TO:
EXCESS CORTISOL PRODUCTION
(ENDOGENOUS)
LONG-TERM STEROID USE
(EXOGENOUS)
THERAPEUTIC
REGIMEN
Step 2: Treat Based on the
Cause
A. IF DUE TO STEROID USE (MOST
COMMON):
SLOWLY REDUCE THE STEROID
DOSE
SWITCH TO A LOWER OR SAFER
DOSE IF POSSIBLE
NEVER STOP SUDDENLY (RISK OF
ADRENAL CRISIS)
THERAPEUTIC
REGIMEN
B. If due to a tumor:
THERAPEUTIC
REGIMEN
Step 3: Medications (if surgery
doesn’t work or isn’t possible):
KETOCONAZOLE – BLOCKS
CORTISOL PRODUCTION
METYRAPONE – BLOCKS
CORTISOL PRODUCTION
MIFEPRISTONE – BLOCKS
CORTISOL EFFECTS
PASIREOTIDE – REDUCES ACTH
IN PITUITARY TUMORS
THERAPEUTIC
REGIMEN
Step 4: Manage Symptoms
Control blood pressure
Control blood sugar
Treat osteoporosis
Support mental health
NURSING INTERVENTIONS
MAINTAINING ADEQUATE DECREASING RISK OF
CARDIAC FUNCTION INJURY
The patient who is taking corticosteroid Establishing a protective environment helps
medications should be monitored for the prevent falls, fractures, and other injuries to
presence of hypertension and hypokale-mia. bones and soft tissues. The patient who is very
The nurse assesses fluid and electrolyte status weak may require assistance from the nurse in
by monitoring laboratory values and daily ambulating to avoid falling or bumping into
weights. The patient should be educated sharp corners of furniture. Foods high in
about foods low in sodium to decrease fluid protein, calcium, and vitamin D are
retention and foods high in potassium; referral recommended to minimize muscle wasting
to a dietitian may be useful. The patient and osteoporosis. Referral to a dietitian may
should also be instructed to report and pedal assist the patient in selecting appropriate foods
edema or changes in activity tolerance. that are also low in sodium and calories.
DECREASING RISK OF PROMOTING SKIN
INFECTION INTEGRITY
The patient should avoid Meticulous skin care is necessary to avoid
unnecessary exposure to others traumatizing the patients fragile skin. The use
with infections. The nurse of adhesive tape is avoided, because it can
frequently assesses the patient for irritate the skin and tear the fragile tissue
subtle signs of infection, because when the tape is removed. The nurse
the anti-inflammatory effects of frequently assesses the skin and bony
corticosteroids may mask the prominences and encourages and assists the
common signs of inflammation patient to change positions frequently to
and infection. prevent skin breakdown.
NURSING INTERVENTIONS
IMPROVING BODY IMAGE
The patient may benefit from discussion of the
effect the. changes have had on their self-
concept and relationships with others. Weight
gain and edema may be modified by a low-
carbohydrate, low-sodium diet, and a high-
protein intake may reduce some of the other
bothersome symptoms.
The patient may also benefit from discussion
of the changes being temporary if the
treatment with corticosteroids is temporary.
IMPROVING COPING
Explanations to the patient and family
members about the cause of emotional
instability are important in helping them
cope with the mood swings, irritability,
and depression that may occur. Psychotic
behavior may occur in a few patients and
should be reported. The nurse encourages
the patient and family members to
verbalize their feelings and concerns.
MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
Addisonian Crisis. The patient with Cushing's syndrome whose
symptoms are treated by withdrawal of corticosteroids, by
adrenalectomy, or by removal of a pituitary tumor is at risk for
adrenal hypofunction and Addisonian crisis. If high levels of
circulating adrenal hormones have suppressed the function of the
adrenal cortex, atrophy of the adrenal cortex is likely. If the
circulating hormone level is decreased rapidly because of surgery
or abrupt cessation of corticosteroid agents, manifestations of
adrenal hypofunction and Addisonian crisis may develop.
Therefore, the patient with Cushing's syndrome should be
assessed for signs and symptoms of Addisonian crisis as discussed
previously. If Addisonian crisis occurs, the patient is treated for
circulatory collapse and shock.
Adverse Effects of Adrenocortical Activity. The nurse assesses
fluid and electrolyte status by monitoring laboratory values and
daily weights. Because of the increased risk of glucose intolerance
and hyperglycemia, blood glucose monitoring is initiated. The
nurse reports elevated blood glucose levels to the primary
provider so that treatment can be prescribed if needed. If
indicated, the patient may need to be educated in self-monitoring
of blood glucose and insulin injections.
DIET
Key Goals:
Manage blood sugar levels
Support bone health
Reduce blood pressure
Maintain a healthy weight
1. High-Protein Foods
To combat muscle loss and support metabolism:
Chicken, turkey, eggs
Fish (especially fatty fish like salmon)
Legumes (lentils, chickpeas)
2. Calcium & Vitamin
D-Rich Foods
To protect against bone loss:
Leafy greens (kale, collards)
Dairy (milk, cheese, yogurt)
Fatty fish, eggs (for vitamin D)
DIET
Key Goals:
Manage blood sugar levels
Support bone health
Reduce blood pressure
Maintain a healthy weight
3. Low-Glycemic Carbs
To help control blood sugar:
Whole grains (quinoa, brown rice, oats)
Sweet potatoes
Non-starchy vegetables (broccoli, bell peppers)
4. Potassium-Rich Foods
To balance sodium and support heart health:
Bananas, avocados
Tomatoes, oranges
Beans, potatoes (with skin)
DIET
Hydration (Stay Hydrated)
Why: Proper hydration is essential for
managing blood pressure, fluid retention,
and skin health.
Additional Tips:
Small, frequent meals: Helps maintain
stable blood sugar levels and prevent
overeating.
Exercise regularly (with approval from
your healthcare provider) to maintain
muscle mass and promote bone health.
THANK
YOU
