Here is a comprehensive explanation of Cushing’s Syndrome, covering its definition, causes,
pathophysiology, clinical manifestations, complications, and collaborative nursing management
in detail — suitable for nursing students.
🌟 Cushing’s Syndrome
📘 Definition
Cushing’s Syndrome is a disorder caused by prolonged exposure to high levels of cortisol
(glucocorticoids), either from endogenous overproduction or exogenous administration (like
corticosteroid therapy).
⚠️Causes
1. Exogenous (Most Common)
Long-term use of glucocorticoids (e.g., prednisone)
2. Endogenous
Cushing’s Disease (pituitary adenoma secreting ACTH)
Ectopic ACTH syndrome (from small cell lung cancer, pancreatic
tumors)
Adrenal tumors (adenoma or carcinoma producing cortisol)
🔄 Pathophysiology
Excess ACTH (Pituitary or Ectopic Source) or Adrenal Tumor
↓
↑ Cortisol Secretion
↓
- ↑ Gluconeogenesis → Hyperglycemia
- ↑ Protein breakdown → Muscle wasting
- ↑ Fat redistribution → Central obesity, moon face, buffalo hump
- ↑ Mineralocorticoid activity → Hypertension, Hypokalemia
- Immune suppression & osteoporosis
🧬 Clinical Manifestations
🔹 General Appearance:
Moon face
Buffalo hump (fat pad on upper back)
Central obesity with thin arms/legs
Weight gain
🔹 Skin Changes:
Thin, fragile skin
Purple striae (stretch marks) over abdomen, thighs
Easy bruising
Poor wound healing
Acne
🔹 Musculoskeletal:
Muscle weakness
Osteoporosis → fractures
Back/joint pain
🔹 Cardiovascular:
Hypertension
Edema due to fluid retention
🔹 Endocrine/Metabolic:
Hyperglycemia
Menstrual irregularities or amenorrhea
Hirsutism in women (excess facial/body hair)
🔹 Psychological:
Mood swings
Depression
Anxiety
Poor memory/concentration
🚨 Complications
Diabetes mellitus (due to cortisol-induced insulin resistance)
Hypertension & cardiovascular disease
Osteoporosis & fractures
Infections (immunosuppression)
Psychiatric disorders (depression, psychosis)
Cushing’s Crisis (rare, sudden worsening of symptoms)
🤝 Collaborative Management
1. Medical Management
Cause Treatment
Exogenous
Taper down dosage (never stop suddenly)
corticosteroids
Cushing’s disease Surgical removal of pituitary adenoma
Adrenal tumor Adrenalectomy (unilateral or bilateral)
Surgery, chemo, or radiation for
Ectopic ACTH
underlying tumor
Ketoconazole, metyrapone (to inhibit
Medications
cortisol)
4 Nursing Management
A. Assessment
Vitals: ↑ BP, ↑ glucose
Physical appearance: obesity, striae, moon face
Muscle strength
Emotional status
Electrolytes: Na⁺, K⁺
Bone pain or fractures
Signs of infection
B. Nursing Diagnoses
1. Risk for infection related to immunosuppression
2. Disturbed body image related to physical changes
3. Risk for injury related to muscle weakness and osteoporosis
4. Imbalanced nutrition: more than body requirements
5. Disturbed thought processes related to elevated cortisol
C. Goals
