Cushing’s Disease
Too much adrenal hormones
Think about what adrenal hormones do:
- Increased blood sugar (too much cortisol)
- Hypertension (too much epinephrine and norepinephrine)
- High sodium and low potassium (too much mineralcorticoids)
- Increased breakdown of protein
- Increased susceptibility to stress (high cortisol)
- Increased anti-inflammatory effects (susceptibility to infection)
- Sex characteristics changes. Virilization in females, gynecomastia in males.
Signs and Symptoms
- Fatigue and muscle weakness (from muscle/protein breakdown)
- Weight gain with thin arms and legs (fat accumulation in abdomen, muscle breakdown in arms/legs)
- Stress intolerance (high cortisol)
- Poor wound healing, thin skin, striae, bruises, petechiae (protein breakdown)
- Moon face (fat accumulation)
- Buffalo Hump (fat pad on back)
- Osteoporosis and menstrual irregularities
- Virilization, amenorrhea, and acne (too much androgens in women)
- Gynecomastia (too much estrogen in males)
- Susceptibility to infection,
- High sodium, low potassium
- Hypertension
Nursing Priorities
Hypertension
Due to increased epinephrine, norepinephrine, and sodium. Restrict sodium and water. Monitor for heart failure.
Infection
Monitor and prevent infection: elevated WBCs, fever
Arrhythmias
Monitor for arrhythmias due to low potassium
Elevated Blood Sugar
Monitor glucose levels. Elevated glucose levels contribute to poor wound healing and infection.
Osteoporosis
Monitor for joint/bone pain. Prevent fractures. Promote weight bearing exercises.
Body Image Disrubances
Buffalo Hump, Truncal obesity, bruises, petechiae, moon face, adiposity.