Nursing Care Plan for Cushing's Syndrome

Definition of Cushing's syndrome

Cushing's syndrome is a condition caused by hyperadrenocorticism, is more often found in women, due to neoplasms in the adrenal cortex / anterior pituitary, or a result of long-term intake of glucocorticoids for therapeutic interest (Dorland).

Etiology of Cushing's syndrome

• Excessive activity of the adrenal cortex
• Corticosteroids / ACTH excess
• Adrenal cortex hyperplasia.

Symptoms of Cushing's syndrome

Most people with Cushing syndrome will have:

• Upper body obesity (above the waist) and thin arms and legs
• Round, red, full face (moon face)
• Slow growth rate in children

Skin changes that are often seen:

• Acne or skin infections
• Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
• Thin skin with easy bruising

Muscle and bone changes include:

• Backache, which occurs with routine activities
• Bone pain or tenderness
• Collection of fat between the shoulders (buffalo hump)
• Rib and spine fractures (caused by thinning of the bones)
• Weak muscles

Women with Cushing syndrome often have:

• Excess hair growth on the face, neck, chest, abdomen, and thighs
• Menstrual cycle that becomes irregular or stops

Men may have:

• Decreased or no desire for sex
• Impotence

Other symptoms that may occur with this disease:

• Mental changes, such as depression, anxiety, or changes in behavior
• Fatigue
• Headache
• Increased thirst and urination

Management of Cushing's Syndrome

As more Cushing's Syndrome is caused by a pituitary tumor than adrenal tumor, the treatment is often directed at the pituitary gland.

1. Transsphenoidal hypophysectomy, surgical removal of the tumor.
2. Radiation pituitary gland, takes several months to control the symptoms.
3. Adrenalectomy, the treatment of choice for patients with primary adrenal hypertrophy.
4. Baffle adrenal enzyme preparations (ie, metyrapon, aminoglutethimide, mitotane, ketoconazole) to reduce hiperadrenalisme if due to ectopic ACTH secretion.

Nursing Care Plan for Cushing's Syndrome

Nursing Diagnosis for Cushing's Syndrome

1. Risk for injury and Risk for infection related to weakness and changes in protein metabolism and inflammatory response.
2. Self-care Deficit: weakness, feeling of tiredness, muscle atrophy and changes in sleep patterns.
3. Impaired skin integrity related to edema, impaired healing and the skin is thin and fragile.
4. Disturbed Body Image related to changes in physical appearance, sexual dysfunction and decreased activity levels.
5. Disturbed Thought Processes related to fluctuations in emotions, irritability and depression.