Case StudyCushings
Case Study 78 Cushing’s Syndrome
Scenario
You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome.
Clinical Presentation
• Centripedal (truncal) obesity or generalized obesity
• Thin arms and legs
• Bruising
• Weakness and fatigue
• Moon-facies with facial plethora
• Purplish-red striae on abdomen, breasts, and buttocks
• Hypertension
• Impaired glucose metabolism Clinical presentation
• Unexplained hypokalemia
• Acne
• Hirsutism
• Menstrual irregularities
1. Differentiate between Cushing’s syndrome and Cushing’s disease.
Cushing’s syndrome is the term used to describe a group of symptoms that occur when a persons’ cortisol levels are too high (known as hypercortisolism) for too long. The majority of people have Cushing’s syndrome because they are regularly taking certain medicine(s) that continually add too much cortisol to the body. Doctors call this an “exogenous” (outside the body) cause of Cushing’s syndrome. Other people have Cushing’s syndrome because something is causing the adrenal gland(s) to overproduce cortisol.5 Doctors call this an “endogenous” (inside the body) cause of Cushing’s syndrome.
Cushing’s disease is the most common form of endogenous Cushing’s syndrome. It is caused by a tumor in the pituitary gland that secretes excessive amounts of a hormone called Adrenocorticotropic hormone, or ACTH.
2. Your assessment
Scenario
You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome.
Clinical Presentation
• Centripedal (truncal) obesity or generalized obesity
• Thin arms and legs
• Bruising
• Weakness and fatigue
• Moon-facies with facial plethora
• Purplish-red striae on abdomen, breasts, and buttocks
• Hypertension
• Impaired glucose metabolism Clinical presentation
• Unexplained hypokalemia
• Acne
• Hirsutism
• Menstrual irregularities
1. Differentiate between Cushing’s syndrome and Cushing’s disease.
Cushing’s syndrome is the term used to describe a group of symptoms that occur when a persons’ cortisol levels are too high (known as hypercortisolism) for too long. The majority of people have Cushing’s syndrome because they are regularly taking certain medicine(s) that continually add too much cortisol to the body. Doctors call this an “exogenous” (outside the body) cause of Cushing’s syndrome. Other people have Cushing’s syndrome because something is causing the adrenal gland(s) to overproduce cortisol.5 Doctors call this an “endogenous” (inside the body) cause of Cushing’s syndrome.
Cushing’s disease is the most common form of endogenous Cushing’s syndrome. It is caused by a tumor in the pituitary gland that secretes excessive amounts of a hormone called Adrenocorticotropic hormone, or ACTH.
2. Your assessment