1. The client/caregiver can define Cushing’s syndrome.
   1. It is a hormonal disorder caused by prolonged exposure to high levels of cortisol.
   2. The adrenal glands release cortisol into the blood stream.
   3. Cushing’s syndrome is caused by an overproduction of cortisol.
   4. It most commonly affects adults who are 20 to 50 years old.
2. The client/caregiver can explain what causes the high levels of cortisol.
   1. Use of glucocorticoid hormones like prednisone for chronic health conditions.
   2. The body overproduces the amount of cortisol because
      1. Benign pituitary tumors, benign adrenal tumors cause a chain reaction that results in increased cortisol levels.
      2. Other benign or malignant tumors that grow outside the pituitary can cause the same reaction. The most common is malignant lung tumors.
3. The client/caregiver can list symptoms of Cushing’s syndrome.
   1. General physical features or change in appearance are as follows:
      1. A tendency to gain weight, especially around abdomen, face (moon face), and neck and upper back (buffalo hump)
      2. Thinning and weakness of the muscle of the upper arms and legs
      3. Thinning of skin with easy bruising and pink or purple stretch marks on the abdomen, thighs, breasts, and shoulders
      4. Increased acne
      5. Growth of facial hair
      6. Scalp hair loss for women
      7. Reddening complexion on the face and neck
      8. Skin darkening (acathosis) on the neck
   2. Other symptoms may be as follows:
      • Elevated blood pressure
      • Fatigue and weakness
      • Depression or mood swings
      • Increased thirst and urination
   3. Common laboratory finding changes are as follows:
      1. Elevated white blood count
      2. Elevated blood sugar
      3. Low serum potassium
4. The client/caregiver can list complications of untreated disease.
   1. Increased weakness and fatigue
   2. Poor skin healing
   3. Osteoporosis of the spine
   4. Increased susceptibility to infections such as pneumonia or tuberculosis
   5. Increased risk of peptic ulcers
5. The client/caregiver can list treatments for Cushing’s syndrome.
   1. If the cause is long-term use of glucocorti- coid hormones to treat another disorder, the physician will reduce it to the lowest adequate dose and monitor the use carefully.
   2. Other treatments may include the following:
      • Surgery
      • Radiation
      • Chemotherapy
      • The use of cortisol-inhibiting drugs
6. The client/caregiver can discuss important measures to manage disease.
   1. Monitor
      • Blood glucose (sugar) levels
      • Blood pressure
      • Weight (weekly)
      • Signs of edema
      • Stools for change in color or that test positive for blood
      • Mood changes or increasing depression
   2. Teach
      1. Safety precautions to prevent falls or injury
      2. The use of medications such as diuretic (fluid pills) or changes in medications
      3. Rest periods between activities
      4. Exercise with rest periods
      5. Avoidance of exposure to infections
      6. No nonprescription drugs without physician’s approval
      7. Recommended diet, usually sodium- restricted diet
      8. Good skin care and hygiene
      9. Expression of feelings over any physical changes
      10. Ways to modify appearance to improve self-esteem
   3. Report
      1. Any epigastric pain or discomfort
      2. Any sores or cuts that do not heal
      3. Any changes in glucose levels, weight, and blood pressure or evidence of blood in stool
      4. Any mood changes or depression

Resources

Counseling

Support groups

National Institutes of Health
www.nih.gov

Cushing’s Support and Research Foundation, Inc.
www.CSRF.net

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care.
Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott
Williams & Wilkins. Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com