A nurse should perform which intervention for a client with cushings syndrome?

Cushing syndrome, or hypercortisolism, occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons.

In most cases, getting treatment can help you manage your cortisol levels.

The most common symptoms of this condition are:

• weight gain
• fatty deposits, especially in the midsection, the face (causing a round, moon-shaped face), and between the shoulders and the upper back (sometimes causing a visual hump)
• purple stretch marks on the breasts, arms, abdomen, and thighs
• thinning skin that bruises easily
• skin injuries that are slow to heal
• acne
• fatigue
• muscle weakness

In addition to the common symptoms above, there are other symptoms that may sometimes be observed in people with Cushing syndrome.

These can include:

• high blood sugar
• increased thirst
• increased urination
• high blood pressure (hypertension)
• a headache
• mood swings
• anxiety
• irritability
• depression
• increased number of infections
• irregular menstrual periods

Cushing syndrome in children

Children can have Cushing syndrome, too, although they develop it less frequently than adults. According to a 2019 review, about 10 percent of new Cushing syndrome cases each year occur in children.

In addition to the symptoms above, children with Cushing syndrome may also have:

• obesity
• slower rate of growth
• high blood pressure (hypertension)

Cushing syndrome in women

Cushing syndrome is more prevalent in women than in men. According to the National Institutes of Health (NIH), three times as many women develop Cushing syndrome compared to men.

Women with Cushing syndrome may develop extra facial and body hair.

This most often occurs on the:

• face and neck
• chest
• abdomen
• thighs

Additionally, women with Cushing syndrome may also experience irregular menstruation. In some cases, menstruation is absent altogether. Untreated Cushing syndrome in women can lead to difficulties becoming pregnant.

Cushing syndrome in men

As is the case with women and children, men with Cushing syndrome can also experience additional symptoms.

Men with Cushing syndrome may have:

• erectile dysfunction
• a loss of sexual interest
• decreased fertility

Cushing syndrome is caused by an excess of the hormone cortisol. Your adrenal glands produce cortisol.

Cortisol helps with a number of your body’s functions, including:

• regulating blood pressure and the cardiovascular system
• reducing the immune system’s inflammatory response
• converting carbohydrates, fats, and proteins into energy
• balancing the effects of insulin
• responding to stress

Your body may produce high levels of cortisol for a variety of reasons, including:

• high stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester
• athletic training
• malnutrition
• alcoholism
• depression, panic disorders, or high levels of emotional stress

Corticosteroids

The most common cause of Cushing syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare professionals can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.

High doses of injectable steroids for the treatment of back pain can also cause Cushing syndrome. However, lower dose steroids in the form of inhalants, such as those used for asthma, or creams, such as those prescribed for eczema, usually aren’t enough to cause the condition.

The one caveat is prolonged topical steroid use in children. This prolonged use has been connected to Cushing syndrome.

Tumors

Several kinds of tumors can also lead to a higher production of cortisol.

Some of these include:

• Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is called Cushing disease.
• Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They usually occur in the lung, pancreas, thyroid, or thymus gland.
• Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to irregular patterns of cortisol production, which can cause Cushing syndrome.
• Familial Cushing syndrome. Although Cushing syndrome isn’t typically inherited, it’s possible to have an inherited tendency to develop tumors of the endocrine glands.

Cushing syndrome vs. Cushing disease

If Cushing syndrome is caused by the pituitary gland overproducing ACTH which in turn becomes cortisol, it’s called Cushing disease.

As with Cushing syndrome, Cushing disease affects more women than men.

The main risk factor for developing Cushing syndrome is taking high-dose corticosteroids over a long period of time. If your doctor has prescribed corticosteroids to treat a health condition, ask them about the dosage and how long you’ll be taking them.

Other risk factors can include:

• being labeled female at birth
• your age
• living with pituitary or adrenal tumors

Some cases of Cushing syndrome are due to tumor formation. Although there can be a genetic predisposition to develop endocrine tumors (familial Cushing syndrome), there’s no way to prevent tumors from forming.

Cushing syndrome can be particularly difficult to diagnose. This is because many of the symptoms, like weight gain or fatigue, can have other causes. Additionally, Cushing syndrome itself can have many different causes.

A healthcare professional will review your medical history. They’ll ask questions about symptoms, any health conditions you may have, and any medications you’re taking.

They’ll also perform a physical exam where they’ll look for signs like a bump between your shoulders, stretch marks, and bruises.

Next, they may order lab tests, including:

• 24-hour urinary free cortisol test: For this test, you’ll be asked to collect your urine over a 24-hour period. The levels of cortisol will then be tested.
• Salivary cortisol measurement: In people without Cushing syndrome, cortisol levels drop in the evening. This test measures the level of cortisol in a saliva sample that’s been collected late at night to see if cortisol levels are too high.
• Low-dose dexamethasone suppression test: For this test, you’ll be given a dose of dexamethasone late in the evening. Your blood will be tested for cortisol levels in the morning. Normally, dexamethasone causes cortisol levels to drop. If you have Cushing syndrome, this won’t occur.
• Dexamethasone–CRH test. High cortisol levels can happen for a variety of reasons, from consuming too much alcohol to living with depression or anxiety. This test, which includes a shot of the hormone CRH and a dose of dexamethasone, can help a doctor note if high cortisol levels are due to Cushing syndrome, or another issue.

If you don’t already have an endocrinologist, you can browse doctors in your area through the Healthline FindCare tool.

Diagnosing the cause of Cushing syndrome

After you receive the diagnosis of Cushing syndrome, your doctor must still determine the cause of the excess cortisol production.

Tests to help determine the cause may include:

• Blood adrenocorticotropin hormone (ACTH) test: Levels of ACTH in the blood are measured. Low levels of ACTH and high levels of cortisol could indicate the presence of a tumor on the adrenal glands.
• Corticotropin-releasing hormone (CRH) stimulation test: In this test, you’re given a shot of CRH. This will raise levels of ACTH and cortisol in people with pituitary tumors.
• High-dose dexamethasone suppression test: This is the same as the low-dose test, except that a higher dose of dexamethasone is used. If cortisol levels drop, you may have a pituitary tumor. Higher levels or cortisol could point to an adrenal tumor or ectopic tumor.
• Petrosal sinus sampling: Blood is drawn from a vein near the pituitary and from a vein far from the pituitary. A shot of CRH is given, and if ACTH rises in the blood near the pituitary, it can indicate a pituitary tumor. Similar levels from both samples indicate an ectopic tumor.
• Imaging studies: These can include things like CT and MRI scans. They’re used to visualize the adrenal and pituitary glands to look for tumors.

The overall goal of Cushing syndrome treatment is to lower the levels of cortisol in your body. This can be accomplished in several ways. The treatment that you receive will depend on what’s causing your condition.

Your doctor may prescribe a medication to help manage cortisol levels. Some medications decrease cortisol production in the adrenal glands or decrease ACTH production in the pituitary gland. Other medications block the effect of cortisol on your tissues.

Examples include:

• ketoconazole (Nizoral)
• mitotane (Lysodren)
• metyrapone (Metopirone)
• pasireotide (Signifor)
• mifepristone (Korlym, Mifeprex) in those with type 2 diabetes or glucose intolerance

If you use corticosteroids, a change in medication or dosage may be necessary. Don’t attempt to change the dosage yourself. You should do this under close medical supervision.

Pituitary tumors

The most common type of treatment for pituitary tumors is surgery. The surgeon will go in through a nostril or an opening made below the upper lip to remove the tumor. When done correctly, this surgery has a 90 percent success rate.

After the surgery, your body won’t make enough ACTH initially, so you will likely be prescribed cortisol medication for months to years.

If surgery is not possible, radiation therapy may be an option.

Ectopic ACTH-producing tumors

Like pituitary tumors, surgery is typically the first option for ectopic tumors.

If surgery doesn’t work or isn’t an option, chemotherapy, radiation, and other cancer treatments may be able to help shrink the tumor.

Medications to reduce cortisol levels may also be part of your treatment plan.

One of the last treatment options is the removal of the adrenal glands.

Adrenal tumors

Surgery to remove the adrenal gland with the tumor is the first line of treatment for adrenal tumors.

In severe cases, it’s possible that both adrenal glands will have to be removed. In this instance, you may need to take medication for life to replace the hormones that adrenal glands produce, including cortisol.

Although certain lifestyle changes like focusing on your diet won’t cure your condition, they can help to keep your cortisol levels from rising even more or help to prevent complications.

Lifestyle tips for those with Cushing syndrome include:

• Lose weight if recommended. Since weight gain is one of the main symptoms of Cushing syndrome, if your doctor has recommended you lose weight, consider working with a nutritionist and increasing your physical activity in order to get your weight to an optimal level.
• Try to avoid drinking alcohol. Because heavy alcohol use can bring on signs and symptoms of Cushing, your doctor may recommend you stop drinking.
• Mange your blood sugar. Cushing syndrome can lead to high blood glucose, so try to limit foods that can cause a rise in blood sugar. Examples of foods to focus on eating include vegetables, fruits, whole grains, and fish.
• Cut back on sodium. Cushing syndrome is also associated with high blood pressure (hypertension). Because of this, your doctor may recommend you limit your sodium intake. This can simply entail not adding salt to food and carefully reading food labels to check sodium content.
• Make sure to get enough calcium and vitamin D. Cushing syndrome can weaken your bones, making you prone to fractures. Both calcium and vitamin D can help to strengthen your bones.

Cushing syndrome involves the release of too much cortisol in the body. There are a variety of different causes of Cushing syndrome, from the long-term use of steroid medication to tumors on the adrenal glands.

The sooner you begin treatment for Cushing syndrome, the better the expected outcome. It’s important to note that your individual outlook depends on the specific cause and treatment you receive.

It may take some time for your symptoms to improve. Be sure to ask a healthcare professional for healthy dietary guidelines, keep follow-up appointments, and increase your activity level slowly.

Support groups can help you cope with Cushing syndrome. Your local hospital or doctor can provide you with information about groups that meet in your area.