Pathophysiology of Cushings syndrome

Legend Disease process

Precipitating factors

Predisposing factors

Manifestations Management

Stress responses inside the hypothalamus

Release of corticotropinreleasing hormone to the anterior pituitary gland Increase activities of

Stimulates the anterior pituitary gland to release adenocorticotro pic hormone

ACTH acts primarily on the adrenal cortex of the kidneys

Hyperplasia of the adrenal cortex

Increase levels of Mineralocorticoids Renin is secreted from the kidneys to stimulate the production of Angiotensin; angiotensin stimulates the secretion of aldosterone. If renin-angiotensin mechanism is

Increase levels of glucocorticoids (cortisol)

Hypertensi on AntiHPN Drugs

Development of the secondary male characteristics in women,menstru al irregularities

Increase levels of androgen sex hormone Can cause virilization of the female Development of low self-esteem

Increase ACTH activities in the adrenal cortex

A
Increase sodium potassium exchange in the late distal and cortical collecting tubules of the Hypokale mia, increase urine output Potassiu m supplem ents

Excess sodium is transported back to the blood Water follows where sodium goes

Potassium is secreted in the tubular filtrate for elimination in the urine

Decrease in intracellular potassium

Sodium and water retention

Decrease in resting potential of the cells Tachycardia, bradycardia, irregular rhythm

Myopat hy; muscle weakne ss, Provide ROM exercises

Cardiac dysrhythmia

Altered blood flow

Avoid strenuous activities,

B G
Increase protein catabolism

E
Mobilization of fatty acids to form glucose for energy
Buffalo hump, moon face, truncal obesity, ecchymoses, thinning of the skin, acne
Collagen supplements, avoid scratching

Diet modificatio n

Hepatome galy Insulin resist ant Polydypsia , polyphagi a, polyuria

Increase gluconeogenesis in the Peripheral glucose use falls Hyperglycemia

Depression Increased viscosity of the blood Counseli ng

F
Diet modification, administer insulin

Suicidal attempt

G F &D

H H

B
Increased pressure in the capillaries/ blood vessels Decrease protein (albumin) in the blood which holds the fluids

G
Altered Calcium metabolism

Leakage of fluids into the extra vascular spaces

Decrease absorption of calcium by the bones

Decrease intensity in muscle contraction

Edem a

Enlargement of the tissues due to increase absorption of leaked out fluids

Muscle weakness and atrophy, cardiac irregularities, bone weakness and osteoporosis

Anticipate the need for diuretics

Stricture of the blood vessels

Provide ROM exercises

Obstruction of the blood flow

C C,F,D, I
Surgical Surgical removal removal of of the the 02 dead dead 02 intubati part part inhalatio on n

Decrease in movements due to weakness

Black Decrease in discoloration of O2 saturation, Greenish-black the affected cyanotic , of the color Cyanotic part, no pain tachypnic affected part events sensorium

C, F, D, I

Poor blood circulation Gangrene Poor tissue perfusion Septicemi Cell death/ necrosis DEATH