HYPERCORTISOLISM

1. PITUITARY DISORDERS
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2. CONDITION DIRECTION HORMONE
Acromegaly overproduction growth hormone
Cushing's disease overproduction adrenocorticotropic hormone
Growth hormone deficiency underproduction growth hormone
Syndrome of inappropriate
anti-diuretic hormone
overproduction Vasopressin
Diabetes insipidus
(can also be nephrogenic)
underproduction Vasopressin
Sheehan syndrome underproduction any pituitary hormone
Pickardt-Fahlbusch-
Syndrome
underproduction
any pituitary hormone,
except prolactin, which is
increased
Hyperpituitarism (most
commonly pituitary
adenoma)
overproduction any pituitary hormone
Hypopituitarism underproduction any pituitary hormone
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3. CUSHING’S SYNDROME
Cushing’s disease is characterized by
abnormally increased secretion of
glucocorticoids ( cortisol) from adrenal
cortex due to increased ACTH secretion
from the pituitary gland.
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4. DEFINITION
Cushing’s syndrome is a metabolic disorder resulting
from the excessive production of cortisol by the
adrenal cortex or by the administration of
glucocorticoids in large doses for several weeks or
longer.
sometimes called hypercortisolism commonly affects
the age of 20 to 50. An estimated 10 – 15 million
people are affected each year.
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5. ETIOLOGICAL FACTORS
1. Hyperplasia of the adrenal glands.
2. Hypothalamic stimulation of pituitary gland
3. Adenoma or carcinoma of pituitary gland.
4. Exogenous secretion of corticotrophin by malignant
neoplasms in the lungs or gallbladder.
5. Excessive or prolonged administration of
glucocorticoids or corticotrophin.
6. Adenoma or carcinoma of the adrenal cortex. 5

6. PATHOPHYSIOLOGY
Due to the etiological factors
Hypothalamic secretion of pituitary gland
Excessive secretion of corticotrophin
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Increased plasma cortisol
Altered protein Altered fat Altered CHO
metabolism metabolism metabolism
Muscle wasting Buffalo hump Elevated
Fatigue obesity blood glucose
Delayed wound Weight gain Diabetes mellitus
healing

8. CLINICAL MANIFESTATIONS:
1. Rapid weight gain, especially in face, neck region, upper
back and torso.
2. Buffalo hump (growth of fat pads along the collar bone and
back of the neck).
3. Hyperhydrosis (excess sweating)
4. Telangiectasia (dilation of capillaries)
5. Abdominal striae
6. Hirsutism (facial male pattern hair growth)
7. Reduced libido and impotence in men.
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9. 9. Moodiness , irritability or depression
10. Muscle and bone weakness
11. Elevated blood pressure
12. Diabetes mellitus
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10. PSEUDO-CUSHING'S SYNDROME:
Elevated levels of total cortisol can also be
due to estrogen found in oral contraceptive pills
that contain a mixture of estrogen and
progesterone, leading to Pseudo-Cushing's
syndrome.
Estrogen can cause an increase of cortisol-
binding globulin and thereby cause the total
cortisol level to be elevated. However, the total
free cortisol, which is the active hormone in the
body, as measured by a 24-hour urine collection
for urinary free cortisol, is normal
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17. DIAGNOSTIC EVALUATION:
• HISTORY COLLECTION – Regarding
dietary history, previous illness & drug regimen.
• PHYSICAL EXAMINATION - Checking of
body weight, moon face, blood glucose level.
• BLOOD CHEMISTRY – showing increased
cortisol level, aldosterone level, sodium level,
corticotrophin and glucose. Decreased potassium
and calcium level.
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18. 4. URINE CHEMISTRY – Showing elevated free
cortisol, decreased specific gravity and glycosuria.
5. CT, MRI AND USG: presence of pituitary and adrenal
tumors.
6. DEXAMETHASONE SUPPRESSION TEST:
Reveals that there is no decrease in plasma cortisol
levels.
7. VISUAL FIELD EXAMINATION TO SEE ANY
VISUAL DEFECT IS PRESENT WHICH CAN BE
DUE TO A PITUITARY ADENOMA COMPRESSING
OPTIC CHIASMA.
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19. MEDICAL MANAGEMENT:
• Monitoring of vital signs, intake output chart,
laboratory studies and reduce the activity.
• Radiation therapy and diet restrictions such as low-
sodium, low-calorie and high-potassium and high-
protein level.
• Glucocorticoids such as prednisone, potassium
supplements such metyrapone, ketoconazole and oral
hypoglycemic agents such as glyburide, glipizide
agents to restore the blood glucose level. 19

20. 4. Mifepristone is a powerful glucocorticoid type II receptor
antagonist and, since it does not interfere with normal cortisol
homeostatis type I receptor transmission, may be especially
useful for treating the cognitive effects of Cushing's syndrome.
SURGICAL MANAGEMENT:
• Adrenalectomy – complete removal of adrenal gland and its
tumors.
• Transphenoidal hypophysectomy - is the other choice of
surgical measure.
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21. NURSING MANAGEMENT:
• Maintain the patients diet pattern, monitor and record vital signs,
intake & output chart, daily weight assessments and laboratory
studies.
• Assess the edema and fluid balance status.
• Check for any infections of the skin and respiratory & urinary
tract infections.
• Protect the patient from falls & bruising and infections.
• Encourage the patient to express his feeling regarding changes in
body image and sexual function.
• Provide rest periods & minimize environmental studies. 21

22. NURSING MANAGEMENT:
• Provide the Post Transphenoidal Hypophysectomy care:
– Keep the head of the bed elevated at least 30 degree.
– Maintain nasal packing.
– Provide frequent mouth care.
– Avoid activities that increase intracerebral pressure.
– Monitor the neurologic status.
• Teach about the individualized home care instructions.
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23. COMPLICATIONS:
• Adrenal insufficiency.
• Infection.
• Peptic ulcers.
• Hypertension.
• Osteoporosis.
• Fractures.
• Heart failure.
• Diabetes mellitus.
• Arteriosclerosis.
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24. Thank You
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