Today we are going to be talking about Cushing’s disease. Cushing’s disease is a condition in which your pituitary gland produces too much hormone that causes an overproduction of the stress hormone Cortisol. Cortisol is responsible for so many things, but amongst them, it causes weight gain around your trunk and also weight loss and fat loss in the legs and arms. Some of the considerations we want to think about when we are taking care of these patients, we want to monitor the vital signs. These patients tend to have higher blood pressure because of the stress hormone. We want to assess for increased glucose levels, and we want to monitor for signs of infection. Our desired outcome with Cushing’s patients is to manage the symptoms, to maintain normal blood pressure and to maintain a normal blood glucose level. We want to keep it to an inappropriate age. 

So subjective. These patients are always complaining about a few things. One of them being weakness and pain, but specifically back pain. They also have irregular menstrual cycles, and they complain of shortness of breath. Some things that we are going to see are classic when it comes to Cushings. And these are the following: a red, they like to describe it as a red, ruddy face and upper body obesity. They have thin arms, thin legs, but obesity in their trunk area. And then, there’s something called a moon face. So, their face just rounds up. So, that is a moon face. And then the other thing is called Buffalo hump. A Buffalo hump is where there is fat storage that goes right behind the neck. They also have tachycardia and hypertension and osteoporosis. Some things that we want to consider and do and intervene when we are taking care of these patients is that we want to do a really good assessment. 

We want to assess these patients really well, focusing on their cardiac and respiratory status. Sometimes we may need to perform a 12 lead and that’s really to rule out any cardiac involvement. Oftentimes these patients will have shifts in their electrolytes and, you know, electrolytes are very responsible for cardiac workups. So we want to make sure that those are good. And we also want to look out for their difficulty breathing. They do have certain medications that they’re going to get. One of the medications is going to be an antihypertensive. We want to make sure that we are controlling their blood pressure because they have way high BP. Their BP is way through the roof because the changing cortisol level is telling them that it’s time to fight and you need that extra blood pressure. We also want to give them some diuretics because patients with Cushing’s disease tend to hold on to water and that just puts on extra strain on the heart. Because these patients have a compromised immune system because of the cortisol levels, we are going to monitor for those infection signs. And those infection signs include fever and wounds that might not be healing. They may complain of nausea and vomiting. Cortisol is telling the body, the immune system to step to the side. That’s good in a fight or flight situation, but with just everyday living, you need your immune system. So we want to monitor for that. We also want to prepare these patients for surgery because some of these patients can not be managed with medications, the surgery to remove the pituitary gland or adrenal glands is the most common treatment for this disease. So we want to do that. Some of the things we want to do with that is we want to keep the patient’s NPO for nothing by mouth, and we want to manage them post-operatively again, because of the electrolyte and the fluid shifts. 

We want to manage their electrolyte balance by drawing labs, the cortisol levels, when it’s overproduced, it causes the body to retain sodium and water. So again, that puts more stress on the heart, but it also leads to low potassium or high hypokalemia, low calcium. We want to promote rest, which is very important. I love rest. So we want to promote rest. These patients are in a constant state of fight or flight. And so it weakens the body, weakens the immune system, and it actually increases their risk of developing a bacterial infection. So we want to make sure that these people can rest. We want to do whatever we can to decrease stimulation, to keep them asleep and let them actually have a chance to fight off. And finally, we want to manage the blood glucose level. These patients with Cushing’s disease tend to have a high glucose level, even if they’re not diabetic, the excess cortisol causes their blood sugar to fluctuate. 

So, we want to monitor their levels. And if it’s outside of the target range, whatever the doctor has a set, we want to make sure we notify them of that; we could possibly get some insulin orders for that. This is just a quick look at the top things of what a Cushing’s patient will look like. So we discussed this a little bit, but we have the moon face and there is a bit of a Buffalo hump on the back of the neck. They have what we call truncal obesity. So a larger stomach, and it is a little extended. There’s a complaint of osteoporosis; so they have very weak and brittle bones, so easy, easy breaks. Okay. And then they have thin extremities. So you have these patients with these large trunks, but very thin arms and legs. That is a classic classic picture of someone who is dealing with Cushing’s disease. 

And the key points, just to remember, is that the pituitary gland causes the overproduction of cortisol, which leads to Cushing’s disease. Some of the things that the patient’s going to tell us is that they’re going to have some back pain and weakness. They’re going to be short of breath. Well, we’re going to see, as nurses, an increase in their heart rate and their blood pressure. They’re also going to have, like I said, that classic Buffalo hump Moon face, high sugars, high blood glucose levels, the glucose management is all about counteracting those increased cortisol levels. So we’re going to do glucose checks and we’re going to treat them as ordered. Also, we’re going to do infection prevention. So part of that is hand hygiene, but we’re also going to encourage the patients to stay away from others who are sick from infections that we just want to encourage and educate the patient about. It’s going to be a fever and wounds that won’t heal. We love you guys; go out and be your best self today. And that’s always happy nursing.