Incidence and prevalence
Cushing’s syndrome is listed as a rare disease, it affects just a fraction of people i.e. around 15 people per a million population each year in America; such rare occurrence has also been reported in countries like Spain, Italy and Denmark. However, statistics show there is increasing prevalence among high risk patient populations. This syndrome tends to be prevalent on people with diabetes mellitus, hypertension and early onset osteoporosis (Parsa & Melmed, 2014) .
Pathophysiology
Cushing’s syndrome occurs when there is overproduction of endogenous glucocorticoid or hypercortisolism that is independent of ACTH usually due to a primary adrenocortical neoplasm. In rare cases, Cushing’s Syndrome might be caused by bilateral micronodular hyperplasia. Researches have shown that ACTH independent Cushing syndrome is caused by ectopic cortisol secretion after a case of ovarian carcinoma. In such an incidence ACTH level is low due to the negative feedback to pituitary corticotroph cells and a high level of serum cortisol (Parsa & Melmed, 2014) . In alternating cases ATCH levels may be high in a classic Cushing’s disease, this increased levels occur due to anterior pituitary tumor.
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Physical Assessment and Examination
Physical examination can be conducted to identify symptoms like the moon face which makes the face to swell up into a rounded shape. The eyes often have pituitarylesion which makes the optic chiasm to appear compressed. There might appearance fat pads on the collar bone and at the back of the neck. Patients can be tested of Cushing’s syndrome by having an analysis of a 24-hour urine collection for urinary free cortisol excretion. Additional measurements might be necessary to rule on a urinary free cortisol value. A physician can also do a I-mg overnight dexamethasone suppression test that is used in measuring the plasma cortisol’s level ( Reincke, 2015).
Evidence-Based Treatment Plan andPatient Education
The most probable treatment of Cushing’s disease is having a transphenoidal removal of the tumor. After the surgery, the patients may be rendered hypoadrenal for months or years this demands that they be placed under a glucocorticoid replacement therapy. The disease is also reported to be recurrent after the surgery in such an incidence total bilateral adrenalectomy may be necessary to control the symptoms. Careful and clear instructions should be given to patients explaining the effect of stress and illness on glucocorticoid dosages. Medical alert labels may also be important for these patients ( Fielders, 2013).
Follow Up and Evaluation to Assess theEfficacy and Outcomes
Long-term follow up and monitoring is important to analyze signs and symptoms of the tumor recurrence. Pituitary adrenal axis should be evaluated six to 12 months after surgery to establish the potential need for a lifetime exogenous steroid replacement therapy. Subsequent to surgery lifetime monitoring and titration of hormone therapy would be necessary. If a patient has unexplained clinical findings suggestive of Cushing’s syndrome should undergo an extensive evaluation for hypercortisolism, an investigation would be necessary if there is presence of hypercortisolism ( Fielders, 2013).
References
Fielders, R. (2013). M22 – Cushing Disease: Evaluation and Management. 2013 Meet-The-Professor: Endocrine Case Management , 270-277. Retrieved from http://press.endocrine.org/doi/abs/10.1210/MTP2.9781936704637.ch43
Parsa, A. A., & Melmed, S. (2014). Genetic Factors in Cushing Disease Pathogenesis. Genetic Steroid Disorders , 365-371. doi:10.1016/b978-0-12-416006-4.00031-4
Reincke, M. (2015). Genetics of Cushings Disease. Endocrine Abstracts . Retrieved from http://www.endocrine-abstracts.org/ea/0037/ea0037S18.3.htm
