NUR231 Challenge And Response To Body Integrity

Question:

Sara Haines Cushing syndrome case study Sara Haines is a 38-year-old who runs Grand Central Restaurant at Toowoomba shopping centre. She presented to St Vincent’s Private Hospital, Toowoomba complaining of drastic weight gain over six months, significant facial hair growth, menstrual abnormalities, and both excessive thirst and appetite. Recently, Sara also feels dull and depressed, does not have much energy, and has stopped performing all her favourite activities including tennis at Action Indoor Sports Stadium.
Sara is a successful and busy business person in Toowoomba, never stroked and only consumes alcohol in moderation at social events. She has several allergies (House dust mites, cockroaches, and dog’s dander) and is not taking any medications other than a daily multivitamin tablet and betamethasone (as needed) for her asthma (used for many years). On clinical examination, the clinician, Dr John Smith noticed protuberant with striae and minimal bruising in her abdomen, and no abdominal tenderness, and both upper and lower extremities show areas of hyperpigmentation. Laboratory results confirmed that her cortisol levels were high indicating Cushing syndrome.

1. Explain the causative factors and pathophysiology of Cushing syndrome and how she developed this condition.

2. Describe the primary signs and symptoms of Cushing syndrome.

3. What aspects of her clinical history place Sara at increased risk of hypertension and, briefly explain the difference between Graves’ disease and Cushing syndrome.

4. What treatment and follow up options are there for her condition?

Answer:

1. Causative Factors and Pathophysiology of Cushing Syndrome

Cushing syndrome refers to an abnormal ailment instigated by a high level of corticosteroids in the body either due to continued use of corticosteroid medication or hyperfunction of the adrenal gland (Bornstein et la., 2016). Typically, the illness is characterized by some changes in the body appearance, for example, muscle weakness, fatigue, moon face, hypertension and truncal obesity. Recent studies have shown that Cushing Syndrome condition occurs more often among women between age 22 to 50 years (Lacroix, Feelders, Stratakis, & Nieman, 2015). Cortisol is a hormone in the body responsible for stress response. In a healthy human being the anterior pituitary gland reevaluates adrenocorticotropic hormone (ACTH) which stimulates the release and production of cortisol hormone (Sharma, Nieman, & Feelders, 2015). However, there are cases where the body is unbaled to regulate the release of the hormone thus, overproduction. For instance, when an individual encounter a stressful situation the body releases additional cortisol hormone to respond to the situation.

Cortisol hormone plays a critical in a person’s body as it keeps cardiovascular system to function normally and it helps to regulate a person’s blood pressure (Bornstein et la., 2016). One of the causative factors of the ailment is the prolonged use of corticosteroid medication like Oral corticosteroid. Also, the illness can be caused by an individual body’s overproduction of cortisol hormone. In the case of Sara, it is clear that Cushing Syndrome occurred because of prolonged use of betamethasone for her asthma. Sara’s medication is Oral corticosteroid in nature. Usually, the doses required to treat asthma are higher than the amount of cortisol a person body uses each day. Therefore, Sara developed Cushing Syndrome.

2. Primary signs and Symptoms of Cushing Syndrome.

Typically, Cushing syndrome is characterized by an assortment of signs and symptoms including a change in appearance marked by truncal obesity, moon face, hypertension, muscle weakness, and fatigue (Lodish, & Stratakis, 2016). However, the symptoms and singes of the ailment vary depending on the level of cortisol in the body. Server fatigue is one of the primary singes and symptoms of the onset of Cushing Syndrome (Ejaz et al., 2015). It is clear from Sara case that she did not have enough energy to participate in her favorite activities. Also, depression is one of the common singes and symptoms of the condition (Nieman, 2015). For example, Sara was dull and depressed. Cushing Syndrome is associated with mood changes; many patients experience hasty emotional ups and downs.

Moreover, Cushing Syndrome is characterized by progressive obesity. Individuals with Cushing Syndrome have fatty tissue deposit especially around the face hence the name moon face and around the shoulder (Nieman et al., 2015). In the case of Sara, she drastically gained weight for a short period. Also, one of the common signs is the development of fragile skin that bruises easily, the legs and the arms are often covered with bruises (Melmed, 2016). Dr. John Smith noticed minimal bruises on Sara’s abdomen which was a clear sign that she had Cushing Syndrome. Lastly, facial hair growth is one of the common signs and symptoms, especially among women. It is clear from Sara’s case she had significant facial hair growth.

References

Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., … & Torpy, D. J. (2016). Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 101(2), 364-389.

Ejaz, S., Vassilopoulou?Sellin, R., Busaidy, N. L., Hu, M. I., Waguespack, S. G., Jimenez, C., … & Habra, M. A. (2015). Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: the University of Texas MD Anderson Cancer Center Experience. Cancer, 117(19), 4381-4389.

Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015). Cushing’s syndrome. The lancet, 386(9996), 913-927.

Lodish, M., & Stratakis, C. A. (2016). A genetic and molecular update on adrenocortical causes of Cushing syndrome. Nature Reviews Endocrinology, 12(5), 255.

Melmed, S. (2016). Williams textbook of endocrinology. Elsevier Health Sciences.

Nieman, L. K. (2015). Cushing’s syndrome: update on signs, symptoms and biochemical screening. European journal of endocrinology, 173(4), M33-M38.

Nieman, L. K., Biller, B. M., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., & Tabarin, A. (2015). Treatment of Cushing’s syndrome: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(8), 2807-2831.

Sharma, S. T., Nieman, L. K., & Feelders, R. A. (2015). Cushing’s syndrome: epidemiology and developments in disease management. Clinical epidemiology, 7, 281.

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