Cushing Disease: Diagnosis, Treatment, Management, Nursing Interventions-An Updated Review

Abstract

Background: Cushing disease is a rare endocrine disorder characterized by the overproduction of adrenocorticotropic hormone (ACTH), usually caused by a pituitary adenoma. This condition leads to excessive cortisol secretion from the adrenal glands, resulting in a range of clinical manifestations such as weight gain, hypertension, glucose intolerance, and psychiatric disturbances. The disease is predominantly seen in women aged 50 to 60 years and can often remain undiagnosed for several years. Untreated, Cushing disease carries a high morbidity and mortality risk, making early diagnosis and management crucial.

Aim: This review aims to provide an updated overview of Cushing disease, focusing on its diagnosis, treatment options, and nursing interventions to manage the condition effectively.

Methods: An extensive literature review was conducted, including a detailed analysis of diagnostic criteria, medical treatments such as trans-sphenoidal surgery (TSS), radiation therapy, and medications like ketoconazole. Nursing interventions were highlighted, emphasizing the importance of monitoring vital signs, cardiovascular health, and the prevention of complications such as infections and electrolyte imbalances.

Results: The review found that the most effective method for diagnosing Cushing disease includes biochemical tests such as salivary cortisol, 24-hour urinary cortisol, and dexamethasone suppression tests. Pituitary MRI and inferior petrosal sinus sampling are crucial for confirming the diagnosis. Treatment options primarily focus on surgical resection of ACTH-secreting tumors, with radiation therapy and bilateral adrenalectomy used in refractory cases. Nurses play a critical role in monitoring patient conditions, managing complications, and providing patient education on managing their disease.

Conclusion: Cushing disease, although rare, requires timely diagnosis and a multidisciplinary approach to treatment. Early intervention through surgery or radiation therapy significantly improves outcomes. Nursing management is essential for the ongoing care and education of patients to ensure optimal recovery and reduce the risk of recurrence. Nurses must remain vigilant in monitoring for complications and educating patients on managing their condition effectively.