PHAR6205 Pharmacology

Answer :

Answers: 

What Is Cushing's Syndrome? 

Cushing's syndrome is a type of endocrine disorder which results in excessive production of the hormone, cortisol. It is a type of glucocorticoid hormone produced by adrenal gland. The primary reason behind too much of cortisol is the development of a non-cancerous tumour that produced high amount of ACTH (Adenocorticotropic) hormone. The ACTH hormone further stimulates adrenal glands to develop high amount of cortisol. Glucocorticoid is a type of steroid hormone and Cushing's syndrome occurs when the glucocorticoid in the body is too high. 

Some of the important functions of cortisol are as follows: 

• Regulation of blood pressure 

• Helping the body to respond to stress 

• Balancing the effect of insulin 

• Regulating the immune system (Nieman, 2018) 

Symptoms Of Cushing's Syndrome 

Some of the common symptoms of Cushing's syndrome are: 

• Weight gain and fatty tissue deposits 

• Stretch marks on the skin of the abdomen, breasts and thighs 

• Thin and fragile skin 

• Delayed healing of cuts 

• Acne In children and teenagers, high level of cholesterol may produce the following symptoms: 

• Puffiness of the face 

• High blood pressure 

• Stretch marks 

• Redness or flushing of the cheeks 

• Poor growth 

• Depression and anxiety 

• Fatigue 

• Disturbance in pubertal development (Ferriere & Tabarin, 2020). 

Risk Factors Of Cushing Syndrome 

Some factors that contribute to the risk of Cushing syndrome are high stress level, athletic training, alcoholism, malnutrition and depression. Another most common cause of Cushing syndrome is the use of corticosteroid drugs such a prednisone for a long period of time. High dose of such drug results in Cushing syndrome (Nieman, 2018). 

Pathophysiology Of The Condition 

Cortisol is a type of steroid hormone that is produced by the adrenal cortex. The cortisol binding protein carries the cortisol to different body parts and almost 90% of the cortisol binds to this protein. The bioavailability of the drug is around 60 to 100%. Due to the excess cortisol, high rate of gluconeogenesis and glycogenolysis takes place. The cortisol also has direct impact on the transcription and translation of enzymes in the Kreb's cycle and fat and glycogen metabolism. The hormone promotes the production of free glucose too, thus contributing to insulin resistance. The prolonged catabolism of the proteins contributes to purplish stripe in the torso and increases the chances of poor wound healing (Chaudhry & Singh, 2021). 

High cortisol level is associated with immune disruptions. It results in a decrease in lymphocyte levels and increase in neutrophils. Other pathophysiological changes observed is the detachment of the margin of neutrophils in the bloodstream and increase in the circulating neutrophil levels. The corticosteroid plays a role in the downregulation of NF-kappaB, regulation of AMP kinase, superoxide dismutase and other enzymes too (Chaudhry & Singh, 2021). 

Diagnosis Of The Disorder

One common diagnostic test that can be done to detect the disorder is blood tests. Blood tests can help to measure the level of cortisol in the body and detect the cause of the disease. In addition to this, urine test and saliva test can also be done. CT scan or MRIs are useful in capturing the image of the pituitary and the adrenal glands (Barbot, Zilio & Scaroni, 2020). 

Possible Interventions For The Disorder Some of the treatment options for Cushing syndrome are as follows: 

• If the Cushing syndrome is due to the long-term use of corticosteroid drugs, the doctors may reduce the dosage of the drug to manage the disease. 

• If the cause of Cushing syndrome is a tumor, then surgical intervention is needed. In this case, the tumor in the pituitary gland is removed by neurosurgeon. In case of tumor in the lungs or pancreas, minimally invasive surgical techniques can be initiated. 

• Pharmacological intervention can be initiated to control the excessive production of cortisol. It may include the use of medications such as ketoconazole and metyrapone. Mifepristone is also approved for treatment of Cushing syndrome (Brown et al., 2020). 

According to Ferriere and Tabarin (2020), as hypertension is the main treatment for patients, the normalization of cortisol production should be targeted. Hence, antihypertensive Therapy is the mainstay for treatment. Angiotensin II receptors blockers can be initiated as the first line treatment for the disorder. Lifestyle and home-based intervention is also targeted. However, there is lack of empirical evidence on any lifestyle intervention being implemented on patients with Cushing's syndrome. 

Patient Education Points It is possible to treat all patients with Cushing's syndrome and promote their recovery. However, for this the affected individual should have all the knowledge regarding the disease and ways to adhere to the medical intervention. 

Some important patient education that should be prioritized is as follows: 

• Firstly, health care professionals should target giving education on the cause of Cushing's syndrome, ways to detect sign and symptoms, risk factors and other possibility of complications in patient. Awareness about sign and symptoms can help patients to inform at the right time about abnormalities. 

• Patients who are taking corticosteroid drug needs to reduce their dose. In such condition, proper advice needs to be given to patients regarding how the dose should be reduced and the consequence of high dosage. In addition, the patient needs to be given education on dosage and side-effects for other drugs to reduce the cortisol level. 

• Patient should be advised to focus on long-term care and monitoring. For this, referral advice should be given to patient so that they remain connected to professional care. Long-term monitoring can be done by general practitioner as well as endocrinologist (Kreitschmann-Andermahr et al., 2018). 

• Newly diagnosed patients with Cushing's syndrome develop stress because of changes in their life due to the diagnosis. They are worried about their lifestyle. For this, they should be given education on coping skills and lifestyle changes. Evidence show that people affected by Cushing's syndrome have poor quality of life because of depression, anxiety, poor coping skills and low level of self-esteem. In this case, referred to specialist such as psychologist and supported with printed information too. Empathetic relationship with physicians can have great impact on patient outcomes (Santos et al., 2019).