Sample Powerpoint Slides With Speaker Notes On Cushing Disease

Slide 1: Overview of Cushing Syndrome 

ü  The disorder is caused by excess levels of the hormone cortisol (Braun et al., 2022)

ü  It emerges due to excess production of cortisol in the body or from the intake of oral corticosteroid medication

ü  Symptoms include a rounded face, stretch marks, fatty bump on the shoulders, weight gain, and thin legs and arms.

ü  In the US, only about 10 to 15 new incidents per million people annually (OHSU, n.d.).

ü  It is more prevalent in people aged between 20 to 50, and women are three times more vulnerable than men.

Speaker Notes

The presentation is about a case study of a patient with Cushing's Syndrome, a disorder caused by the excess or abnormal accumulation of the hormone cortisol in the body (Braun et al., 2022). The excess hormone levels can be caused by oral intake of a corticosteroid medication or when the body produces it in excess. Some symptoms of the Syndrome include excess weight gain, thinning of legs and arms, the emergence of pink or purple stretch marks on the skin, and bumps around the shoulder. It is a rare syndrome in the United States, where only 10 to 15 cases are reported per 1 million people annually (OHSU, n.d.). The condition is prevalent in people between 20 and 50 years and is three times more likely to occur in women than men.

Slide 2: Pathophysiology

ü  The Syndrome affects approximately 6.2-7.6 million people in the US annually and 1.2-2.4 million in Europe (Nieman et al., 2019).

ü  If not treated, it causes osteoporosis, type 2 diabetes, hypertension, and causes people to lose muscles and strength.

ü  It also causes frequent infections, heart attack or stroke, depression or anxiety, and concentration problems.

ü  Over 70% of adult cases are caused by pituitary adenomas (Cushing's disease), compared to 60-70% of the cases in children and adolescents.

ü  The Syndrome also causes erection dysfunction among men and amenorrhea and hirsutism in women.

Speaker Notes

The slide states that the Cushing syndrome is more prelevant in the US than in Europe. For instance, Nieman et al. (2019) report that it affects between 6.2 and 7.6 million people in the US compared to 1.2 to 2.4 million people in Europe. More so, pituitary adenomas (or Cushing's disease) contribute to over 70% of Cushing syndrome cases in adults, compared to 60 to 70% in children and adolescents (OHSU, n.d.). Also, the Syndrome causes complications like election dysfunction in men and amenorrhea and hirsutism in women, as well as other complications like type 2 diabetes, depression and anxiety, hypertension, frequent infections, and concentration problems. However, early detection can avoid such adverse effects.

Slide 3: Information about the Patient 

ü  The patient is a 44-year-old man who presented to the hospital after eight months of immobility and falls

ü  He has had type 2 diabetes in the past, as well and hypertension and cardiac failure

ü  The patient reports having weaker muscles and strength, is obese, and has a history of depression

ü  He also feels tired and weak and has been experiencing erection dysfunction for the past nine months

ü  He has also gained excess weight around her neck, above the collar bone, and in the face

Speaker Notes

The patient explains to the caregiver some of the issues he has been facing. He reports increasing immobility, weaker muscles, a lack of strength, and erection dysfunction. The patient has also had other complications directly associated with the Syndrome, including type 2 diabetes, cardiac failure, and hypertension. The excessive weight gain around the neck, collar bone, and neck also hint that he may be suffering from Cushing syndrome. Other symptoms of the disorder evident in this case include a history of depression, feeling tired and weak, and obesity. Therefore, the nurse should conduct a physical examination to confirm all the symptoms the patient may be experiencing.

Slide 4: Patient's Physical Examination

ü  The patient has purple stretch marks around the armpits, belly, and the chest

ü  He can barely stand for 5 minutes, possibly due to muscle weakening

ü  His face is round and has fatty tissue between the neck and the shoulders

ü  Also, the skin has bruises, have a moody face, and is obese

ü  The patient has a thicker body and facial hair

ü  However, fatigue and weight can also be signs of Metabolic Syndrome, meaning further testing is needed.

Speaker Notes

The doctor conducted a physical examination of the patient and noticed he could barely stand for 5 minutes, meaning he may be experiencing a weakening of the muscles. The patient also has purple stretch marks around the belly, chest, and armpits, a round face, and fatty tissues between the neck and the shoulder. He is also obese and has skin bruises, a moody face, a thicker body, and facial hair. The patient demonstrated most of the signs of Cushing Syndrome outlined by OHSU (n.d.). However, fatigue and excess weight gain can be due to many conditions, like Metabolic Syndrome. The doctor needs to conduct a further diagnosis to ascertain whether the patient has Cushing's Syndrome.

Slide 5: Diagnostics 

ü  The doctor conducted a 24-hour urinary cortisol test and reported a urine-free cortisol value of 229 micrograms

ü  The normal value is less than 50, showing the patient has excess cortisol hormone (Lefkowitz et al., 2017)

ü  After performing an inferior petrosal sinus sampling, the doctor concluded that the Syndrome was caused by pituitary

ü  The tests confirmed that, indeed, the patient had Cushing disorder

ü  I agree with the lab and diagnosis results since high cortisol hormone levels prove the existence of the Syndrome (Lefkowitz et al., 2017)

Speaker Notes

According to Lefkowitz et al. (2017), a 24-hour cortisol urinary test effectively measures the hormone level, whose excess accumulation above 50 micrograms per day causes Cushing Syndrome. Therefore, since the patient's value was 229, they had the disorder. To further conform to the cause of the disorder, inferior petrosal sinus sampling was conducted, which confirmed that the pituitary caused the patient's Cushing Syndrome. As mentioned earlier, over 70% of adult cases are caused by the pituitary (OHSU, n.d.). I am confident of how the diagnosis was conducted, and the lab results confirmed that the patient had the Syndrome, as hinted by the physical examination.

Slide 6: Differential Diagnosis

ü  Metabolic Syndrome co-occurs with cardiac disease and type 2 diabetes. A CT or MRI scan could rule it out by showing images of tumors in the pituitary and adrenal glands. 

ü  Muscular dystrophy causes frequent falls and muscle loss. The urinary cortisol test rules out as it is not associated with increased cortisol hormone levels (Barros et al., 2019).

ü  Parkinson's disease causes frequent falls, skin problems, and depression. The blood or salivary tests would be used to confirm high levels of ACTH, and MRI or CT scans would confirm pituitary.

Speaker Notes

Differential diagnosis helps doctors eliminate the conditions that could share the same symptoms and results as the one the patient suffers from (Barros et al., 2019). In this case, metabolic Syndrome, like the Cushing Syndrome, is associated with type 2 diabetes. A CT or MRI scan could be used to confirm the existence of any tumors or abnormalities in the adrenal glands and the pituitary. The scan confirms that the patient has Cushing Syndrome, following the laboratory tests and not the physical examination of the signs and symptoms the patient displays (Barros et al., 2019). Muscular dystrophy also causes frequent falls and muscle loss, which the patient experiences. Therefore, further tests like the urinary cortisol test would confirm the patient has an excess accumulation of the cortisol hormone. Finally, Parkinson's disease also causes frequent falls, skin problems, and depression, which the patient faces (Barros et al., 2019). However, following blood and salivary tests, the doctor can confirm the high levels of cortisol hormone and the existence of a tumor or abnormalities in the pituitary. These additional tests help the doctor diagnose the patient for the right condition.

Slide 7: Treatment of the Syndrome

ü  The patient underwent transsphenoidal surgery to remove the pituitary micro-adenoma

ü  The patient's level of cortisol hormone was monitored every 6 hours after the surgery

ü  The patient underwent counseling before, during, and after the surgery to help him control anxiety and stress

ü  The patient was discharged on the fifth day after the surgery as the hormone level had declined to 40 mg.

ü  He was to take a 40g dose of hydrocortisone every morning and evening for the next three weeks before sifting to 20g in the morning and 15g in the evening.

ü  Eight weeks later, he had lost 10 pounds, and his face was thinner

Speaker Notes

The patient's pituitary micro-adenoma was removed through surgery two weeks after the laboratory results. After the surgery, he was carefully monitored to assess whether the cortisol hormone levels declined every 6 hours. On day 1, the cortisol level had reduced from 229 micrograms to 190. The level dropped to 130 on day 2, 90 on day 3, and 40 on day 4. After showing no sign of diabetes insipidus, the patient was discharged on a dose of 40g of hydrocortisone every morning and evening, which he was instructed to take for three weeks before shifting to a 20g dose in the morning and 15g in the evening. To deal with anxiety and stress, he underwent counseling before, during, and after the surgery. A follow-up three weeks later showed the patient's face thinner, and the cortisol hormone level was normal. Eight weeks later, the patient had lost 10 pounds, fatigue had disappeared, and falling ad stopped.

Slide 8: Evidence-Based Practice

ü  The transsphenoidal surgery has been proven to control Cushing Syndrome in 68 to 98% of the patients (Simoes Correa Galendi et al., 2021)

ü  Caregivers should educate patients and their families regarding the disease, the symptoms, and treatment alternatives (Nieman et al., 2015).

ü  Doctors must be crateful while diagnosing the patients, selecting the treatment method, and long-term engagement for better outcomes (Fleseriu et al., 2021).

ü  The 24-hour urine-free cortisol test is more effective in determining the cortisol level when started on an empty bladder (Chaudhry & Singh, 2021).

Speaker Notes

The current evidence-based practice and guidelines support the current treatment method, transsphenoidal surgery, which has been proven to control the disease in over 68% of the patients (Simoes Correa Galendi et al., 2021). The current research also requires caregivers to educate patients and their families about the disease, its causes, and alternative treatment (Nieman et al., 2015). Nursing practitioners can also help the patients recover from the surgeries or treatment by offering support to control their anxiety and stress. The current guidelines require doctors to be extra careful while diagnosing the patients and selecting the treatment method to facilitate better outcomes (Fleseriu et al., 2021). Finally, research supports using a 24-hour urine-free cortisol test as long as the test begins on an empty bladder to improve efficiency (Chaudhry & Singh, 2021).

Slide 9: Did the Treatment go along with EBP?

ü  The treatment went along with the EBP, as the treatment method is proven to be very effective (Simoes Correa Galendi et al., 2021)

ü  The patient was also offered counseling to help him recover before, during, and after the surgery

ü  The treatment follow-ups ensured the patient was recovering and bosts the long-term outcome of the care (Fleseriu et al., 2021)

ü  The surgery has helped over 68% of the patients to recover from the Syndrome and lower the levels of the cortisol hormone, as it did in this case

ü  The diagnosis was effective as the patient showed much improvement after eight weeks

Speaker Noted

The treatment applied by the doctor, in this case, was effective, as the patient's cortisol level stabilized five days after the surgery, allowing him to be discharged on the 5^th day. Transsphenoidal surgery has been proven effective in managing the Syndrome, and it helped the patient recover faster (Simoes Correa Galendi et al., 2021). Also, the follow-up with the patient after the third and eighth weeks enabled the doctor to keep track of the progress and offer alternative medication or treatment if the condition was reoccurring (Fleseriu et al., 2021). Fortunately, the patient's condition improved, and additional treatment was not needed. Therefore, the doctor's treatment aligned with the current EBP and guidelines.

Slide 10: Summary

ü  Cushing's Syndrome is caused by excess production of the hormone cortisol

ü  The disorder affects approximately 6.7 to 7.6 million people in the US, and women are twice as vulnerable to it as men

ü  The case study involved a 44-year-old man who has had frequent falls, type 2 diabetes, fatigue and loss of muscles, obesity, and weight gain on the face

ü  The 24-hour urinary cortisol test revealed his urine-free cortisol value of 229 micrograms, while the normal value is below 50

ü  The patient underwent transsphenoidal surgery and was given a hydrocortisone dosage.

ü  The treatment was in line with the current EBP and guidelines

Speaker Notes

The presentation presents a case study of a 40-year-old man suffering from Cushing Syndrome, which is caused by excessive production of the hormone cortisol. The presentation reveals that although the disorder cases are rare, it affects over 6.7 million annually in the US alone. Based on the patient's physical examination, he shows signs and symptoms of the condition, like loss of muscle and strength, depression and anxiety, and weight gain. However, a physical examination is not enough to offer treatment, which is why the doctor conducts a laboratory test. The rest reveals that the patient's urine-free cortisol value was 229 micrograms, above the average level of 50. As a result, the diagnosis confirmed the patient had the Syndrome. He underwent transsphenoidal surgery and was given a hydrocortisone dosage, which helped lower the hormone cortisol level in his body. The presentation also reveals that the treatment was offered per the current EBP guidelines.

References

Barros, A. P., Lamback, E. B., Coelho, M. C. A., & Neto, L. V. (2019). Limitations of Basal Cortisol in the Diagnosis of Cushing Syndrome. AACE Clinical Case Reports, 5(2), e91-e94. https://www.sciencedirect.com/science/article/pii/S2376060520305174

Braun, L. T., Rubinstein, G., Zopp, S., Vogel, F., Schmid-Tannwald, C., Escudero, M. P., ... & Reincke, M. (2020). Recurrence after pituitary surgery in adult Cushing's disease: a systematic review on diagnosis and treatment. Endocrine, 70(2), 218-231. https://doi.org/10.1007/s12020-020-02432-z

Chaudhry, H. S., & Singh, G. (2021). Cushing syndrome. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470218/

Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., ... & Biller, B. M. (2021). Consensus on diagnosis and management of Cushing's disease: a guideline update. The lancet Diabetes & endocrinology, 9(12), 847-875. https://doi.org/10.1016/s2213-8587(21)00235-7

Lefkowitz, E. G., Cossman, J. P., & Fournier, J. B. (2017). A case report of Cushing's disease presenting as hair loss. Case reports in dermatology, 9(1), 45-50. https://doi.org/10.1159/000457898

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. https://doi.org/10.1210/jc.2015-1818

Nieman, L. K., LACROIX, A., & MARTIN, K. A. (2019). Epidemiology and clinical manifestations of Cushing's Syndrome. UpToDate. Oct. https://www.medilib.ir/uptodate/show/143

OHSU., n.d. Cushing Disease/Cushing Syndrome. Oregon Health & Science University. https://www.ohsu.edu/brain-institute/cushing-disease-cushing-syndrome

Simoes Correa Galendi, J., Correa Neto, A. N. S., Demetres, M., Boguszewski, C. L., & Nogueira, V. D. S. N. (2021). Effectiveness of Medical Treatments of Cushing's Disease: A Systematic Review and Meta-Analysis. Frontiers in endocrinology, 12, 732240. https://doi.org/10.3389/fendo.2021.732240