Symptoms and Biochemical Screening †Free Samples to Students

Question: Discuss about the Symptoms and Biochemical Screening. Answer: Introduction: Cushings syndrome encompasses a collection of symptoms and signs that occur due to prolonged cortisol exposure. In other words, Cushings syndrome or hypercortisolism occurs due to abnormality in the levels of cholesterol. Corticosteroid medications are considered as a primary reason for this physiological abnormality (Lacroix, Feelders, Stratakis Nieman, 2015). Most common symptoms of this condition include hypertension, abdominal obesity, round red face, lump between shoulders, muscle weakness and weak bones. This essay will contain a discussion on a case study of a patient Susan Summers and will describe the etiology, pathophysiology, cause and symptoms of this health abnormality management. Pathophysiology refers to the disorder or disrupted physical processes that are associated with development of an illness or disease. The pituitary gland and hypothalamus, located in the brain are responsible for the disease. The hypothalamus comprises for paraventricular nucleus (PVN), which releases CRH, the corticotropin-releasing hormone. This hormone is responsible fro stimulating the pituitary gland, which in turn gets triggered to release the polypeptide tropic hormone, adrenocorticotropin (ACTH) (Manenschijn et al., 2012). This hormone is found to get released in the bloodstream and travel along it, followed by reaching the adrenal glands, located on the top of kidneys. Upon reaching the adrenal gland, ACTH facilitates secretion of cortisol. Evidences suggest that cortisol belongs to the class of glucocorticoids and are released by the zona fasciculata layer of the adrenal cortex, in response to ACTH secretion (Lodish, Dunn, Sinaii, Keil Stratakis, 2012). An increase in the levels of cortisol is found to create a negative feedback loop on corticotropin hormone, which results in a subsequent reduction in the ACTH amount released from the anterior pituitary (Dekkers et al., 2013). Cortisol is responsible for regulating blood pressure and maintain normal functioning of the cardiovascular system. Thus, cortisol-releasing adenoma present in the adrenal cortex of the adrenal glands can be considered as the primary aetiology of Cushings syndrome. This results I an elevation in the levels of cortisol. A dexamethasone suppression test, followed by MRI of the pituitary gland and CT scan of the adrenal glands confirms the disease. The potential causes or aetiology of Cushings syndrome include prescribed administration of glucocorticoids for the treatment of other health abnormalities. Corticosteroid treatment is used for a plethora of diseases such as, rheumatoid arthritis, asthma, or immunosuppression after an organ transplantation to prevent the immune cells from rejecting the transplant. Administration of medroxyprogesterone is also considered as a major factor that contributes to development of Cushings syndrome (Stratakis, 2012). It results in glucocorticoids are found to downregulate the release of ACTH hormone. Furthermore, a deviation from the normal functioning of the body in cortisol secretion also result in a condition, commonly referred to as endogenous Cushings syndrome. ACTH secretion is also found to occur from tumors located outside the pituitary-adrenal system, which in turn creates an impact on the adrenal glands (Guaraldi Salvatori, 2012). This aetiology is commonly referred to as paraneopl astic Cushings syndrome, due to its association with cancer cells in the body (de Bruin et al., 2012). Excess cortisol secretion can also occur due to high levels of stress, malnutrition, alcoholism or depression. Thus, the fact that Susan consumes wine on a regular basis significantly contributes to her current medical state management. Most common signs and symptoms associated with Cushings syndrome include rapid gain of weight, in the face and trunk, sparing certain parts of the limbs. Accumulation of fat along the collarbones, back of neck and face are commonly observed. Other major symptoms encompass capillary dilation, excess perspiration, skin thinning that results in dryness and bruises along the hands, red or purple striae, muscle weakness or hypoglycemia (Nieman, 2015). Women suffering from the condition are also found to suffer from irregular menstrual period and thicker facial or body hair. In addition, other symptoms such as, cognitive impairment, headache, impaired growth among children, emotional disturbances, and hypertension may also be observed. Thorough assessment and monitoring of post-operative patients are considered imperative for identifying all kinds of deterioration in the prevailing health condition. Such physical assessments involve measurement of a patients vital signs that encompass evaluation of the major life-sustaining functions of the physiological system. Measurements of vital signs help in assessing the general physical condition of the individual and also provides cues to detect probable health deteriorations or recuperation from a disease. Susans post-operative respiratory rate (RR) was found to be 30 breaths per minute. It commonly refers to the number of breaths taken by a person per minute. In other words, it indicates the number of movements that depict inspiration and expiration per unit time. Normal levels of RR range from 16-20, at rest (Elliott Coventry, 2012). This suggests that the patient Susan is suffering from tachypnea, where her RR has increased beyond 20 bpm. Blood pressure is another vital sign, the normal range of which is around 120/80 mmHg (Elliott Coventry, 2012). The patient demonstrates a higher blood pressure (160/90 mm Hg), that indicates presence of hypertensive symptoms. Her post-operative vital signs also show a huge deviation from the normal pulse range of 50-80 bpm for adults, which indicate the rate at which the heart beats for pumping blood in the arteries. Pulse rate of 128 bpm area clear indication of deterioration in the health status, following laparoscopic right adrenalectomy (Elliott Coventry, 2012). Susan also demonstrates a decrease in body temperature, below the normal range 36.5 C. Evidences suggest that elevated heart rate are found to be associated with an increase in blood pressure or hypertension. Normal urine output is around 800-2000 milliliters/day with an intake of 2 liters/day. Low urine output can be attributed to the surgical procedure of adrenalectomy that was performed in the patient. High abdominal pressure due to pneumoperitoneum contributes to a reduction in urine production. Overweight is also considered as a major risk factor that contributes to an increase in blood pressure (Nguyen Lau, 2012). Furthermore, regular alcohol consumption results in a temporary increase in blood pressure, and heart rate and results in weakening of the heart muscles. This contributes to irregularities in the heart beat. Moreover , associations have also been established for obesity and respiratory complications that result in an increased demand for ventilation (Sarkhosh, Birch, Sharma Karmali, 2013). This elevates the breathing rate due to inefficiency of the respiratory muscles. Alcohol consumption can have also been linked to diminished respiratory compliance. Moreover, the post-operative deteriorating vital signs can be directly correlated with Cushings syndrome. Hypertension occurs due to the fact that renal conversion of cortisol hormone to cortisone gets reduced in the disorder. This directly elevates mineralocorticoids., which in turn result in increased reabsorption of tubular sodium, and hypokalemia. Cortisols also inhibit the vasodilators, thereby increasing blood pressure (Prodam et al., 2013). The glucocorticoids exert their direct effect on the heart that results in tachycardia (over 100bpm). Furthermore, hypertension leads to dysregulation of the autonomic nervous system that leads to heart rate variability. Hypothermia refers to core bosy temperatures that are below 35C. It results in a drastic drop in the metabolic rate of the body. At such low temperatures, the bosy will fail to produce the necessary heat and the core body temperature will quickly drop. This will make the patient shiver, followed by contraction of the blood vessels and release of hormones to facilitate heat generation. A direct impact of the condition will be observed on the other vital signs such as, blood pressure, respiratory rate and heart rate, all of which will increase. Further drop in temperature will lead to reduction in oxygen consumption, and irregular heart rhythm. Major effects will be manifested in the form of reduced cardiac output, slow brain activity, dilated pupils, and a state of coma (Pasquier et al., 2014). Post-operative safe care involves administration of a regular diet after problems of nausea get resolved. All wounds should be closed using skin glue and the patient might be allowed to shower the following morning. Performing exercise should be prevented until 10 days following the operation. Deep breathing exercise and administration of Tylenol are required to relieve pain and aches (Dimopoulou et al., 2014). Persistent swelling or calf pain would indicate presence of blood clot and the patient should be immediately assessed. The patient needs to be started on steroid therapy such as, prednisone to restore normal functioning of the adrenal gland (Hartmann et al., 2016). NSAIDs such as, naproxen and ibuprofen should also be prescribed for immediate pain relief. Narcotics might result in constipation. Thus, there is a need to intake extra fluids, fiber, along with usage of stool softeners. Several healthcare professionals will play a major role in enhancing the health outcome and subsequent patient satisfaction in this context. A nutritionist would play an essential role in evaluating the diet consumed by the patient on a regular basis. This healthcare professional will be responsible for formulating a diet plan that includes around 8 ounces or 2 liters of daily fluid intake. The nutritionist will also help in making the patient consume a diet that is rich in fibers, such as, whole grain, cereals and fruits (Dietiticians association of Australia, 2014). The endocrinologist will also assist in the patients long term recovery by monitoring and balancing long-term hormonal imbalances in the body. He/she will be involved in administering selective steroids following the surgery to restore the levels of coritsol in the body, Another healthcare professional imperative to improvement of patient health is a physical therapist who will assist the patient in pain reduction and mobility restoration (Australian physiotherapy association, 2016). This professional will help the patient during walking or climbing steps. Thus, complete assistance from the aforementioned healthcare professionals are needed to improve Susans health condition. To conclude, it can be stated that Cushing syndrome is a major health abnormality that occurs due to prolonged exposure of the human body to cortisol hormones, and results in fat accumulation in the face, shoulders and marks on the skin. This occurs due to improper functioning or tumor of the adrenal glands. 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