jiwa

• Cushing Syndrome = hiperkortisolisme

Kortisol : suatu hormon steroid (kelenjar adrenal)Fungsi : • mengatur stres

• menjaga TD & fungsi kardiovaskular• menjaga sistem imun• mengubah lemak , karbohidrat dan protein menjadi energi

Etiologi

• Endogen – biasanya lbh jarang, dan sulit u/ didiagnosa, proses mnjdi sindroma cushingnya butuh waktu lama– Kelenjar adrenal – biasanya tumor yg memproduksi kortisol

yg berlebihan– pituitary – tumor memproduksi ACTH (the hormone that

tells the adrenal glands to make cortisol). Dan biasanya dikenal dgn Cushing’s disease jika tumor yg berasal dari pituitary.

• Eksogen– Penggunaan glukokortikoid jangka lama spti prednisone

( Asma, RA, imuno supressan stlh transplantasi)

Anamnesis When did the symptoms begin? What are the areas that are affected by increased hair growth? Past medical history Dietary history Body weight in childhood Physical activities History of medications Psycho-social history /any history of depression Family history of depression or obesity Alcohol intake or smoking

• Put on a lot of weight: Cushing's syndrome Psychological factors

Excessive caloric intake Metabolic disorder Genetic and familial causes

• Rounded face: Excessive secretion of cortisol Mobilization of fat to the face Simple obesity Generalized anaphylaxis Generalized edema

• Difficulties in climbing stairs: Problems with the proximal muscles of lower limbs Bone problems Joint problems Body weight problems Motor nerve problems

Pathophysiology of some Cushing’s disease clinical features

• Polyuria, polydipsia• cortisol binds & inhibits ADh release

• Diabetes• increased gluconeogenesis (opposite insulin action)

• supress immune system • decrease amount of circulating leukocytes & migration of tissue leukocyteslysis

of lymphocyes

• Skin pigmentation • Increase in ACTH

• Increased BP• cortisol also causes increase in aldosterone, therefore there will be water

retention.• binds to receptors of the mineralocorticoid due to it’s similar chemical structure

Discuss the impact of such disease on psychological health: Cortisol over secretion might cause psychological disturbances since cortisol can affect neurotransmitters. Disturbances might be depression, anxiety or others. The changes that happened to body might also affect self-esteem, and thus will affect psychological health.

• Faktor Resiko• Seorang Wanita• Umur 20-50th

• Menggunakan Kortikosteroid

• Komplikasi• Diabetes• Hipertensi• Osteoporosis• Infeksi

Exam & Test

• Low ACTH• Low Cortisol Level• Higher than normal fasting glucose• Low blood potassium level• Low bone density (DEXA)• High cholesterol, particulary high triglycerides

and low high-density lipoprotein (HDL)

Treatment

• If the cause is exogenous cortisol: If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Then, the daily dose of glucocorticoid hormones may be doubled but given on alternate days to lessen side effects.

• Treat high blood sugar aggressively with diet, medications taken by mouth, or insulin.

• Treat high cholesterol with diet or medications.• If you will be on steroids for longer than 4 - 6

weeks, you may need to take medication to prevent bone loss (calcium, vitamin D, or bisphosphonates, such as alendronate or risedronate). This may reduce the risk of fractures if you develop osteoporosis

Prognosis

• Slowly tapering off the drug that is causing the condition can help reverse the effects of adrenal gland shrinkage (atrophy), although this may take as long as a year. During this time, you may need to restart or increase the dosage of your steroids in times of stress or illness

• Kelebihan glukokortikoid dapat menghambat proses metabolisme protein dan karbohidrat. Glukokortikoid mempunyai efek katabolik dan antianabolik pada protein, menyebabkan menurunnya kemampuan sel-sel pembentuk protein untuk mensistesis protein, sebagai akibatnya terjadi kehilangan protein pada jaringan seperti kulit, otot, pembuluh darah, dan tulang