Cushing's disease is a condition caused by prolonged exposure to high levels of cortisol, often due to a tumor in the pituitary gland that leads to excessive secretion of adrenocorticotropic hormone (ACTH). This, in turn, stimulates the adrenal glands to produce excess cortisol.
In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Cushing's disease, which may include:
Hypertension: High blood pressure is a common feature of Cushing's disease due to the effects of excess cortisol on blood vessel function.
Weight Gain and Obesity: Patients may exhibit central obesity, particularly in the abdomen, along with increased fat deposits in the face (moon face) and neck (buffalo hump).
Muscle Weakness & Wasting: Excess cortisol can lead to muscle weakness and atrophy, which may affect the patient's mobility and ability to cooperate during assessment and treatment.
Skin Changes: Patients with Cushing's disease may have thin, fragile skin that bruises easily. They may also develop stretch marks (striae) on the abdomen, thighs, and breasts.
Glucose intolerance & Diabetes: High cortisol levels can impair glucose metabolism, leading to insulin resistance and, ultimately, diabetes mellitus.
Psychological Symptoms: Patients may experience mood swings, irritability, depression, or cognitive disturbances due to the effects of excess cortisol on the brain.
In terms of potential issues for prehospital care, EMS providers should consider the following:
Cardiovascular Complications: Patients with Cushing's disease may be at increased risk of cardiovascular events such as heart failure, myocardial infarction, or stroke due to hypertension and other metabolic disturbances.
Fluid & Electrolyte Imbalances: Excess cortisol can disrupt fluid and electrolyte balance, leading to conditions such as hypokalemia (low potassium levels) or hypernatremia (high sodium levels).
Adrenal Crisis: In some cases, abrupt withdrawal of cortisol due to treatment or other factors can precipitate an adrenal crisis characterized by hypotension, dehydration, and shock. EMS providers should be prepared to recognize and manage adrenal crisis promptly.
Communication Challenges: Patients with Cushing's disease may have physical or cognitive impairments that affect their ability to communicate effectively. EMS providers should employ clear communication techniques and be patient and empathetic when interacting with these patients.
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The discovery of Cushing's disease is credited to Dr. Harvey Cushing, an American neurosurgeon. Dr. Cushing first described the condition in 1912 in a detailed report titled "The Pituitary Body and its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri."
In this seminal work, he provided comprehensive observations of patients with pituitary tumors, including those exhibiting symptoms of hypercortisolism, now recognized as Cushing's disease.
Dr. Cushing's pioneering research laid the foundation for understanding and diagnosing this disorder, and he is regarded as a key figure in the history of endocrinology and neurosurgery.
Further Reading:
Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education
Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.
Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education
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