Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
Correct Answer: C. Deposits of adipose tissue in the trunk and dorsocervical area.
Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Physical examination of the patient will reveal increased fat deposits in the upper half of the body leading to “Buffalo torso,” characteristic moon facies (earlobes are not visible when viewed from the front), thin arms and legs, acne, hirsutism, proximal muscle weakness of shoulder and hip girdle muscles, paper-thin skin, abdominal pain due to gut perforation in rare cases, and wide vertical purplish abdominal striae.
Option A: Hypertension is caused by fluid retention. Patients may also have a history of hypertension, peptic ulcer disease, and diabetes. Hypertension is a very common comorbidity in patients with Cushing’s disease/syndrome, resulting from the interplay of several pathophysiologic mechanisms, including stimulation of mineralocorticoid and glucocorticoid receptors as well as the associated insulin resistance, sleep apnea, and overexpression of renin-angiotensin system.
Option B: Thinning of the skin and other mucous membranes: the skin becomes dry and bruises easily. Cortisol causes the breakdown of some dermal proteins along with the weakening of small blood vessels. In fact, the skin may become so weak as to develop a shiny, paper-thin quality which allows it to be torn easily.
Option D: Muscle wasting causes muscle atrophy and thin extremities. The effect of circulating levels of cortisol on the muscles varies from slight to marked. Muscle wasting can be so extensive that the condition stimulates muscular dystrophy. Marked weakness of the quadriceps muscle often prevents affected people from rising out of a chair unassisted.
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