Cushing's Syndrome: Pathophysiology, Causes, and Management

Question 1

Which of the following is a classic manifestation of Cushing's syndrome?

Accepted Answer

Weight gain with central obesity

Answer

Hypoglycemia

Answer

Polyuria

Answer

Muscle weakness

Question 2

What is the primary mechanism by which cortisol excess leads to hypertension in Cushing's syndrome?

Accepted Answer

Increased sodium reabsorption

Answer

Decreased potassium reabsorption

Answer

Vasoconstriction

Answer

Increased cardiac output

Question 3

What is the surgical treatment of choice for Cushing's syndrome caused by a pituitary adenoma?

Accepted Answer

Transsphenoidal surgery

Answer

Adrenalectomy

Answer

Thyroidectomy

Answer

Nephrectomy

Question 4

Which of the following medications is commonly used in the medical management of Cushing's syndrome?

Accepted Answer

Ketoconazole

Answer

Spironolactone

Answer

Metformin

Answer

Insulin

Question 5

Explain the underlying physiological mechanism leading to elevated cortisol levels in Cushing's syndrome:

Accepted Answer

Increased ACTH production stimulates the adrenal glands

Answer

Decreased ACTH production inhibits the adrenal glands

Answer

Directly elevated cortisol secretion from the pituitary gland

Answer

Reduced cortisol secretion from the adrenal glands

Question 6

Which of the following is NOT a common complication associated with Cushing's syndrome?

Accepted Answer

Hypothyroidism

Answer

Elevated blood glucose levels

Answer

High blood pressure

Answer

Osteoporosis

Question 7

Name the hormone that inhibits ACTH secretion:

Accepted Answer

Cortisol

Answer

Epinephrine

Answer

Somatostatin

Answer

Insulin

Question 8

Which of the following is a potential complication of Cushing's syndrome that arises from disrupted bone metabolism?

Accepted Answer

Osteoporosis

Answer

Hyperthyroidism

Answer

Hypoglycemia

Answer

Anemia

Question 9

Which hormone is excessively secreted in Cushing's syndrome?

Accepted Answer

Cortisol

Answer

Glucagon

Question 10

The surgical removal of the adrenal glands is indicated for which type of Cushing's syndrome?

Accepted Answer

Adrenal-dependent Cushing's syndrome

Question 11

Which of the following is the most common cause of Cushing's syndrome?

Accepted Answer

Pituitary adenoma

Answer

Adrenal adenoma

Answer

Ectopic ACTH production

Answer

Primary cortisol resistance

Question 12

What is the primary mechanism of cortisol excess in Cushing's disease?

Accepted Answer

Increased ACTH secretion from the pituitary gland

Answer

Increased cortisol secretion from the adrenal glands

Answer

Decreased cortisol metabolism

Answer

Increased cortisol binding globulin

Question 13

What is the first-line treatment for Cushing's disease?

Accepted Answer

Transsphenoidal pituitary surgery

Answer

Adrenalectomy

Answer

Radiation therapy

Answer

Medical therapy with dopamine agonists

Question 14

What is the hormone responsible for the metabolic and physiological effects associated with Cushing's syndrome?

Accepted Answer

Glucocorticoids

Answer

Mineralcorticoids

Answer

Estrogens

Answer

Insulin

Question 15

What is the primary mechanism by which pituitary adenomas contribute to the development of Cushing's syndrome?

Accepted Answer

Excessive production of ACTH

Answer

Impaired secretion of cortisol

Answer

Direct stimulation of adrenal glands

Answer

Reduced production of growth hormone

Question 16

Describe the hormonal mechanism responsible for cortisol excess in Cushing's syndrome caused by a pituitary tumor:

Accepted Answer

Increased secretion of ACTH by the pituitary tumor

Answer

Decreased secretion of ACTH by the pituitary tumor

Answer

Increased secretion of CRH by the hypothalamus

Answer

Decreased secretion of CRH by the hypothalamus

Question 17

What is the primary aim of pharmacological therapy in Cushing's syndrome?

Accepted Answer

Suppress ACTH production

Answer

Block cortisol synthesis

Answer

Reduce fluid retention

Answer

Improve glucose control

Question 18

Identify the surgical treatment of choice for Cushing's syndrome caused by an adrenal tumor:

Accepted Answer

Adrenalectomy to remove the affected adrenal gland

Answer

Pituitary resection to remove a pituitary tumor

Answer

Hypophysectomy to remove the pituitary gland

Answer

Stereotactic radiosurgery to target and destroy the tumor

Question 19

Which hormone is primarily responsible for the clinical manifestations of Cushing's syndrome?

Accepted Answer

Cortisol

Answer

Aldosterone

Answer

Adrenocorticotropic hormone (ACTH)

Answer

Growth hormone

Question 20

What is the most common cause of Cushing's syndrome in adults?

Accepted Answer

Pituitary adenoma

Answer

Primary adrenal hyperplasia

Answer

Ectopic ACTH production

Answer

Adrenal carcinoma

Question 21

Which electrolyte imbalance is commonly associated with Cushing's syndrome?

Accepted Answer

Hypokalemia

Answer

Hyperkalemia

Answer

Hypocalcemia

Answer

Hypernatremia

Question 22

Which surgical procedure is typically indicated for patients with Cushing's syndrome caused by an adrenal tumor?

Accepted Answer

Adrenalectomy

Answer

Pituitary surgery

Answer

Thyroidectomy

Answer

Nephrectomy

Question 23

In the management of Cushing's syndrome, which action is crucial for respecting patient autonomy?

Accepted Answer

Involving the patient in decision-making

Answer

Administering medications without patient consent

Answer

Withholding information about potential risks

Answer

Ignoring the patient's cultural beliefs

Question 24

In Cushing's syndrome, the hypothalamus-pituitary-adrenal (HPA) axis is disrupted, leading to cortisol excess. Describe the sequence of events that causes this disruption.

Accepted Answer

Increased hypothalamic corticotropin-releasing hormone (CRH) secretion, stimulating ACTH release, leading to adrenal hyperplasia and cortisol excess.

Answer

Decreased hypothalamic CRH secretion, suppressing ACTH release and reducing cortisol production.

Answer

Impaired ACTH secretion from the pituitary gland, leading to decreased cortisol production and adrenal atrophy.

Answer

Dysregulation of the adrenal glands, causing autonomous cortisol secretion and suppression of the HPA axis.

Question 25

When educating patients with Cushing's syndrome, which lifestyle modification is most important to emphasize?

Accepted Answer

Low-sodium diet to manage fluid retention and hypertension

Answer

Regular exercise

Answer

Smoking cessation

Answer

Stress management

Question 26

What is the primary mechanism leading to hypercortisolism in Cushing's syndrome?

Accepted Answer

Excessive ACTH secretion

Answer

Increased aldosterone production

Answer

Reduced cortisol clearance

Answer

Impaired cortisol metabolism

Question 27

Which of the following is a common clinical manifestation of Cushing's syndrome?

Accepted Answer

Moon face

Answer

Bradycardia

Answer

Hypoglycemia

Answer

Hyperthyroidism

Question 28

What is the primary nursing intervention for a patient with Cushing's syndrome on corticosteroid therapy?

Accepted Answer

Monitor for signs of adrenal insufficiency

Answer

Provide emotional support

Answer

Encourage weight gain

Answer

Restrict sodium intake

Question 29

Which type of Cushing's syndrome is caused by an ectopic source of ACTH production?

Accepted Answer

Ectopic Cushing's syndrome

Answer

Adrenal Cushing's syndrome

Answer

Pituitary Cushing's syndrome

Answer

Iatrogenic Cushing's syndrome

Question 30

What is the first-line treatment for patients with pituitary Cushing's syndrome?

Accepted Answer

Transsphenoidal surgery

Answer

Medical therapy

Answer

Adrenalectomy

Answer

Radiation therapy

Question 31

What is an important nursing consideration when caring for a patient with Cushing's syndrome who is undergoing surgery?

Accepted Answer

Monitor for adrenal crisis

Answer

Encourage deep breathing exercises

Answer

Restrict fluid intake

Answer

Provide pain medication as needed

Question 32

Which hormone stimulates the adrenal cortex to secrete cortisol?

Accepted Answer

Adrenocorticotropic hormone (ACTH)

Answer

Antidiuretic hormone (ADH)

Answer

Follicle-stimulating hormone (FSH)

Answer

Thyroid-stimulating hormone (TSH)

Question 33

Which clinical manifestation is commonly associated with Cushing's syndrome?

Accepted Answer

Moon face

Answer

Hypoglycemia

Answer

Bradycardia

Answer

Polyuria

Question 34

Which laboratory test is used to diagnose Cushing's syndrome?

Accepted Answer

24-hour urine free cortisol measurement

Answer

Plasma cortisol level

Answer

ACTH blood test

Question 35

What is the primary goal of treatment for Cushing's syndrome?

Accepted Answer

Control cortisol levels

Answer

Manage electrolyte imbalances

Answer

Prevent infection

Answer

Reduce blood pressure

Question 36

When administering glucocorticoids to a patient with Cushing's syndrome, which nursing intervention is essential?

Accepted Answer

Monitor for adrenal insufficiency

Answer

Restrict fluids

Answer

Encourage a high-sodium diet

Answer

Administer potassium supplements

Question 37

What is a characteristic of ectopic ACTH syndrome?

Accepted Answer

Increased ACTH secretion from non-pituitary sources

Answer

Decreased cortisol secretion

Answer

High ACTH levels with low cortisol levels

Question 38

What is the hallmark physiological mechanism in Cushing's syndrome?

Accepted Answer

Chronic and excessive secretion of cortisol

Answer

Excess of antidiuretic hormone

Answer

Deficiency of thyroid hormone

Answer

Deficiency of growth hormone

Question 39

Which clinical sign is most strongly associated with Cushing's syndrome?

Accepted Answer

Moon-shaped face (moon facies)

Answer

Yellowing of the whites of the eyes (scleral icterus)

Answer

Yellowish discoloration of the skin (jaundice)

Answer

Red, raised, vascular lesions resembling spiders (spider angiomas)

Question 40

What is the recommended primary diagnostic test for Cushing's syndrome?

Accepted Answer

24-hour urine free cortisol measurement

Answer

Electrocardiogram (ECG)

Answer

Blood glucose level measurement

Answer

Thyroid function test

Question 41

Which medication is a treatment option for Cushing's syndrome?

Accepted Answer

Ketoconazole

Answer

Levothyroxine

Answer

Metformin

Answer

Spironolactone

Question 42

Which surgical procedure is used to treat Cushing's syndrome caused by an adrenal gland tumor (adenoma)?

Accepted Answer

Adrenalectomy (surgical removal of the adrenal gland)

Answer

Thyroidectomy (surgical removal of the thyroid gland)

Answer

Pancreatectomy (surgical removal of the pancreas)

Answer

Nephrectomy (surgical removal of the kidney)

Question 43

Which diagnostic test is considered the most specific for Cushing's syndrome?

Accepted Answer

Overnight dexamethasone suppression test

Answer

24-hour urine cortisol measurement

Answer

ACTH stimulation test

Answer

MRI of the pituitary gland

Question 44

The goals of medical management for Cushing's syndrome include:

Accepted Answer

Reducing cortisol production and treating underlying causes

Answer

Treating symptoms only

Answer

Increasing cortisol production and suppressing the pituitary gland

Question 45

When treating Cushing's syndrome, which of the following medications may be used?

Accepted Answer

Ketoconazole

Answer

Digoxin

Answer

Coumadin

Answer

Lisinopril

Question 46

Which of the following is a potential nursing intervention for a patient with Cushing's syndrome?

Accepted Answer

Monitoring for hyperglycemia and administering insulin as needed

Answer

Restricting fluid intake

Answer

Increasing physical activity

Question 47

What is the prognosis for patients with Cushing's syndrome?

Accepted Answer

Varies depending on the underlying cause and severity of the condition

Answer

Poor due to irreversible complications

Answer

Excellent with early detection and treatment

Question 48

Which of the following is NOT a potential cause of Cushing's syndrome?

Accepted Answer

Addison's disease

Answer

Ectopic ACTH production

Answer

Pituitary adenoma

Question 49

The primary mechanism of cortisol excess in Cushing's syndrome is:

Accepted Answer

Increased ACTH secretion

Answer

Altered cortisol receptor function

Answer

Decreased cortisol metabolism

Answer

Impaired cortisol clearance

Question 50

Which of the following is a potential complication of Cushing's syndrome?

Accepted Answer

Osteoporosis

Answer

Hyperthyroidism

Answer

Anemia

Answer

Hypoglycemia

Question 51

In the management of Cushing's syndrome, which of the following interventions is typically used?

Accepted Answer

Adrenalectomy

Answer

Antibiotic therapy

Answer

Insulin therapy

Answer

Thyroid hormone replacement

Question 52

Which of the following is an important nursing assessment finding that may suggest Cushing's syndrome?

Accepted Answer

Moon face

Answer

Bradycardia

Answer

Hypothermia

Answer

Tremor

Question 53

Which of the following diagnostic tests is most commonly used to confirm a diagnosis of Cushing's syndrome?

Accepted Answer

24-hour urine free cortisol test

Answer

Cortisol level test

Answer

MRI of the pituitary gland

Answer

ACTH level test

Question 54

Which of the following patient education points is important in managing Cushing's syndrome?

Accepted Answer

Monitor blood sugar levels and report any changes to the doctor

Answer

Increase sodium intake to prevent dehydration

Answer

Avoid caffeine and alcohol consumption