So, let’s look at what happens in your body when you have excess ACTH and excess cortisol
and even some excess aldosterone,
so, you’ve got that body systems there that kind of remind you
that we like to think through this head to toe.
We’re looking at the systemic effects of these excess corticosteroids
and remember it would be the same whether it’s a disease or syndrome
but see if you can answer that question to yourself,
what is the difference between Cushing's Disease and Cushing's Syndrome?
Well, the impact on the body is the same, but the cause is what’s different between those two.
Cushing disease, the body has gone rogue on its own.
Cushing syndrome, the patient's experiencing those Cushing-like effects,
because we've given them medications, and now they have excess corticosteroids.
Remember, our goal is to suppress inflammation, that’s what we’re looking for.
Now, I wanna do something a little active with you.
So, let’s stop, put down your writing instruments for just a minute
and I wanna kinda go over the side effects of corticosteroids.
Now, I’m gonna be ahead of a list, but I want you to not worry about writing them down
or putting notes on your notes right now, I just want you to focus on being active, okay?
So, we’re gonna think through the systemic effects of excess corticosteroids.
That's what your patients with Cushing's Disease and Cushing's Syndrome will feel.
Now first of all we’re gonna say, moon face, next, facial hair, mood swings, buffalo hump.
Are you with me? Moon face, facial hair, mood swings, buffalo hump.
Okay, this is not gonna work if you’re just sitting there watching me, okay?
I have no problem looking goofy, but if you'll stand up, stretch, really get ready, shake it out,
do this with me, I’m gonna shorten your study time if you actually get active, so ready?
Moon face, facial hair, mood swings, buffalo hump.
Do that one more time. Moon face, facial hair, mood swings, buffalo hump.
Now, we've talked about things kind of in the top of your body, right?
Moon face, they get a really full face, nobody wants that,
but it's commonly happens when people take corticosteroids.
Now, the facial hair. Hey, if you’re a guy, you’re not seeing this as a big deal
but if you’re a female, this is a big deal, we don’t want to shave in the morning,
we don’t wanna deal with that kind of stuff.
So, facial hair is a big problem.
Remember, adrenal gland kinda deals with those sexual characteristics
and that’s one, us girls would like to avoid.
So, let’s go back, do it one more time.
Moon face, facial hair, mood swings, yeah, they get real moody, irritable.
Look, euphoria, depression but any kind of crazy mood swing, it can happen.
Now up here, when I say buffalo hump, that’s a big fat pad on your back,
cuz you get this weird accumulation and distribution of fat,
we'll talk about that again in just a minute.
So, from here up, you do it with me.
Moon face, facial hair, mood swings, buffalo hump. Good.
You got the top half. Now, before we keep going through slides,
just staying with me, we'll go through these slides again, I promise.
So, moon face, facial hair, mood swings, buffalo hump.
You’ve got that. Next, let’s look at heart.
Now, we know that we've tried to eliminate most of the mineralocorticoids,
the aldosterone, the sodium in water,
but if there’s any mineralocorticoids component of the medication,
if we see a change in a patient's vital signs,
it’s likely that their blood pressure will be elevated
because they'll have a little bit of extra sodium and then they'll have more water.
Another thing you wanna keep in mind, when someone takes in extra sodium,
reabsorbs extra sodium, the body will get rid of potassium,
and there’s certain drugs with that becomes a problem.
So, when we’re writing your notes stop for just a minute, write a note,
I know, I said don’t look at your slides but right now just write this note,
that when someone is on a mineralocorticoids, they've got that aldosterone,
when they hang on to sodium, serum sodium goes up, serum potassium will go down.
We’ll talk to you about other medications with that begins a problem
but right now you could just write down Digoxin, D-I-G-O-X-I-N,
because low potassium for any reason, low potassium for any reason,
puts your patient at an increased risk for digoxin toxicity,
so that’s an important one you want to know if your patient is taking digoxin
and we have them on corticosteroids, we wanna watch that potassium level very closely.
Now, we did something, we talked about the side effects, then we talked about digoxin,
let’s go back and see how your brain is doing.
Can you pause the video for a second and see if you can go from moon face
all the way down to cardiovascular on your own?
Okay, I hope you got moon face, facial hair, mood swings, buffalo hump,
cardiovascular, if you’re hanging on to sodium and water,
the change you'll see on your vital signs would be elevated blood pressure.
Lungs, meh, as we say, not a big deal.
Now, we start getting down on my trunk, this is where it becomes very personal
because that fat distribution, I know you got the buffalo hump
but they also put fat right around the middle.
Okay. So, I always say, "You look like a martini olive on toothpicks."
So, everyone putting like you’re wearing a barrel, it’s not attractive.
Nobody likes that part either, but they’re not gonna put it on their legs or their arms,
just right here in the middle.
So, moon face, facial hair, mood swings, buffalo hump,
possibly elevated blood pressure and fat right around the middle.
I'm getting now closer to my kidneys, this can elevate your blood sugar
so you're gonna end up with the higher blood sugar,
particularly problematic for a diabetic patients,
so a lot of times they have to monitor their blood sugar more frequently
and their doctor may have to change their insulin coverage, so that’s the key point to keep them safe.
Now, we started from head, moon face, facial hair, mood swings, buffalo hump,
possibly elevated blood pressure, talked about no big deal on my lungs,
fat right around the middle, look like a martini olive on toothpicks,
it's gonna elevate blood sugar particularly problematic with diabetics.
It also can be really hard on your bones and your skin.
Okay. Those are the major side effects.
Now, I’ve used repetition intentionally, not just to be annoying
although I get it, it can be, but the more often you repeat things,
and I always wanna remind students of that,
repetition for these type of things is your best friend.
As you become more familiar with it, you can take longer periods of time.
So sadly, do you know when is the best time to review your notes is?
Yeah, right after you've experienced a video or a live class,
that’s the best time and probably the least likely time that you wanna look at them,
but that’s gonna be the biggest benefit for you.
So, one more time, let’s do it together.
Moon face, facial hair, mood swings, buffalo hump,
possibly elevated blood pressure, fat right around my middle,
my blood sugar is gonna off and be elevated,
and it's gonna be really hard on my skin and my bones.
Okay. Now, let’s walk back, there you sit down take a big stretch, let’s start taking notes again.
So, the systematic effects, we already talked about euphoria, depression, I just call those mood swings.
Moon face, their face gets really, really full, and the hirsutism,
that's just a say a nice name for saying, lady beard, which I personally don’t want.
Now, hypertension possibly, remember put a little question mark by that,
it depends on how much aldosterone component there is in the medication.
If you have that your body’s gonna hang on to sodium, water will follow,
and you will have a possibility of having a raised blood pressure.
Remember that an increasing sodium means a decreasing potassium,
and I did have you write that down before, that any decreasing potassium,
we've got it marked by K there, any decreased in potassium
put you in an increased risk for digoxin toxicity, if your patient is also taking that medication.
I love this picture, I kinda laughed the first time I saw it but yeah, that’s what it looks like.
You have rapid weight gain in your trunk and face not your limbs.
This can build up insulin resistance, remember we talked about your blood sugar is being up,
your body can be resistant to insulin, you might have the insulin available
but it just can’t use it to get the glucose from your blood stream into your cells for energy,
so you're going to have higher serum glucose levels.
Now, if we're in an informercial, I shall say, “Wait, there’s more.”
As if those side effects we've already discussed weren’t difficult enough,
remember that your adrenal glands are involving your sexual characteristics too.
So, if you have excess corticosteroids disease or syndrome, you can have decreased libido,
you're not as interested in sex.
Men might experience impotence, women can have all types of problems with their cycles,
and it might cause infertility.
Now, we've got some issue with the skin that I wanted to break down,
we already talked about already mood swings and buffalo humps,
but you also can develop this horrible acne, sometimes you see muscle wasting
or the patient might be excessively sweating
and might have these weird purple or red striae marks on their skin,
their skin is likely to bruise easily we just kinda called that, steroid skin.
Now, the reason we avoid trying to give this to small children is because it suppresses their growth
or it can suppress their growth.
So, if we’re gonna give it to children, we absolutely try to avoid oral or IV
because remember you'll have more systemic effects,
but we try to limit corticosteroids in any of our patients,
to the smallest doze that we can give that will still be effective.
And lastly it's hard on those bones.
Okay. I told you there’s a lot of side effects with corticosteroids.
Now, it's your chance to see what you can remember.
I wanna supercharge your memory by trying to answer this question.
Remember to not look at your notes, see what your brain can recall.
And I want you to list the items you think based on what we studied
you should teach your patients who are taking corticosteroids,
we've got a bulleted list for you there, see how many of those you can fill in.
Now, some of you like these type of memory aids, so we took the word Cushing's.
And wrote it with capital letters for you.
The U stands for unhappy, or euphoric, you can think about those mood swings.
The H stands for buffalo hump, and hypertension.
The I stands for “insulin resistance.
The G stands for gut, remember we put that right around the middle,
and the S stands for changes to their skin.
Remember that steroid skin and decrease interest in sex
and other characteristics of impotence and amenorrhea.
So, you may or may not like that type of memory aid,
but we'd like to throw those in there every ones in a a while,
just to help you learn a different way to look at something.