Cushing, Harvey

Cushing, Harvey (Williams)

(1869–1939) neurosurgeon; born in Cleveland, Ohio. The fourth generation in his family to become a physician, he showed great promise at Harvard Medical School and in his residency at Johns Hopkins Hospital (1896–1900), where he learned cerebral surgery under William S. Halsted. After studying a year in Europe—on his return, he introduced the blood pressure sphygmomanometer to the U.S.A.—he began a surgical practice in Baltimore while teaching at Johns Hopkins Hospital (1901–11), and gained a national reputation for operations such as the removal of brain tumors. From 1912–32 he was a professor of surgery at Harvard Medical School and surgeon in chief at Peter Bent Brigham Hospital in Boston, with time off during World War I to perform surgery for the U.S. forces in France; out of this experience came his major paper on wartime brain injuries (1918). In addition to his pioneering work in performing and teaching brain surgery, he was the reigning expert on the pituitary gland since his 1912 publication on the subject; later he discovered the condition of the pituitary now known as "Cushing's disease." On retiring from Harvard he spent his final years at Yale as professor of neurology and director of studies in the history of medicine; his bequest of his books on this latter field form the basis of Yale's medical history library. America's most admired surgeon in his day, he was a man of many talents, even winning the Pulitzer Prize (1926) for his biography of the man who had greatly influenced his career, The Life of Sir William Osler.

Cushing, Harvey

(koosh'ing) U.S. surgeon, 1869–1939.

Cushing disease

Cushing syndrome caused by excessive production of adrenocorticotropic hormone.

Cushing response

A reflex due to cerebral ischemia that causes an increase in systemic blood pressure. This maintains cerebral perfusion during increased intracranial pressure.

Cushing syndrome

The symptoms from prolonged exposure to excessive glucocorticoid hormones. Glucocorticoids are naturally excreted by the adrenal glands; however, Cushing syndrome is a side effect of the pharmacological use of steroids in the management of inflammatory illnesses, e.g., reactive airways disease or arthritis. Glucocorticoid excess from pituitary or adrenal adenomas or from the production of excess levels of adrenocorticotropic hormone by lung cancer is exceptionally rare (and is called Cushing disease).

Symptoms

The affected patient may complain of muscular weakness, thinning of the skin, easy bruising due to capillary fragility, weight gain, rounding of facial features (“moon-like” facies), cervicodorsal fat (buffalo hump) on the upper back, poor wound healing related to immunosuppression, decreased sexual drive and function, menstrual irregularities, insomnia, or psychological depression. Symptoms of diabetes mellitus, e.g., thirst, polyuria, and polyphagia, may be present because glucocorticoid hormones oppose the action of insulin. On physical examination, patients may have excessive fat in the face, upper back, and trunk, but none on the limbs. The abdominal skin may be marked by purplish lines (striae). Women may have excessive hair growth on the face and extremities due to increased androgen production. Increased catabolism leads to muscle wasting and osteopenia or osteoporosis. Hypertension is often present.

Treatment

Cushing's syndrome caused by the chronic use of steroid hormones may improve if steroids can be given every other day or if high doses of these medications can be gradually tapered. When Cushing's disease is present, surgery to remove the causative adenoma is usually needed, sometimes with adjunctive radiation therapy. Before surgery a medication to inhibit cortisol production, e.g., mitotane, may be prescribed along with drugs to reduce blood glucose and blood pressure.

Patient care

When prolonged administration of therapeutic, as opposed to replacement, doses of adrenocortical hormones is required, the patient is monitored for development of adverse reactions. A diet is provided that is high in protein and potassium but low in calories, carbohydrates, and sodium. The patient is assisted to adjust to changes in body image and strength. Realistic reassurance and emotional support are provided, and the patient is encouraged to verbalize feelings about losses and to develop positive coping strategies. Intermittent rest periods are recommended, and assistance is provided with mobility, esp. with movements requiring arm-shoulder strength. Safety measures are instituted to prevent falls. Instruction to the patient should include information about the risk for the development of diabetes mellitus, cataracts, easy bruising, and infections. For information and support, refer the patient to The National Adrenal Diseases Foundation.

Cushing ulcer

A stress ulcer in patients with increased intracranial pressure. Cushing ulcer may be caused by increased secretion of gastric acid due to vagus nerve stimulation. See: stress ulcer

单词	cushing, harvey
释义	DictionarySeeCushing disease Cushing, Harvey Cushing, Harvey (Williams) (1869–1939) neurosurgeon; born in Cleveland, Ohio. The fourth generation in his family to become a physician, he showed great promise at Harvard Medical School and in his residency at Johns Hopkins Hospital (1896–1900), where he learned cerebral surgery under William S. Halsted. After studying a year in Europe—on his return, he introduced the blood pressure sphygmomanometer to the U.S.A.—he began a surgical practice in Baltimore while teaching at Johns Hopkins Hospital (1901–11), and gained a national reputation for operations such as the removal of brain tumors. From 1912–32 he was a professor of surgery at Harvard Medical School and surgeon in chief at Peter Bent Brigham Hospital in Boston, with time off during World War I to perform surgery for the U.S. forces in France; out of this experience came his major paper on wartime brain injuries (1918). In addition to his pioneering work in performing and teaching brain surgery, he was the reigning expert on the pituitary gland since his 1912 publication on the subject; later he discovered the condition of the pituitary now known as "Cushing's disease." On retiring from Harvard he spent his final years at Yale as professor of neurology and director of studies in the history of medicine; his bequest of his books on this latter field form the basis of Yale's medical history library. America's most admired surgeon in his day, he was a man of many talents, even winning the Pulitzer Prize (1926) for his biography of the man who had greatly influenced his career, The Life of Sir William Osler. Cushing, Harvey Cushing, Harvey (koosh'ing) U.S. surgeon, 1869–1939. Cushing disease Cushing syndrome caused by excessive production of adrenocorticotropic hormone. Cushing response A reflex due to cerebral ischemia that causes an increase in systemic blood pressure. This maintains cerebral perfusion during increased intracranial pressure. Cushing syndrome The symptoms from prolonged exposure to excessive glucocorticoid hormones. Glucocorticoids are naturally excreted by the adrenal glands; however, Cushing syndrome is a side effect of the pharmacological use of steroids in the management of inflammatory illnesses, e.g., reactive airways disease or arthritis. Glucocorticoid excess from pituitary or adrenal adenomas or from the production of excess levels of adrenocorticotropic hormone by lung cancer is exceptionally rare (and is called Cushing disease). Symptoms The affected patient may complain of muscular weakness, thinning of the skin, easy bruising due to capillary fragility, weight gain, rounding of facial features (“moon-like” facies), cervicodorsal fat (buffalo hump) on the upper back, poor wound healing related to immunosuppression, decreased sexual drive and function, menstrual irregularities, insomnia, or psychological depression. Symptoms of diabetes mellitus, e.g., thirst, polyuria, and polyphagia, may be present because glucocorticoid hormones oppose the action of insulin. On physical examination, patients may have excessive fat in the face, upper back, and trunk, but none on the limbs. The abdominal skin may be marked by purplish lines (striae). Women may have excessive hair growth on the face and extremities due to increased androgen production. Increased catabolism leads to muscle wasting and osteopenia or osteoporosis. Hypertension is often present. Treatment Cushing's syndrome caused by the chronic use of steroid hormones may improve if steroids can be given every other day or if high doses of these medications can be gradually tapered. When Cushing's disease is present, surgery to remove the causative adenoma is usually needed, sometimes with adjunctive radiation therapy. Before surgery a medication to inhibit cortisol production, e.g., mitotane, may be prescribed along with drugs to reduce blood glucose and blood pressure. Patient care When prolonged administration of therapeutic, as opposed to replacement, doses of adrenocortical hormones is required, the patient is monitored for development of adverse reactions. A diet is provided that is high in protein and potassium but low in calories, carbohydrates, and sodium. The patient is assisted to adjust to changes in body image and strength. Realistic reassurance and emotional support are provided, and the patient is encouraged to verbalize feelings about losses and to develop positive coping strategies. Intermittent rest periods are recommended, and assistance is provided with mobility, esp. with movements requiring arm-shoulder strength. Safety measures are instituted to prevent falls. Instruction to the patient should include information about the risk for the development of diabetes mellitus, cataracts, easy bruising, and infections. For information and support, refer the patient to The National Adrenal Diseases Foundation. Cushing ulcer A stress ulcer in patients with increased intracranial pressure. Cushing ulcer may be caused by increased secretion of gastric acid due to vagus nerve stimulation. See: stress ulcer
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