Adrenal disorders

• Addison's Disease

  "Add Hormones to Treat ADDison's"
• Clinical Manifestations of Addison's Disease


  • Progressive muscle weakness
  • Joint pain
  • Anorexia
  • Nausea/vomiting/diarrhea
  • Fatigue
  • Dark pigmentation of skin (bony prominences and creases) and mucosa
  • Hypotension
  • Headache
  • Low blood glucose
  • Low serum sodium - salt craving
  • High serum potassium
  • Apathy
  • Emotional lability
  • Confusion
  • Loss of body hair
  • Decreased sex drive

  
• Key features of Addison's Disease


  • Hyperkalemia
  • Hyponatremia
  • Bronze color pigmentation

  
• Addison's disease - low sodium - 135
• Medications for Addison's Disease

  • Glucocorticoids - hydrocortisone
  • Prednisone
  • Dexamethasone
• Treatment for Addison's Disease

  1. D5NS for dehydration

  2. Vasopressors such as Dopamine and Norepinephrine to maintain blood pressure

  3. Antibiotics if needed
• Lack of cortisol

  Decreased aldosterone and decreased sodium
• Addison's disease can lead to cardiac issues, especially on bony prominences/creases like knuckles and knees
• Addison's disease can lead to small, weak, tanned appearance

  
• Addison's disease requires safety checks and monitoring of fluid and electrolyte status
• Addison's disease can be associated with diabetes
• Hydrocortisone can cause Cushing's Disease if too much is given

  
• Hypertonic solutions

  expand fluid volume, given in cases of severely low sodium
• Patient Teaching for Addison's Disease


  1. Monitor for signs and symptoms of fluid volume deficit

  2. Encourage fluids and foods high in sodium

  3. Administer hormone replacement as prescribed

  4. Avoid stress and activity until stable

  5. Perform all activities for patient when in crisis

  6. Maintain a quiet, non stressful environment

  7. Measures to reduce anxiety
• Addisonian Crisis


  Acute adrenal insufficiency<|>Insufficient or sudden, sharp decrease in hormones
• Manifestations of Addisonian Crisis


  • Severe hypotension
  • Cyanosis
  • Fever
  • Confusion
  • Headache
  • GI symptoms

  
• Addisonian Crisis is life-threatening, concerned for shock
• Triggers for Addisonian Crisis


  • Stress
  • Sudden withdrawal of cortisol (main trigger)
  • Post adrenal surgery
  • Severe dehydration
  • Traumatic event like a car accident

  
• Never give a patient with an addison crisis Aminogluthemid. The priority with Addison's disease is to prevent shock.

  
• Lab Findings/Diagnostics for Addison's Disease

  • Early morning cortisol tests
  • Serum plasma ACTH
• Primary Addison's Disease

  Normal or high ACTH, decreased cortisol, decreased aldosterone

  
• Urinalysis findings in Addison's Disease

  • Glucose (low)
  • Potassium (high)
  • Sodium (low)
  • Leukocytosis
• Nursing Considerations for Addison's Disease

  • Note any illness or stressors that may precipitate problems
  • Monitor fluid and electrolyte status
  • Monitor vital signs and orthostatic blood pressures
  • Note signs and symptoms related to adrenocortical insufficiency: weight changes, muscle weakness, fatigue
  • Monitor medications - Hydrocortisone
  • Monitor for signs and symptoms of Addisonian crisis: Abdominal or flank pain, confusion, loss of consciousness, coma, dehydration, dizziness, fatigue, severe weakness, headache, high fever, anorexia

  
• Cushing's Disease


  Opposite of Addison's Disease<|>Adrenal glands produce too much cortisol or aldosterone

  
• Causes of Cushing's Disease

  • Excessive adrenocortical activity
  • Corticosteroid medications

  
• Cushing's Disease


  Adrenal tumor
• Medication adherence is very important for addisons Disease patients
• Addison’s disease patients need a medical alert bracelet
• Cushing's Disease patients should avoid strenuous activity in hot, humid weather
• Cushing's Disease patients should increase fluid and salty food intake with sweating
• Addisons Disease

  Decreased aldosterone, cortisol, and sex hormones

  
• Key Lab Findings in Addisons Disease

  • Decreased sodium
  • Increased potassium
  • Bronze color pigmentation

  
• Priority care for addisonA Disease is to always try to prevent shock
• Nursing Interventions for Cushing's Disease

  1. Monitor vital signs and fluid volume

  2. Prevent shock

  3. Monitor for recent trauma or surgery

  4. Monitor kidney function
• Metyrapone inhibits adrenal enzymes, triggering the adrenal gland to release cortisol
• Cortisol tests should always be done in the morning
• Cushing's Disease can affect the white blood cell count
• Cushing's Disease requires monitoring of sodium, potassium, and cardiac status

  
• Hydrocortisone oral dose


  15-25 mg daily, taken in 2 doses
• Hydrocortisone is given when the adrenal gland is not producing hormones due to hyponatremia, which can cause muscle pains and salt cravings