Addisons Disease vs Cushings Disease

ADDISONS DISEASE CUSHINGS DISEASE

Hyposecretion of adrenocortical hormones

leading to:
Metabolic disturbances (sugar)
Fluid and electrolyte imbalances (salt)
Deficiency of neuromuscular function (salt Hypersecretion of adrenocortical
Definition and sex) hormone

1. Hyperplasia of Adrenal gland

Predisposing 1. Atrophy of the Adrenal gland 2. Tubercular infection (MILIARY
Factors 2. Fungal infections TB to adjacent organs)

1. Hyperglycemia can lead to

DM
1. Polyuria
1. hypoglycemia (TIRED) 2. Polydipsia
Tremors and tachycardia 3. Polyphagia
Irritability 4. Wt. Gain
Restlessness 5. Glucosuria
Extreme fatigue 2. Increased susceptibility to
Diaphoresis and depression infection (Reverse isolation!)
2. Decreased tolerance to stress (d/t decreased 3. Hypernatremia
cortisol) Addisonian Crisis 1. HPN
3. Hyponatremia 2. Edema
Hypotension 3. Wt. gain
Signs of dehydration 4. Moonface appearance, buffalo
Weight loss hump, obese trunk, pendulous
4. Hyperkalemia abdomen, thin extremities
Irritability and agitation 5. Hypokalemia
Diarrhea 1. Weakness and fatigue
Arrhythmias 2. Constipation
5. Decreased Libido 3. U wave on ECG tracing
6. Loss of pubic and axillary hair 6. Hirsutism
7. Bronze-like skin pigmentation d/t decreased 7. Easy brusing
Signs and cortisol stimulation of MSH from pituitary 8. Acne and Striae
Symptoms gland 9. increased masculinity in females

1. FBS decreased (N= 80-120 mg/dl) 1. FBS elevated

2. Serum Na decreased (N= 135-145) 2. Elevated Na
3. Serum K elevated (N=3.5-5.5meq/L) 3. Decreased K
Diagnostics 4. Plasma cortisol decreased 4. Elevated Cortisol

1. Monitor strictly VS, IO to determine 1. Monitor IO, VS

presence of Addisonian crisis which results 2. Restrict Na and Fluids
from acute exacerbation of Addisons 3. Weigh pt. daily and assess for
disease characterized by: pitting edema (ANASARCA
Hyponatremia generalized edema nephritic
Hypovolemia syndrome)
Nursing Dehydration 4. Measure abdominal girth daily,
Management Severe Hypotension notify MD
 Weight loss Which may lead to 5. Diet: low CHO, NA, High
progressive stupor coma. CHON and K
6. 6. Administer medications as
Assist in mech vent, steroids as ordered
ordered, forced fluids K-sparing diuretics
2. Administer medications as ordered Spironolactone
Corticosteroids (Aldactone); excretes
1. sodium but retains
Universal rule: administer 2/3 potassium
dose in AM and 1/3 dose in PM 7. Prevent Complications DM
to mimic the N diurnal rhythm 8. Provides meticulous skin care
of the body 9. Assist in Surgical Procedure
Taper the dose. Withdraw Bilateral Adrenalectomy
gradually from the drug 10. Hormonal replacement for life
Monitor SE: Cushingoid Sx 11. Importance of ffup care
HPN, Increased susceptibility to
infection, Weight gain,
Hirsutism, Moon face
appearance
Ex: Hydrocortisone,
Dexamethasone, Prednisone
Mineralocorticoids fluorocortisone
3. Forced fluids
4. Maintain patent IV line
5. Diet: high CHO/calories, Na and CHON,
low K
6. Meticulous skin care
7. Provide health teaching and d/c planning
Avoidance of precipitating factors
leading to addisonian crisis:
Stress, Infection, Sudden
withdrawal to steroids
Prevent Complications hypovolemic
shock
Hormonal replacement therapy for life
Importance of ffup care