DEFINITION

Addison'sdisease

DEFINITION
Addison'sdiseaseishypofunc8onoftheadrenal
cortex.
EndocrinedisorderalsoknownasAdrenocor8cal
Insuciency.
Thereisadecreaseinadrenalsteroidswhichare:
glucocor8coids,mineralcor8coids,andandrogen.
Theadrenalcortexfunc8onisinadequatetomeetthe
pa8entsneedforcor8calsteroids.
Addisonsdiseaseoccurswhen90%oftheadrenal
cortexhasbeendestroyed

CAUSES

Autoimmuneoridiopathicatrophyoftheadrenal
glandsisresponsiblefor80%to90%ofcases.
Surgicalremovalofbothadrenalglands
Infec8onoftheadrenalglands
Tuberculosisandhistoplasmosisarethemost
commoninfec8onsthatdestroyadrenalgland8ssue.
Inadequatesecre8onofACTHfromthepituitary
gland.(Decreaseds8mula8onoftheadrenalcortex)
Therapeu8cuseofcor8costeroids.

SIGNSANDSYMPTOMS

Earlysigns:
!Tiredness
Tiredness
!Weakness
Weakness
!Lossofappe8te
Lossofappe8te
!Weightloss
Weightloss
!Dizzinesswhenstanding
Dizzinesswhenstanding
!Muscleaches
Muscleaches
!Nasuea,vomi8ng
Nasuea,vomi8ng
!Diarrhea
Diarrhea
!Patchesofdarkened
Patchesofdarkened
skinorunexplained
tanning.
!Depression
Depression
Latesigns:
!Sharppaininthe
Sharppaininthe
lowerback,
abdomen,orlegs
!Lossoftoomuch
Lossoftoomuch
uidfrombody.
(Dehydra8on)
!Hypotension
Hypotension
!Lossof
Lossof
consciousness

HOWISITDIAGNOSED?

Earlystagesdiculttodiagnose.
!CheckCor8sollevels
CheckCor8sollevels
ACTHS8mula8onTest
CRHS8mula8onTest
Othertests
!XRAY
XRAY

TREATMENT
Hormonereplacementtherapy
Dependingonwhichhormoneislow(ifnotall
three)
!Glucocor8coidtwiceaday
Glucocor8coidtwiceaday
!Mineralcor8coidonceaday
Mineralcor8coidonceaday
!Aldosteronetherapyinvolvesincreased
Aldosteronetherapyinvolvesincreased
sodium
intake.

ADDISONIANCRISIS

Symptomsincludesuddenpenetra8ngpainin:
!lowerback
lowerback
!abdomenorlegs
abdomenorlegs
!severevomi8ng
severevomi8ng
!diarrhea
diarrhea
!followedbydehydra8on
followedbydehydra8on
!lowbloodpressure
lowbloodpressure
!lossofconsciousness
lossofconsciousness

SECONDARYADRENAL
INSUFFICIENCY

Muchmorecommonthanprimaryadrenal
insuciency.
TracedbythelackofACTH
Abruptlystoppinggucocor8coidtherapy
ini8ates
SecondaryAdrenalInsuciency.
Surgicalremovalofbenignornoncancerous
tumorsonthepituitarygland.

NURSINGASSESSMENT

Completehealthhistory
Baselineweight
Muscleweakness/fa8gue
Historyofillness
Stressresponse
Assessglucoselevels
Baselinevitals
Skinpigmenta8on
Skinturger
Assessmood
Assessknowledgeofdisease

NURSINGDIAGNOSIS

FluidVolumeDecitrelatedtohypovolemiaor
nauseaandvomi8ng.
Riskforinjuryrelatedtoweakness
SelfCaredecitrelatedtoweakness,fa8gue,muscle
aches.
Disturbedbodyimagerelatedtochangeinpigment
Ac8vityintolerancerelatedtoweakness,fa8gue,
and/ormuscleaches.
Riskforsuiciderelatedtodepression
Disturbedthoughtprocessrelated

PLANNING

Manage/monitorAddsoniancrisis
Restoreuidbalance
Increaseac8vitytolerance
Providehomeandcommunitybasedcare.
PreventstressorsthattriggerAddisonian
crisis.

IMPLEMENTATION

MonitorIandO
Monitorwieght
LabsFluid/electrolytebalanceqdaily.
Administermedsasordered.
Monitormoodchanges
Glucosetestq6hrs.
Increasesaltintake

EVALUATION

Maintainweight
Stablevitals
Glucosecontrolled
Behavior
Appearance
Neurologicalchanges
Labs(Evaluate)

PATIENTEDUCATION
Adherencetoprescribedcor8soldosageand
schedule
Increasedcor8soldosein8mesofstress
Neverabruptlystopcor8solreplacement
therapy
Alwayswhereamedicalbracelet
CarryanEmergencycor8solKit
Avoidperiodsoffas8ng
Followup
Feverornauseaandvomi8ngno8fyMD.

QUIZ!!!

Whattestswouldyouperformifapa8entcomes
incomplainingofnausea,vomi8ng,fa8gue,
muscleaches,andrecentskinblotching?(Select
allthatapply)
A.CRHS8mula8onTest
B.XRay
C.ACTHS8mula8onTest
D.Cor8solLevel
E.DDimer
F.Alloftheabove

Whichofthefollowingstatementsbythepa8ent
wouldindicateafurtherneedforteaching?

(Selectallthatapply)
A.Icanstopmytreatmentinoneweek.
B.Iwillbeonsteroidsfortherestofmylife.
C.Ihavetowearmymedicalbracelet,evenif
itclasheswithmyoujit.
D.IcancureAddison'sdiseasebylivinga
healthylifestyle.

Yourpa8entisafraidtogainweightwhentold
thatshewillbeonhormonetherapyduetoher
recentdiagnosisofAddison'sdisease.Shestates
sheisgoingtoeatsmallmealsevenifsheis
hungry.Whatisthepropernursinginterven8on?

A.Tellheryouknowagreatdiet.
B.Informherthatperiodsoffas8ngcan
causehertogointoacrisis.
C.Informherthatifshecutsthesaltoutof
herdietshecanlossweight.
D.Referhertoadie8cian

Apa8entwithAddison'sdiseaseinformsyouthat
hisdogjustdied,heislateontherent,andhis
wifeistalkingaboutdivorcinghim.Whatisthe
propernursingstatement?

A.Iknowagreatdivorcelawyer.
B.Wow,itmustbequiettenseinyourhouse
rightnow.
C.Youwillhavetoincreaseyourcor8sol
dose.
D.Youmayhavetodecreaseyourhormone
therapy.