Addison Cushings notes PDF

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addisons and cushings disease...

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Addison’s Disease vs Cushing’s Major Players in these endocrine disorders: 

Adrenal Cortex



Steroid Hormones o

Corticosteroids (specifically Aldosterone (mineralocorticoid) & Cortisol (glucocorticoid)

Role of Adrenal Cortex: releases steroid hormones and sex hormones Role of Aldosterone: regulates blood pressure through renin-angiotensin-aldosterone system, helps retain sodium and secretes potassium (balances sodium and potassium levels). Role of Cortisol: “STRESS Hormone” helps the body deal with stress such as illness or injury, increases blood glucose though glucose metabolism, break downs fats, proteins, and carbs, regulates electrolytes.

Lecture on Cushing’s vs Addison’s Disease Cushing’s (Syndrome & Disease) Cushing’s: hyper-secretion of CORTISOL (watch video for clever ways to remember this) Cushing’s Syndrome vs Cushing’s Disease Cushing’s Syndrome: caused by an outside cause or medical treatment such as glucocorticoid therapy Cushing’s Disease: caused from an inside source due to the pituitary gland producing too much ACTH (Adrenocorticotropic hormone) which causes the adrenal cortex to release too much cortisol.

Signs & Symptoms of Cushing’s Remember the mnemonic: “STRESSED” (remember there is too much of the STRESS hormone CORTISOL) Skin fragile Truncal obesity with small arms

Rounded face (appears like moon), Reproductive issues amennorhea and ED in male(due to adrenal cortex’s role in secreting sex hormones) Ecchymosis, Elevated blood pressure Striae on the extremities and abdomen (Purplish) Sugar extremely high (hyperglycemia) Excessive body hair especially in women…and Hirsutism (women starting to have male characteristics), Electrolytes imbalance: hypokalemia Dorsocervical fat pad (Buffalo hump), Depression

Causes of Cushing’s  

Glucocorticoid drug therapy ex: Prednisone Body causing it: due to tumors and cancer on the *pituitary glands or adrenal cortex, or genetic predisposition

Nursing Management for Cushing’s Syndrome 

Prep patient for Hypophysectomy to remove the pituitary tumor

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Prep patient for Adrenalectomy: o

If this is done educate pt about cortisol replacement therapy after surgery

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Risk for infection and skin breakdown

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Monitor electrolytes blood sugar, potassium, sodium, and calcium levels

Addison’s Disease Addison’s: Hyposecretion of Aldosterone & Cortisol (watch the video for a clever way on how to remember this and not get it confused with Cushing’s)

Signs & Symptoms of Addison’s Disease Remember the phrase: “Low STEROID Hormones” (remember you have low production of aldosterone & cortisol which are STEROID hormones) Sodium & Sugar low (due to low levels of cortisol which is responsible for retention sodium and increases blood glucose), Salt cravings Tired and muscle weakness

Electrolyte imbalance of high Potassium and high Calcium Reproductive changes…irregular menstrual cycle and ED in men lOw blood pressure (at risk for vascular collapse)….aldosterone plays a role in regulating BP Increased pigmentation of the skin (hyperpigmentation of the skin) Diarrhea and nausea, Depression

Causes of Addison’s Disease 

Autoimmune due to the adrenal cortex becoming damaged due to the body attacking itself: o

Tuberculosis/infections

o

Cancer

o

Hemorrhaging of the adrenal cortex due to a trauma

Nursing Management of Addison’s Disease   

Watching glucose and K+ level Administer medications to replace the low hormone levels of cortisol and aldosterone For replacing cortisol: o

ex: Prednisone, Hydrocortisone 

Education: Patient needs to report if they are having stress such as illness, surgery, or extra stress in life ( will need to increase dosage), take medication exactly as prescribed….don’t stop abruptly without consulting with MD.

For replacing aldosterone:

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ex: Fludrocortisone aka Florinef

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Education: consume enough salt..may need extra salt

Wearing a medical alert bracelet

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Eat diet high in proteins and carbs, and make sure to consume enough

 sodium 

Avoid illnesses, stress, strenuous exercise

Watch for Addisonian Crisis This develops when Addison’s Disease isn’t treated. In addisonian crisis, the patient has extremely LOW CORTISOL levels (life threatening). Remember the 5 S’s 1.

Sudden pain in stomach, back, and legs

2.

Syncope (going unconscious)

3.

Shock

4.

Super low blood pressure

5.

Severe vomiting, diarrhea and headache

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NEED IV Cortisol STAT: o

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Solu-Cortef and IV fluids (D5NS to keep blood sugar and sodium levels good and fluid status)

Watch for risk for infection, neuro status (confusion, agitation), electrolyte levels (sodium and potassium, glucose)...