ADDISON’S DISEASE
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CUSHING’S DISEASE
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Definition
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Hyposecretion of adrenocortical hormones leading to:
§ Metabolic disturbances (sugar)
§ Fluid and electrolyte imbalances (salt)
§ Deficiency of neuromuscular function (salt and sex)
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Hypersecretion of adrenocortical hormone
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Predisposing Factors
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1. Atrophy of the Adrenal gland
2. Fungal infections
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1. Hyperplasia of Adrenal gland
2. Tubercular infection (MILIARY – TB to adjacent organs)
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Signs and
Symptoms
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1. hypoglycemia (TIRED)
a. Tremors and tachycardia
b. Irritability
c. Restlessness
d. Extreme fatigue
e. Diaphoresis and depression
2. Decreased tolerance to stress (d/t decreased cortisol) à Addisonian Crisis
3. Hyponatremia
a. Hypotension
b. Signs of dehydration
c. Weight loss
4. Hyperkalemia
a. Irritability and agitation
b. Diarrhea
c. Arrhythmias
5. Decreased Libido
6. Loss of pubic and axillary hair
7. Bronze-like skin pigmentation d/t decreased cortisolà stimulation of MSH from pituitary gland
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1. Hyperglycemia à can lead to DM
a. Polyuria
b. Polydipsia
c. Polyphagia
d. Wt. Gain
e. Glucosuria
2. Increased susceptibility to infection (Reverse isolation!)
3. Hypernatremia
a. HPN
b. Edema
c. Wt. gain
4. Moonface appearance, buffalo hump, obese trunk, pendulous abdomen, thin extremities
5. Hypokalemia
a. Weakness and fatigue
b. Constipation
c. U wave on ECG tracing
6. Hirsutism
7. Easy brusing
8. Acne and Striae
9. increased masculinity in females
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Diagnostics
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1. FBS decreased (N= 80-120 mg/dl)
2. Serum Na decreased (N= 135-145)
3. Serum K elevated (N=3.5-5.5meq/L)
4. Plasma cortisol decreased
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1. FBS elevated
2. Elevated Na
3. Decreased K
4. Elevated Cortisol
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Nursing
Management
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1. Monitor strictly VS, IO to determine presence of Addisonian crisis which results from acute exacerbation of Addison’s disease characterized by:
a. Hyponatremia
b. Hypovolemia
c. Dehydration
d. Severe Hypotension
e. Weight lossà Which may lead to progressive stupor à coma.
§ Assist in mech vent, steroids as ordered, forced fluids
2. Administer medications as ordered
a. Corticosteroids
§ Universal rule: administer 2/3 dose in AM and 1/3 dose in PM to mimic the N diurnal rhythm of the body
§ Taper the dose. Withdraw gradually from the drug
§ Monitor SE: Cushingoid Sx
§ HPN, Increased susceptibility to infection, Weight gain, Hirsutism, Moon face appearance
§ Ex: Hydrocortisone, Dexamethasone, Prednisone
b. 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
a. Avoidance of precipitating factors leading to addisonian crisis:
§ Stress, Infection, Sudden withdrawal to steroids
b. Prevent Complications – hypovolemic shock
c. Hormonal replacement therapy for life
d. Importance of ffup care
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1. Monitor IO, VS
2. Restrict Na and Fluids
3. Weigh pt. daily and assess for pitting edema (ANASARCA – generalized edemaà nephritic syndrome)
4. Measure abdominal girth daily, notify MD
5. Diet: low CHO, NA, High CHON and K
6. Administer medications as ordered
a. K-sparing diuretics - Spironolactone (Aldactone); excretes sodium but retains potassium
7. Prevent Complications – DM
8. Provides meticulous skin care
9. Assist in Surgical Procedure – Bilateral Adrenalectomy
10. Hormonal replacement for life
11. Importance of ffup care
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