Addison's Disease

"Atrophy of the Adrenal Gland"

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Pathophysiology

Addison's disease, or primary adrenal insufficiency (PAI), occurs when damaged adrenal glands can no longer produce enough cortical hormones needed by the body.

 

Etiology

Causes of Addison's Disease include:

  • Autoimmune or idiopathic atrophy of the adrenal glands (80 to 90% of all cases)  

  • Surgical removal of the adrenal glands 

  • Tuberculosis and histoplasmosis are the most common infections associated with infection-induced adrenal gland destruction. 

  • Inadequate ACTH from the pituitary is a secondary cause of Addison's.

 

Lab & Diagnostics

Labs and diagnostics for Addison's include:

  • Measurement of early-morning serum cortisol and plasma ACTH to separate primary from secondary.

  • Blood glucose measurement (hypoglycemia)

  • Sodium measurement (hyponatremia)

  • Potassium measurement (hyperkalemia)

  • WBC (White Blood Cell) Count (leukocytosis)

 

Signs & Symptoms

S/S for Addison's include:

  • Muscle weakness 

  • Anorexia 

  • GI symptoms 

  • Fatigue 

  • Emaciation, 

  • Dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows, 

  • HTN 

  • Low blood glucose

 

Risk Factors

Risk factors for Addison's include:

  • Having had cancer

  • Taking anticoagulants

  • Having Tuberculosis

  • Surgical removal of the adrenal gland

  • Having an autoimmune disease like type 1 Diabetes or Graves Disease

 

Treatment

Medical: Immediate treatment is toward combating circulatory shock; restoring blood circulation, admin fluids and corticosteroids, monitoring vitals signs, and placing the patient in a recumbent position with the legs elevated. Hydrocortisone (Solu-Cortef) is administered by IV, followed by 5% dextrose in normal Saline.

 

Pharmacologic: Antibiotics for infection If the adrenal gland does not regain function, lifelong replacement of corticosteroids and mineralocorticoids will be needed to prevent adrenal insufficiency.

 

Oral intake can happen as soon as tolerated by the patient, the main goal is to prevent hypovolemia. Also, the patient may need to supplement sodium during GI losses of fluids through nausea and vomiting.

 

Nursing

Interventions

Assessment: Health and History, with the exam being focused on S/S of fluid imbalance and stress levels.

 

Monitor and Manage Addisonian Crisis: monitor for shock, hypotension, weak pulse, rapid breaths, pallor, and fatigue.

  • This crisis requires immediate IV fluids, glucose, and electrolytes, namely sodium.

 

Fluid Balance: In working with a dietitian, encourage the patient to eat and drink along with fluids to restore balance. Salt may need to be added to the diet.

 

Stress: Avoid stressful situations and increased outside stimuli to avoid a hypotensive crisis.

 

Education: Educate the patient about the disease process, and the lifelong treatment needed to prevent Addisonian Crisis.

  • The patient needs to know the S/S of too high or too low hormone replacement.

  • The patient should have an emergency kit of corticosteroid injections.

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