Lecture Notes: Addison's and Cushing's Disease

Introduction

• Focus on Addison's and Cushing's disease, all about steroids.
• Addison's Disease: Absence of steroids.
• Cushing's Disease: Excessive steroids.

Addison's Disease

• Characteristics:
  • Small, skinny, frail, weak appearance.
  • Odd tan (hyperpigmentation).
• Symptoms:
  • Low blood pressure (critical).
  • Low weight due to water loss.
  • Cold intolerance, low temperature.
  • Hair loss (alopecia).
  • Depression or irritability.
  • Low energy.
  • Hyponatremia (sodium < 135).
  • Salt craving.
  • Irregular periods.
  • High pigmentation (bronze skin).
  • High potassium (> 5.0), leading to muscle spasms, EKG changes including peaked T-waves and ST elevations.

Cushing's Disease

• Characteristics:
  • Big, round, hairy appearance.
• Symptoms:
  • High blood pressure.
  • High blood sugar.
  • High sodium.
  • Weight gain, truncal obesity.
  • Moon face, buffalo hump.
  • Hirsutism (excessive hair growth).
  • Purple stretch marks on face and abdomen.
  • Rosy cheeks.
  • Increased infection risk, slow wound healing.
  • Brittle bones (osteoporosis).

Memory Aids

• Addison's:
  • "Add" for added tan and potassium.
  • "Decreased" for weight, blood pressure, hair, sugar, energy.
• Cushing's:
  • "Cushion" for fat, moon face, buffalo hump.
  • "Unusual" for hair growth.

Pathophysiology

• Hypothalamus and Pituitary Gland Role:
  • CRH from hypothalamus –> ACTH from pituitary –> adrenal cortex produces steroids.
  • Steroids control sugar, salt, and sex hormones.

Causes

• Addison's:
  • Autoimmune destruction of adrenals.
  • Secondary causes like infections or trauma.
• Cushing's:
  • Exogenous steroids (medications).
  • Endogenous causes like tumors or cancers.

Treatments

• Addison's:
  • Add steroids (hydrocortisone, prednisone).
  • High protein, carb, sodium diet.
  • Wear medical alert bracelet.
  • Lifelong hormone replacement therapy.
• Cushing's:
  • Remove tumors or reduce steroid use.
  • Lifelong hormone replacement if gland removed.

Steroid Side Effects

• Seven S's:
  • Swollen (weight gain).
  • Sepsis (infection risk).
  • Sugar (hyperglycemia).
  • Skinny (muscles and bones, osteoporosis).
  • Sight (cataracts risk).
  • Slowly taper off to prevent Addisonian crisis.
  • Stress (increase dose during stress).

Addisonian Crisis

• Causes:
  • Added stress, abrupt stop of medication.
• Symptoms:
  • Low blood pressure leading to shock and death.
• Treatment:
  • Immediate IV steroid administration.
  • IV fluids and dextrose for low sugar and fluids.

Conclusion

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