Overview
This lecture explains the differences between Addison's disease and Cushing's syndrome/disease, focusing on causes, signs and symptoms, and nursing interventions essential for NCLEX and nursing exams.
Adrenal Cortex & Hormones
- The adrenal cortex is located atop the kidneys and releases corticosteroid and sex hormones.
- Key hormones: aldosterone (a mineralocorticoid) regulates blood pressure, sodium, and potassium; cortisol (a glucocorticoid) is the stress hormone and increases blood glucose, regulates metabolism, and electrolytes.
- Cortisol and aldosterone imbalances disrupt blood pressure, electrolyte, and glucose levels.
Negative Feedback System
- The hypothalamus releases CRH (corticotropin-releasing hormone).
- CRH prompts the pituitary to release ACTH (adrenocorticotropic hormone).
- ACTH stimulates the adrenal cortex to release cortisol.
Causes: Cushing’s vs Addison’s
- Cushing’s syndrome: outside cause, usually prolonged glucocorticoid use (ex: prednisone).
- Cushing’s disease: inside cause, usually pituitary overproducing ACTH.
- Addison’s disease: most often autoimmune destruction of the adrenal cortex; can also be from cancer, TB, or hemorrhage.
Key Signs & Symptoms
Cushing’s Syndrome/Disease (mnemonic: STRESSED)
- Fragile skin, easy bruising (S)
- Truncal obesity with thin limbs (T)
- Round “moon” face (R)
- Reproductive issues (R)
- Easy bruising/ecchymosis, hypertension (E)
- Purple striae/stretch marks (S)
- High blood sugar (hyperglycemia) (S)
- Excessive body hair (E)
- Buffalo hump (D)
- Depression (D)
Addison’s Disease (mnemonic: LOW STEROID)
- Low sodium and sugar (S)
- Salt cravings (S)
- Tiredness, muscle weakness (T)
- Electrolyte imbalances: hyponatremia, hyperkalemia, hypercalcemia (E)
- Irregular periods, erectile dysfunction (R)
- Low blood pressure, risk of shock (O)
- Increased skin pigmentation (I)
- Diarrhea, nausea, depression (D)
Nursing Interventions
Cushing’s
- Prepare for hypophysectomy (pituitary removal) or adrenalectomy if indicated.
- Monitor blood glucose, potassium, infection risk, and skin breakdown.
- Provide emotional support and educate on lifelong hormone replacement if adrenalectomy.
Addison’s
- Monitor for hypoglycemia and hyperkalemia.
- Administer hormone replacements: hydrocortisone/prednisone for cortisol, fludrocortisone for aldosterone.
- Educate on dose adjustment during stress or illness and not to stop medication abruptly.
- Recommend a high protein/carbohydrate, normal sodium diet.
- Advise on medic-alert bracelet and avoidance of stress.
Addisonian Crisis (Acute Adrenal Insufficiency)
- Signs: sudden pain, unconsciousness, shock (very low BP), severe vomiting/diarrhea/headache.
- Emergency treatment: IV corticosteroids (solu-cortef), IV D5NS fluids, monitor for infection.
Key Terms & Definitions
- Adrenal Cortex — outer part of adrenal gland; produces steroid hormones.
- Aldosterone — hormone controlling sodium and potassium, thus blood pressure.
- Cortisol — stress hormone regulating metabolism and immune response.
- ACTH (Adrenocorticotropic hormone) — stimulates cortisol release.
- Cushing’s disease — endogenous excess cortisol from pituitary ACTH overproduction.
- Cushing’s syndrome — excess cortisol, often from external glucocorticoid therapy.
- Addison’s disease — deficiency of cortisol and aldosterone due to adrenal cortex damage.
Action Items / Next Steps
- Take the free quiz on Cushing’s vs Addison’s at registerednursern.com.
- Review endocrine system videos for further NCLEX preparation.