Addison's Disease and Cushing's Syndrome Lecture Notes

Introduction

• Lecture by Nurse Mike on SimpleNursing.com
• Focus on Addison's Disease and Cushing's Syndrome, related to steroid imbalance
• Emphasis on NCLEX exam preparation with key focus areas

Key Concepts

• Addison's Disease: Absence of steroids, need to "add" steroids

  • Symptoms: Small, skinny, frail, odd tan
  • Low levels: Blood pressure, weight, temperature, hair, mood, energy, sodium
  • Key signs: High pigmentation (bronze), high potassium (hyperkalemia)

• Cushing's Syndrome: Excess of steroids

  • Symptoms: Big, round, hairy (like a "cushion")
  • High levels: Blood pressure, sugar, sodium, weight
  • Key signs: Truncal obesity, moon face, buffalo hump, hirsutism (unusual hair growth), purple striae, slow wound healing, bone fractures

NCLEX Exam Tips

• Focus on Addison's disease with keywords: Pigmentation, Potassium
• Cushing's syndrome with keywords: Truncal obesity, Moon face, Buffalo hump
• Addison's critical symptom: Low blood pressure (Addisonian crisis)

Pathophysiology

• Hypothalamus-Pituitary-Adrenal Axis
  • Hypothalamus secretes CRH ➔ pituitary releases ACTH ➔ adrenal cortex produces steroids
• Steroid Functions
  • Cortisol: Increases sugar during stress
  • Aldosterone: Adds salt, water, releases potassium
  • Androgens: Control hair and sex characteristics

Causes of Addison's and Cushing's

• Addison's Disease

  • Autoimmune destruction of adrenals (primary)
  • Secondary causes: Cancer, infections like TB, trauma

• Cushing's Syndrome

  • Exogenous: High steroid medications (e.g., prednisone)
  • Endogenous: Tumors on adrenal/pituitary, small cell lung cancer

Treatment Strategies

• Addison's Disease

  • Add steroids (hydrocortisone, prednisone)
  • Maintain fluid levels, manage stress
  • High protein, carb, sodium diet
  • Lifelong hormone replacement therapy

• Cushing's Syndrome

  • Remove tumors or gradually taper steroids
  • Lifelong hormone replacement if glands are removed

Steroid Side Effects and Nursing Considerations

• Seven S's of Steroids
  • Swollen (weight gain)
  • Sepsis (increased infection risk)
  • Sugar (hyperglycemia)
  • Skinny muscles/bones (osteoporosis)
  • Sight (risk for cataracts)
  • Slowly taper off (prevent Addisonian crisis)
  • Stress and surgery (increase steroid dose)

Addisonian Crisis

• Causes
  • Added stress without increased steroids
  • Abrupt stopping of steroid medication
• Signs and Symptoms: Low blood pressure leading to shock
• Nursing action: Administer IV steroids immediately

Conclusion

• Reinforcement of main points for NCLEX preparation
• Encourage use of resources like cheat sheets and study guides
• Reminder to subscribe to SimpleNursing for more educational content

Additional Resources

• Access to free quizzes and study guides
• Emphasis on using tools for effective exam preparation