Addison's and Cushing's Disease and Steroid Management

Introduction

• Addison's and Cushing's diseases involve cortisol and steroid levels.
• Addison's: Insufficient steroids ("Add some"), leading to symptoms of weight loss and weakness.
• Cushing's: Excessive steroids ("More cushion"), leading to symptoms of weight gain and excessive hair growth.
• Important for NCLEX exam.

Addison's Disease Overview

• Key Characteristics:

  • Absence of steroids.
  • Symptoms: Low blood pressure, weight loss, cold intolerance, hair loss, depression, fatigue, low sodium (hyponatremia), and salt cravings.
  • Two Highs: High pigmentation (bronze skin) and high potassium (hyperkalemia).

• Memory Aids:

  • Double P's: Pigmentation and Potassium.
  • ADD:
    • A for Added tan and potassium.
    • D for Decreased weight and blood pressure.
    • S for Sodium loss (below 135) and Salt craving.

Cushing's Disease Overview

• Key Characteristics:

  • Excessive steroids.
  • Symptoms: High blood pressure, high sugars, high sodium, weight gain, truncal obesity, moon face, buffalo hump, hirsutism (hair growth), purple striae, slow wound healing, and risk for fractures.

• Memory Aids:

  • CUSH:
    • C for cushion of fat.
    • U for unusual hair growth (hirsutism).
    • S for skin stretch marks.
    • H for high sugar, BP, and weight.

Pathophysiology

• Hypothalamic-Pituitary-Adrenal (HPA) Axis:

  • CRH stimulates ACTH, which stimulates adrenal cortex.
  • Adrenal cortex produces steroids, regulating sugar, salt, and sex.

• Cortisol Function:

  • Stress hormone, increases sugar during stress.
  • Aldosterone increases salt/water, decreases potassium.
  • Steroids shield against stress (e.g., surgery, infection).

Causes of Addison's and Cushing's

• Addison's Causes:
  • Autoimmune disease, diseases (cancer, TB), trauma.
• Cushing's Causes:
  • Exogenous: Long-term steroid use.
  • Endogenous: Tumors on adrenal/pituitary, small cell lung cancer.

Treatment Approaches

• Addison's Treatment:

  • Add steroids (e.g., prednisone, hydrocortisone) and IV fluids.
  • Stress management: Teach patients to increase steroids during stress.
  • Diet: High protein, carbs, and sodium.

• Cushing's Treatment:

  • Remove tumors or reduce steroid use slowly to avoid crisis.
  • Lifelong hormone replacement therapy post-surgery.

Addisonian Crisis

• Triggered by stress, abrupt stop of steroids.
• Symptoms: Low blood pressure, shock, risk of death.
• Intervention: Administer steroids (hydrocortisone/prednisone) IV push immediately.

Key Nursing Considerations and NCLEX Tips

• Steroid Side Effects:

  • Swollen body (weight gain, moon face).
  • Risk of infection (low WBC, slow healing).
  • High sugar levels (manage with insulin).
  • Risk of osteoporosis (fractures, cataracts).
  • Taper off steroids slowly, never abruptly stop.
  • Increase steroids during stress (surgery, illness).

• Priority Actions:

  • For Addisonian crisis, prioritize stabilizing blood pressure.
  • Ensure patient education on stress, diet, lifelong treatment.

Conclusion

• Remember key differences: Addison's (absence) vs. Cushing's (excess).
• Use memory aids (ADD, CUSH) for symptoms and treatment.
• Always refer back to the NCLEX priorities and side effect management.