Lecture Notes: Addison's and Cushing's Disease - Steroids and NCLEX Exam Tips

Introduction

• Presenter: Nurse Mike, SimpleNursing.com
• Focus on Addison's and Cushing's disease, especially for NCLEX exams.
• Encouragement to access additional study guides and quizzes.

Addison's Disease

• Absence of Steroids: Characterized by low levels of steroids.
• Presentation:
  • Small, skinny, frail, weak, with odd tan.
  • Low blood pressure (critical), low weight, low temperature, low hair (alopecia), low mood, low energy.
  • Low sodium (hyponatremia, <135), leads to salt craving.
  • High pigmentation (bronze skin) and high potassium (>5.0, hyperkalemia).
  • Causes muscle spasms, EKG changes (peak T waves, ST elevations).

Cushing's Disease

• Excess of Steroids: Characterized by high levels of steroids.
• Presentation:
  • Big, round, hairy, with big blood pressure, big sugars, big sodium.
  • Big belly (truncal obesity), moon face, buffalo hump (fat pad), hirsutism (hairy suit-ism).
  • Purple stretch marks (striae) on face and abdomen.
  • Red face, slow wound healing, risk for fractures (osteoporosis).

Memory Tricks for NCLEX

• Addison's:
  • "Add": Add tan and potassium.
  • Decreased weight, blood pressure, hair, sugar, energy.
  • Salt craving, sodium loss.
• Cushing's:
  • "Cush": Cushion of fat (truncal obesity), moon face, buffalo hump.
  • Unusual hair growth, skin with stretch marks, high sugar/BP/weight.

Pathophysiology

• Hypothalamus secretes CRH, pituitary gland releases ACTH, adrenal cortex produces steroids.
• Cortisol, aldosterone, and androgens: Control sugar, salt, and sex.
• High cortisol = Cushing's (big body, slow immunity, high BP/sodium).
• Low steroids = Addison's (skinny, low BP, salt craving).

Causes

• Addison's:
  • Autoimmune disease, cancer, infection (TB), trauma.
• Cushing's:
  • Exogenous causes: High doses of steroid meds (e.g., prednisone).
  • Endogenous: Tumors on adrenal/pituitary, small cell lung cancer.

Treatments

• Addison's: Add steroids (prednisone, hydrocortisone), IV fluids.
• Cushing's: Remove tumors, taper steroids, replace hormones after gland removal.

Nursing Considerations

• Addison's Disease Management:
  • Teach patients to report stress and increase steroids.
  • Diet high in protein, carbs, sodium.
  • Never stop steroids abruptly, wear medical alert.
• Steroid Side Effects (7 S's):
  • Swollen (weight gain), Sepsis, Sugar (hyperglycemia), Skinny (osteoporosis), Sites (cataracts), Shock prevention (slow tapering), Stress increases (steroids during stress).

Key NCLEX Tips

• Addisonian Crisis:
  • Low BP, shock, death: Treat with IV steroids.
  • First action: Administer hydrocortisone or prednisone IV push.
• Cushing's Treatment:
  • Remove cause, taper steroids, lifelong hormone replacement.

Conclusion

• Reminder to download study materials and quizzes.
• Encouragement to subscribe and gratitude to team.