Endocrine Disorders: Addison's Disease vs Cushing's

Introduction

• Lecture by Sarah from RegisteredNurseRN.com
• Focus on Addison's disease and Cushing's disease
• Key points: causes, signs and symptoms, nursing interventions
• Includes mnemonics for easier recall

Key Players in Endocrine Disorders

• Adrenal Cortex:
  • Located on top of kidneys
  • Releases steroid hormones: aldosterone (mineralocorticoid) and cortisol (glucocorticoid)
• Functions:
  • Aldosterone:
    • Regulates blood pressure through renin-angiotensin-aldosterone system
    • Retains sodium, secretes potassium
  • Cortisol:
    • Stress hormone
    • Increases blood glucose, breaks down fats, proteins, carbs
    • Regulates electrolytes

Negative Feedback Control

• Hypothalamus releases CRH (corticotropin releasing hormone)
• Pituitary gland releases ACTH (adrenocorticotropic hormone)
• Adrenal cortex releases cortisol

Cushing's Disease

• Cushing’s:

  • Increased secretion of cortisol (stress hormone)
  • Only involves cortisol, not aldosterone
  • Mnemonics: Cushing's -> Cortisol

• Causes:

  • Cushing's Syndrome: External cause like glucocorticoid treatment (e.g., prednisone)
  • Cushing's Disease: Internal source like pituitary tumor causing excess ACTH

• Signs & Symptoms (Mnemonic: STRESSED):

  • Skin fragile
  • Truncal obesity
  • Round face (moon face)
  • Reproductive issues
  • Ecchymosis, Elevated blood pressure
  • Striae on extremities
  • Sugars high (hyperglycemia)
  • Excessive body hair, Dorsal cervical fat pad (buffalo hump)
  • Depression

• Nursing Interventions:

  • Prepare for hypophysectomy or adrenalectomy
  • Monitor blood sugars and low potassium
  • Watch for infection, skin breakdown
  • Provide emotional support

Addison's Disease

• Addison’s:

  • Decreased secretion of cortisol and aldosterone
  • Mnemonics: Addison's -> Aldosterone added

• Causes:

  • Autoimmune disorder
  • Can be due to cancer, tuberculosis, or trauma

• Signs & Symptoms (Mnemonic: LOW STEROIDS):

  • Sodium and sugar low
  • Salt cravings
  • Tiredness, muscle weakness
  • Electrolyte imbalance
  • Reproductive changes
  • Orthostatic hypotension
  • Increased pigmentation
  • Diarrhea, Depression

• Nursing Interventions:

  • Monitor for hypoglycemia and hyperkalemia
  • Replace cortisol (prednisone, hydrocortisone) and aldosterone (Floranef)
  • Educate about stress, illness, and medication adherence
  • Diet: high protein and carbs, normal sodium
  • Avoid stress and strenuous exercise
  • Monitor for Addisonian crisis

Addisonian Crisis

• Life-threatening due to very low cortisol levels
• Symptoms: sudden pain, syncope, shock, super low blood pressure, severe vomiting, diarrhea
• Treatment: IV cortisol (solucortef) and fluids (D5 normal saline)

Conclusion

• Differences between Addison's and Cushing's
• Reminder to take the quiz on RegisteredNurseRN.com
• Explore other videos in the endocrine series for NCLEX review