Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to be going over the differences between Addison's disease and Cushing's. This is part of our endocrine series that we're going to be doing for an NCLEX review. So what I'm going to do for you is I'm going to break this material down.
I'm going to go over the causes, the signs and symptoms, and the nursing interventions. And I'm going to go over the things specifically you need to know for the NCLEX exam and your nursing lecture exams and give you some clever mnemonics on how to remember these things. Now after this video, be sure to go to my website RegisteredNurseRN.com and take the free quiz that will test your knowledge on Cushing's versus Addison's.
And a card should be popping up where you can access that quiz. So let's get started. Let's begin by talking about the key players in these two endocrine disorders. The key players are the adrenal cortex and steroid hormones, specifically aldosterone and cortisol. Okay, so let's talk about the function of each of these key players because if you can see what they normally do in the body, then the signs and the symptoms and the nursing interventions will all make sense.
So let's talk about the role of the adrenal cortex. The adrenal cortex is located on top of the kidneys in the adrenal glands. This purple area right here is your adrenal glands and inside that is the adrenal cortex. And The adrenal cortex releases these steroid hormones, it releases corticosteroids such as aldosterone and cortisol.
Aldosterone is also known as a mineral corticoid and cortisol is also known as a glucocorticoid. It also releases sex hormones. Your adrenal cortex releases your corticosteroids and sex hormones. Let's look at the function of aldosterone and cortisol. Those, that is what we are most interested in in these two endocrine problems.
Okay, what's the function of aldosterone? Aldosterone regulates our blood pressure through the renin-angiotensin-aldosterone system. So it keeps our blood pressure nice and regulated. And if anything happens to your aldosterone levels, it throws off that whole system.
So you're going to either have high blood pressure or low blood pressure. It also, aldosterone plays a role in retaining sodium. So if you...
If you have too much aldosterone, you're going to be retaining way too much sodium, and vice versa if you have too low. It also secretes potassium. Aldosterone is regulating our potassium and sodium levels. Anything that's throwing your aldosterone off is going to throw those levels off.
Now let's look at the function of cortisol. Cortisol is known as the stress hormone. Commit that to memory. Whenever you get stressed, your body releases cortisol.
It helps your body. deal with stress. For instance, any illnesses you have which is stress on your body or even external stress going on in your life, cortisol is our stress hormone.
It helps us and it also increases blood glucose by metabolizing sugars that you eat and it breaks down fats, proteins, and carbs and it regulates electrolytes. So if you have any problems with too high cortisol, levels are too low these things are going to be thrown out of whack for instance if you have high cortisol levels you're gonna have crazy high blood sugars elevated glucoses and here in a second whenever we go over Cushing's and Addison's you will see why you are having that based on the production of each steroid hormone. But first, let's go over this real fast because I want you to see this because this plays a role in especially Cushing's syndrome. This is the negative feedback control.
Now, we talked about this in SIADH and diabetes insipidus a little bit, but here is the negative feedback control. And what you have, all this works together in secreting your steroid hormones. And if you have a little glitch somewhere up the line, it's going to mess up how cortisol and those other hormones are released so let's go over that real fast so you can be familiar with it okay in your brain you have your hypothalamus and your hypothalamus releases CRH which is a corticotropin release hormone then whenever it releases that the pituitary gland releases an ACTH so commit that to memory because we're gonna go over that a little bit later and that is your adrenocorticotropin hormone which causes the adrenal cortex to release cortisol so that is just the negative feedback of how everything works now let's go over the differences between Cushing's and Addison's disease the biggest thing that really confuses people on Cushing's and Addison's is knowing which hormone is elevated which hormones not elevated and what's going on in it so what I want to do is I want to break it down for you and give you some ways on how to remember that because that's the biggest thing that will really confuse people on a test okay so let's look at Cushing's Cushing's starts with a C and in Cushing's you have an increased secretion of cortisol. What was cortisol again?
It was that stress hormone. How I remember this is Cushing starts with C and it's only dealing with one thing and it's dealing with cortisol. Aldosterone does not play a role in this, just cortisol.
So just commit that to memory cortisol. Cortisol starts with C, Cushing starts with C and it's just dealing with one of them. And you have an increased secretion and think of Cushing's cushion.
You have a cushion, There's two, you have a lot of padding, you have a lot going on. So remember that you have an increased secretion of cortisol. Now let's flip it over to Addison's disease.
This is where you have a lower hyposecretion of cortisol and aldosterone. So you're dealing with both cortisol, the stress hormone and aldosterone. How I remember this is in Addison's, you have the word add, the first. three letters ADD and you're dealing with two stress hormones two steroid hormones so you had to add some Addison's add some you had to add a steroid hormone in there which is aldosterone and it starts with an A and so does Addison so both of these deal with cortisol but this one Addison's because you added one deals with aldosterone okay so what causes Cushing's now You have probably heard of Cushing syndrome and Cushing disease.
They both present with the same signs and symptoms, but they are a little bit different based on what is causing it. So let me go over that for you real fast. Okay, Cushing syndrome. Cushing syndrome is you have this whenever there is an outside cause, meaning that there is something causing the body to produce too much cortisol.
And this is usually due to a medication treatment of glucocorticoid. corticoids like prednisone. The patient's on a prednisone therapy and it causes them to go into Cushing's syndrome.
Now you have Cushing's disease whenever it's caused by an inside source. There's something wrong inside the body. For instance, like the pituitary gland is producing too much of that ACTH hormone.
So that's why I wanted to go over that negative feedback thing. So what happens is that your pituitary gland produces the adrenocorticotropin hormone the HCT H and whenever you have too much of that being secreted that causes your cortisol levels to shoot up to produce too much so that would be an inside source pituitary gland is causing that so that is the difference between those now causes of Addison disease typically this is an autoimmune disorder this is where your body is just attacking that adrenal cortex on top in the adrenal glands and this can be due to cancer tuberculosis or hemorrhaging due to like a car accident trauma something and traumatically affected the adrenal glands okay so now let's go over the signs and symptoms this is what you really really need to know for NCLEX and for your nursing lecture exams because it's going to give you scenarios and say which of the following patients is presenting with Cushing's or Addison's or something like that or which thing is not a sign and symptom of this disorder. For Cushing syndrome, let's remember the word stress because with this you have increased secretion of cortisol, that stress hormone. So for the first S, they will have a skin that is fragile. It'll bruise easily.
It'll tear. So you want to provide meticulous skincare. T, they'll have the truncal obesity with really small arms and legs.
They'll be really thick up in their abdomen and back area. R, they will have a round face, they term it as the moon face where their face is really really full especially in the cheek areas. Another R, they will have reproductive issues, females will not have menstruation and males could have erectile dysfunction. E for ecchymosis, they bruise easy, goes back to the skin is fragile.
And the other E, they'll have hypertension, elevated blood pressure. S for striatum on the extremities this sort of looks like stretch marks and it's purplish they will have it on their arms and on their abdomen and the key with that is that it looks purplish in color and other s they will have sugars will be very high they will have hyperglycemia because remember cortisol deals with metabolizing your glucose so if you have way too much cortisol levels you're going to have a lot of glucose metabolizing and you're going to have increased sugars e for excessive body hair females will have start to take on male characteristics and will have facial hair, back hair as males. The last part D, they'll have the dorsal cervical fat pad which is known as the buffalo hump. It's where on the back they accumulate a lot of fat and it appears to be a buffalo hump on an animal. The last D, they will have depression mainly due to everything that's going on, those high cortisol levels.
but also because of their appearance of what's going on with the cortisol levels causing them to accumulate fat in places you normally don't accumulate fat. Okay, now let's look at the signs and symptoms of Addison's disease. Okay, with this, remember you had hyposecretion of cortisol and aldosterone.
So, we have low steroid hormones. So, what we're going to remember, we're going to remember the phrase low steroid hormones, specifically steroids. avoid.
So, how they will have, first S, they will have sodium and sugar levels will be very low. And again, that goes back to your cortisol. Cortisol plays a role in metabolizing the glucose.
You have low levels of it. You're not going to really be metabolizing glucose. So, you're not going to have a lot of sugar.
So, you're going to have hypoglycemia. And your sodium, aldosterone, remember, plays a role in retaining sodium. So, if you don't have a lot of aldosterone in the body, you're going to have...
low sodium levels so you're going to have hyponatremia and another s they will have salt cravings because their sodium levels are so low so they'll actually be craving salt okay t for tired they'll be tired they'll have muscle weakness e for electrolyte imbalances and again that just goes back to your aldosterone they have low levels of aldosterone aldosterone plays a role in regulating the sodium and potassium levels so they'll have high potassium hyperclean and hyponatremia and they can also have high calcium levels because in our electrolyte video series we talked about how hyperkalemia and hypokalemia go hand-in-hand with one another okay are they will also have reproductive changes where women will have periods but they'll be very irregular scattered and males will also have erectile dysfunction as well Oh the word low the O and low low blood pressure and these patients are very much at risk for vascular collapse going into shock. And again, that plays a role with that renin, angiotensin, aldosterone system. An eye for increased pigmentation of the skin. So they're going to have like a brownish hyper pigmentation of the skin. Remember that?
That's one of the hallmark signs of this Addison's. And in Cushing's, remember they had the purple striae on their skin. And D for diarrhea and depression, nausea. Okay, this is another important section that you'll want to remember, just like the signs and symptoms, because this is where a lot of test questions come from.
So what I'm going to do is highlight the things that you need to know. Okay, so let's look at the Cushing. syndrome.
What are we going to do for Cushing disease, Cushing syndrome, or the nursing interventions? Okay, remember before we talked about Cushing disease, how the pituitary gland was releasing too much of that ACTH hormone, which is causing that cortisol to shoot up. So typically, you will be prepping the patient for a hypophysectomy, which will remove that pituitary tumor, which will help cure that and bring those cortisol levels down. Or if it's due to a tumor on the adrenal gland they will go for an adrenal ectomy where they'll actually remove the adrenal gland.
Now with this, remember this very important whenever patients have this procedure done they usually have to go on therapy for cortisol treatment because they're not going to be producing it by themselves anymore because the adrenal gland produces it. So they'll have to go on some type of hormone replacement therapy with that so educate them about that and it's something that they're going to have to be taking. Also, with these patients, you'll want to watch for their increased blood sugars. We're monitoring that routinely. Their low potassium levels, so looking at those electrolytes, watching them for signs and symptoms of infection because their body is really stressed out.
They got a lot of cortisol going on. Their skin breakdown and most importantly, the emotional support. This is mainly due to the appearance, due to that moon face, the buffalo hump, things like that.
Just being there for them emotionally with what's going on. Now let's look at the nursing- interventions for Addison's disease. What are you going to do for this patient?
Okay, you want to make sure you're monitoring them for hypoglycemia and hyperkalemia because those are going to be out of whack. A big part that you definitely want to remember is the pharmacological aspect of that because what's going on with this patient is that they have low cortisol and aldosterone levels. So we need to give that to them synthetically so they can have those hormones.
So they have low cortisol levels so we're going to replace cortisol levels and generally that's in the drug form of prednisone or hydrocortisone. Education pieces because as a nurse you're always educating the patient about their medications. You want to let them know that if all of a sudden they get sick, they're going to have surgery or they're having extra external stress in their life, they need to notify the doctor because remember cortisol is our stress hormone. It helps us deal with stress. The doctor may have to increase their dosage of prednisone and hydrocortisone just to help them cope during those times because they can't produce that themselves.
Also, let them know it's very important you take this medicine regularly. You just do not abruptly stop that. You take them regularly.
You don't take them as needed. Just take them according to the dosing schedule. For replacing aldosterone, generally the doctors may prescribe Floranef. The only thing that they can do is to make sure they can see the dosage.
adequate salt levels because their sodiums are already the sodium levels already low so they want to make sure while they're taking this drug that they're consuming enough salt okay other things as to go along with this you need to make sure that they get a medic alert bracelet because these patients are at risk if they're not compliant with their medicines or their dosage isn't high they can go into addisonian crisis which we'll go here in a second pass out someone can find them don't know what's wrong with them but they have the bracelet and tells them that they have Addison's then it'll help EMT everyone provide better care to them also another important thing is their diet they need to eat a diet high in protein and carbs and normal sodium sodium because remember your cortisol is responsible for breaking down those fats and proteins and carbs so they have low levels of cortisol so they need to make sure that they are consuming a great diet in that they need to avoid stress and strenuous exercise and illness. Again, that goes back to because they're low in cortisol and cortisol is their stress hormone and they can't tolerate that. Now, as a nurse, you need to watch out for the adisonian crisis, which is known as an adrenal gland crisis. And this happens whenever either the patient hasn't taken their medication properly or they just haven't had enough dosage.
And what's happened is that there is absolutely barely any cortisol levels left. So they are low and this is life threatening. So remember the five S's to help you remember this. All of a sudden, they will get sudden pain, specifically in their abdomen, the stomach, the back, or the legs. Syncope, they'll be unconscious.
Shock, they'll go in shock. They'll have really low blood pressure. They're at vascular collapse.
The other S, super low blood pressure. And then the last S, severe vomiting, diarrhea, and a headache. Now, treatment for this. Okay, so think of this.
Why did they go into this? Because their cortisol levels are like nothing. So what do they need?
They need cortisol. The best and fastest way to give that to them is IV cortisol, ASAP. And typically that is called solucortef. And the physician will order that for you to give IV. You'll give that IV push and start on IV fluids.
That is because they're literally, they have a low blood pressure. They're on vascular collapse. They are going into shock, they have low sugar, and so typically what they prescribe is D5 normal saline, which will help increase that sugar, increase that sodium, increase fluid size, increase that blood pressure. And these patients who are in this are definitely at risk for infection, so you'll want to watch that.
So that is the differences between Addison's and Cushing's. Now go take that free quiz on my website, RegisteredNurseRN.com, and check out my other videos on the endocrine system for NCLEX review. And thank you so much for watching, and consider subscribing to this YouTube channel.