Lecture on Addison's and Cushing's Disease

Introduction

• Speaker: Nurse Mike from simplenursing.com
• Topics: Addison's and Cushing's Disease
• Focus: Effects of steroids on the body, symptoms, and treatments
• Exam Relevance: High likelihood of appearing on NCLEX exams

Addison's Disease

Key Characteristics

• Absence of Steroids: Need to "add" steroids
• Client Presentation:
  • Small, skinny, frail, and weak
  • Odd skin pigmentation (tan)
• Symptoms:
  • Low blood pressure (critical)
  • Low weight, water loss
  • Low temperature, cold intolerance
  • Hair loss (alopecia)
  • Low mood, depression, irritability
  • Low energy, fatigue
  • Low sodium (hyponatremia, <135)
  • Salt craving
  • Irregular periods
• High Levels:
  • Pigmentation (bronze pigmentation)
  • Potassium (>5.0, hyperkalemia)

NCLEX Tips

• Double P's: Pigmentation and Potassium
• Critical Symptoms: High pigmentation and potassium, muscle spasms, EKG changes (Peak T waves and ST elevations)

Cushing's Disease

Key Characteristics

• Excess Steroids: "Cushion" of steroids
• Client Presentation:
  • Big, round, hairy
  • Weight gain, water retention
• Symptoms:
  • High blood pressure
  • High sugar levels
  • High sodium
  • Truncal obesity
  • Moon face
  • Buffalo hump
  • Hirsutism (unusual hair growth)
  • Purple striae (stretch marks)
  • Red face, rosy cheeks
  • Slow wound healing, infections
  • Risk for fractures (osteoporosis)

NCLEX Tips

• Keywords: Moon face, Buffalo hump, Truncal obesity
• Remember: Big, round, hairy

Pathophysiology

• Steroid Production Pathway:
  • Hypothalamus secretes CRH
  • Pituitary releases ACTH
  • Adrenal cortex produces steroids (sugar, salt, sex)
• Key Hormone: Cortisol (stress hormone)
• Functions of Steroids:
  • Suppress inflammation
  • Control stress response

Causes of Disease

• Addison's Disease Causes:
  • Autoimmune (primary)
  • Diseases (cancer, TB, trauma)
• Cushing's Disease Causes:
  • Exogenous drugs (steroids)
  • Endogenous (tumors)
  • Small cell lung cancer

Treatment

• Addison's Disease:
  • Add steroids (e.g., hydrocortisone)
  • IV fluids for blood pressure
  • High protein, carb, sodium diet
  • Medical alert bracelet
  • Lifelong hormone replacement
• Cushing's Disease:
  • Remove cause (tumor or reduce steroids)
  • Lifelong hormone replacement if glands removed

Steroid Side Effects and Considerations

• "7 S's" of Steroids:
  • Swollen (weight gain)
  • Sepsis (infection risk)
  • Sugar (hyperglycemia)
  • Skinny muscles/bones (osteoporosis)
  • Sight (cataracts)
  • Slowly taper off
  • Stress (increase dose)

Nursing Actions for Crisis

• Addisonian Crisis:
  • Emergency: Low BP, risk of death
  • First action: IV push steroids (hydrocortisone/prednisone)
  • Supplement fluids and sugars (IV saline and dextrose)

Conclusion

• Resources: Downloadable cheat sheets and study guides
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These notes summarize the key points of Nurse Mike's lecture on Addison's and Cushing's Disease, crucial for exam preparation.