Addison's Disease vs Cushing's Syndrome: NCLEX Review

Key Players in Endocrine Disorders

• Adrenal Cortex: Located on top of the kidneys; releases corticosteroids (aldosterone, cortisol) and sex hormones.
• Aldosterone (Mineralocorticoid): Regulates blood pressure through the renin-angiotensin-aldosterone system, retains sodium, and secretes potassium.
• Cortisol (Glucocorticoid): Known as the stress hormone, increases blood glucose, breaks down fats, proteins, carbs, and regulates electrolytes.

Cushing's Syndrome

Cause

• Cushing's Syndrome: Outside cause, usually medication (e.g., long-term prednisone use).
• Cushing's Disease: Inside cause, often due to pituitary gland overproducing ACTH.

Signs and Symptoms (Mnemonics: STRESSED)

• S: Skin fragile, bruises easily.
• T: Truncal obesity (thick abdomen, small limbs).
• R: Round face (moon face).
• R: Reproductive issues (e.g., amenorrhea in women, erectile dysfunction in men).
• E: Ecchymosis (bruising).
• S: Hypertension (high blood pressure).
• S: Striae (purple stretch marks).
• S: Sugars high (hyperglycemia).
• E: Excessive body hair (hirsutism).
• D: Dorsocervical fat pad (buffalo hump) & Depression.

Nursing Interventions

• Prep for hypophysectomy (pituitary tumor removal) or adrenalectomy (adrenal gland removal).
• Monitor blood sugar, potassium levels, signs of infection, and emotional support.

Addison's Disease

Cause

• Usually an autoimmune disorder affecting the adrenal cortex. Other causes include cancer, TB, or hemorrhage.

Signs and Symptoms (Mnemonics: LOW STEROID)

• S: Sugar low (hypoglycemia).
• S: Sodium low (hyponatremia).
• S: Salt cravings.
• T: Tiredness and muscle weakness.
• E: Electrolyte imbalance (high potassium - hyperkalemia; high calcium).
• R: Reproductive changes (irregular menstruation or erectile dysfunction).
• O: Orthostatic hypotension (low BP and risk of shock).
• I: Increased pigmentation (bronze skin).
• D: Diarrhea & Depression.

Nursing Interventions

• Monitor hypoglycemia and hyperkalemia.
• Replace cortisol (prednisone, hydrocortisone); educate patients about stress and medication compliance.
• Replace aldosterone (Fludrocortisone); advise adequate salt intake.
• Encourage high protein and carbs diet, monitor for Addisonian crisis.

Addisonian Crisis

• Signs: Sudden pain, syncope, shock, super low BP, severe vomiting/diarrhea.
• Treatment: IV cortisol (Solucortef), IV fluids (D5 Normal Saline). Watch for infection risk.

Conclusion

• Take the free quiz on registerednurseorion.com to test your knowledge.
• Additional videos available for the NCLEX endocrine system review.