Class notes NCLEX-RN

Endocrine  Adult Health  Cushing & Addison Disease

Table of Contents:
1. Adrenal Gland Physiology 4. Hyperaldosteronism
2. Adrenocortical Insufficiency (Conn Syndrome)
(Addison Disease) 5. Pheochromocytoma
3. Hypercortisolism (Cushing Syndrome)


Cushing & Addison Disease

1. Adrenal Gland Physiology
y The cortex produces androgens and corticosteroids
FIGURE 1. ADRENAL HORMONE REGULATION (cortisol, aldosterone).
y Cortisol:inflammation and immunity,




Endocrine
blood glucose
y Aldosterone:Na+ and fluid retention,BP, and
renal K excretion (K+ levels)
y Corticosteroid secretion is regulated by a negative
feedback loop (FIGURE 1).
Adrenal cortex disorders (TABLE 1)
y Addison disease: Corticosteroid deficiency
y Cushing and Conn syndromes: Corticosteroid excess



TABLE 1. ADDISON DISEASE VS. CUSHING SYNDROME

Feature Addison Disease Cushing Syndrome

Fluid balance y Na+ and y Na+ and fluid
fluid volume volume
y BP y BP
y Weight loss y Weight gain

Glucose & K+ y K+ y K+
y glucose y glucose

Treatment y Corticosteroid y Discontinuation
replacement of chronic
The adrenal glands produce hormones essential for stress steroid use
and immune response, metabolism, and fluid balance. y Surgery if
caused by
Adrenal glands are located on top of the kidneys and
tumor
consist of two parts.
y The medulla produces catecholamines (epinephrine,
norepinephrine).
y Epinephrine and norepinephrine activate the
“fight or flight” (sympathetic) response.
y BP,HR, blood glucose




 Addison disease vs. Cushing syndrome: Addison disease causes corticosteroid deficiency;
findings include weight loss, low BP, and skin hyperpigmentation. Cushing syndrome causes high
corticosteroid levels; findings include weight gain, high BP, and moon face.

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, Endocrine  Adult Health  Cushing & Addison Disease

1. Adrenal Gland Physiology, Continued 1. Increase corticosteroid levels:

In primary adrenal insufficiency (Addison disease),
FIGURE 2. ADRENAL DISORDER FINDINGS lifelong corticosteroid replacement is required
to prevent hypotension, hypoglycemia, and
hyperkalemia.

Administer corticosteroids as prescribed
(hydrocortisone, prednisone) (TABLE 2).
y steroid dose is required during times of stress or
illness to prevent Addisonian crisis (acute adrenal
insufficiency), which is a life-threatening state of
shock, hypoglycemia, and hyperkalemia (TABLE 3).
y Teach clients at risk for Addisonian crisis to:




Endocrine
y Wear a medical alert bracelet.
y Report signs of infection (fever) promptly.
y Avoid triggers for Addisonian crisis (strenuous
exercise, stress).
2. Adrenocortical Insufficiency (Addison Disease)

TABLE 2. CORTICOSTEROIDS AT A GLANCE
Adrenocortical insufficiency: Corticosteroid deficiency
due to primary (Addison disease) or secondary causes
Medications Nursing Considerations
(ACTH)
y Addison disease: Autoimmune or malignant (tumor)
Corticosteroids For corticosteroids,
adrenal destruction cortisol + aldosterone 
prednisone remember to STOP and
Impaired fluid, electrolyte, and glucose regulation
methylprednisolone teach:
Assessment findings (see FIGURE 2) y S - Sugar: Monitor
dexamethasone

aldosterone  Sodium and water loss + potassium blood sugar, especially if
hydrocortisone
retention client has diabetes.
y Hypotension y T - Taper: Taper slowly
y Hyponatremia and fluid deficit to prevent adrenal
y Hyperkalemia insufficiency. Do not

cortisol SNS (“fight or flight”) response: stop abruptly.
y Hypoglycemia y O - Osteoporosis:
y Fatigue, muscle weakness Encourage weight-
y Weight loss bearing exercises and a

Bronze skin frommelanin production diet high in calcium and
vitamin D.
Interventions
y P - Prevent infection:
Addison disease care focuses on: Teach client proper hand
1. Increasing corticosteroid levels hygiene and to avoid
2. Managing electrolyte, glucose, and fluid balance crowded places.


See CORTICOSTEROIDS CHEAT SHEET.




 Addison disease treatment: Addison disease requires lifelong corticosteroid therapy. Do not abruptly
stop corticosteroids, as this can trigger a life-threatening Addisonian crisis.


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