Addison's vs. Cushings
Med Surg: Endocrine
Addison Cushing
Absent Steroids LOW Cushion of Steroids HIGH
Small, Weak, Tanned Big, Round, Hairy
Pathophysiology Pathophysiology
A • ADD “some steroids” (Cortisol & Aldosterone) C • Cushing (HIGH Cortisol Steroids)
A • ADDed Stress will KILL! C • Cushion Pillow ‘Air Bag”
Causes
A • AUTOIMMUNE (body kills adrenals or Pituitary) Causes
D • DISEASES: Cancer, Infections (TB/HIV)
D • DAMAGE: Adrenal Hemorrhage (Trauma) STEROIDS Prednisone LONG TERM Therapy (asthma + RA)
TUMOR (Pituitary/Adrenal)
Signs & Symptoms
SMALL CELL LUNG CANCER NCLEX TIP
LOW BP, Wt, Glucose, Temp, Hair, Mood, Sodium, Energy
HIGH Skin Tan (bronze) + Potassium (K+) Over 5.0
Signs & Symptoms
LOW BP - TICKING TIME BOMB
BIG BP, Infections, Wt, Hair, Belly, Brittle Bones
A • ADDED Tan
“Bronze pigmentation” “hyper pigmentation”
A • ADDED Potassium
“Hyperkalemia” Over 5.0 (normal 3.5–5.0)
D • DECREASE Weight (Water loss = weight loss) HIGH BP
NOT TRUNCAL OBESITY
C • CUSHION
D • DECREASED BP, hair, sugar & energy
“fatigue” “alopecia” “hypoglycemia” TRUNCAL Obesity + Moon Face +
“hypotension" Buffalo hump
S • SODIUM loss 135 or LESS U • UNUSUAL HAIR Growth
(135–145 normal) *NOT hairy NOT “Hirsutism” = hair suit & “Hirsutism” (hairy suit)
S • SALT craving *NOT thin skin is cushings
S • SKIN
“Purple Striae” “butterfly mark”
Treatment
H • HIGH Sugar, BP, Weight
A • Add Steroids “-sone” Prednisone)
Increase the Dose during Stress, Surgery, Sepsis
D • Diet HIGH in Protein, Carbs & Sodium
Treatment
D • Don’t “Abruptly” STOP Steroids! (Crisis)
D • Don’t believe this medication will cure you SURGERY Cut out Tumor REmove organ = REplace Steroids
I • Indefinitely: “Lifelong” hormone replacement SLOWLY decrease Steroids “taper off gradually”
ADDisonian "Adrenal" Crisis
Caution: No Steroids = DEATH!
A • Addisonian Crisis NCLEX Question
D • Drop in BP 89/40 LESS (Normal: 120/80) Which clinical manifestation(s) would be observed in a patient with Cushing syndrome?
Select all that apply:
1ST NURSE ACTION 1. Easy bruising
2. Increased blood glucose
4. Increased potassium
5. Increased abdominal girth
3. Increased blood pressure 4. Decreased weight
ADD steroids (IV push)
“-sone” hydrocortisone prednisone
Med Surg: Endocrine
Addison Cushing
Absent Steroids LOW Cushion of Steroids HIGH
Small, Weak, Tanned Big, Round, Hairy
Pathophysiology Pathophysiology
A • ADD “some steroids” (Cortisol & Aldosterone) C • Cushing (HIGH Cortisol Steroids)
A • ADDed Stress will KILL! C • Cushion Pillow ‘Air Bag”
Causes
A • AUTOIMMUNE (body kills adrenals or Pituitary) Causes
D • DISEASES: Cancer, Infections (TB/HIV)
D • DAMAGE: Adrenal Hemorrhage (Trauma) STEROIDS Prednisone LONG TERM Therapy (asthma + RA)
TUMOR (Pituitary/Adrenal)
Signs & Symptoms
SMALL CELL LUNG CANCER NCLEX TIP
LOW BP, Wt, Glucose, Temp, Hair, Mood, Sodium, Energy
HIGH Skin Tan (bronze) + Potassium (K+) Over 5.0
Signs & Symptoms
LOW BP - TICKING TIME BOMB
BIG BP, Infections, Wt, Hair, Belly, Brittle Bones
A • ADDED Tan
“Bronze pigmentation” “hyper pigmentation”
A • ADDED Potassium
“Hyperkalemia” Over 5.0 (normal 3.5–5.0)
D • DECREASE Weight (Water loss = weight loss) HIGH BP
NOT TRUNCAL OBESITY
C • CUSHION
D • DECREASED BP, hair, sugar & energy
“fatigue” “alopecia” “hypoglycemia” TRUNCAL Obesity + Moon Face +
“hypotension" Buffalo hump
S • SODIUM loss 135 or LESS U • UNUSUAL HAIR Growth
(135–145 normal) *NOT hairy NOT “Hirsutism” = hair suit & “Hirsutism” (hairy suit)
S • SALT craving *NOT thin skin is cushings
S • SKIN
“Purple Striae” “butterfly mark”
Treatment
H • HIGH Sugar, BP, Weight
A • Add Steroids “-sone” Prednisone)
Increase the Dose during Stress, Surgery, Sepsis
D • Diet HIGH in Protein, Carbs & Sodium
Treatment
D • Don’t “Abruptly” STOP Steroids! (Crisis)
D • Don’t believe this medication will cure you SURGERY Cut out Tumor REmove organ = REplace Steroids
I • Indefinitely: “Lifelong” hormone replacement SLOWLY decrease Steroids “taper off gradually”
ADDisonian "Adrenal" Crisis
Caution: No Steroids = DEATH!
A • Addisonian Crisis NCLEX Question
D • Drop in BP 89/40 LESS (Normal: 120/80) Which clinical manifestation(s) would be observed in a patient with Cushing syndrome?
Select all that apply:
1ST NURSE ACTION 1. Easy bruising
2. Increased blood glucose
4. Increased potassium
5. Increased abdominal girth
3. Increased blood pressure 4. Decreased weight
ADD steroids (IV push)
“-sone” hydrocortisone prednisone
