ADRENOCORTICAL INSUFFICIENCY

[Addison’s Disease]

Pathophysiology

Cortecosteroid Inadequate
and sudden Autoimmune Surgical secretion of
cessation of disorder, Idiopathic removal of ACTH from the
exogenous atrophy, TB and adrenal glands pituitary gland
adrenocortical histoplasmosis
hormonal
therapy

Inadequate adrenal cortex

function

Adrenocortical Insufficiency

Signs and Symptoms

• Muscle weakness
• Anorexia
• Gastrointestinal symptoms
• Fatigue
• Emaciation
• Dark pigmentation of skin, knuckles, knees, elbows, and mucous
membranes
• Hypotension
• Low blood glucose levels
• Low serum sodium levels
• High serum potassium levels
• Mental status changes
 • Depression
• Emotional lability
• Apathy
• Confusion

• Addisonian crisis
• Cyanosis
• Classic signs of circulatory shock:
 Pallor
 Apprehension
 Rapid and weak pulse (Tachycardia)
 Tachypnea
 Hypotension

Assessment and Diagnostic Findings

• Laboratory findings:
• Hypoglycemia
• Hyponatremia
• Hyperkalemia
• Leukosytosis
• Low level of adrenocortical hormones in blood or urine and
decreased serum cortisol levels

Medical Management
1. Prevent circulatory shock
a. Restore blood circulation
b. Administer fluids and corticosteroids
c. Monitor vital signs
d. Place the patient in a recumbent position with legs
elevate
e. Administer hydrocortisone (Solu-Cortef) intravenously
followed by 5% dextrose in normal saline
f. Vasopressor amines – if hypotension persists
g. Antibiotics – if infection occurs

Nursing Management
a. Vital signs monitoring
b. Assess skin color and turgor
c. Assess history of weight changes, muscle weakness, and
fatique
d. Ask about onset of illness
e. Restore fluid balance
 Addison’s Cushing’s Syndrome
Disease
Sugar Hypoglycemia Hyperglycemia
Salt Hyponatremia Hypernatremia
Sex Decreased libido Sexual urge not merely
affected
Potassium Hyperkalemia Hypokalemia
Physical Not seen, more on Buffalo hump, moonface,
appearance symptoms pitting edema, hirsutism,
breast atrophy, purple striae on
abdomen, easy bruising, facial
flushing, acne,
hyperpigmentation
Diet High Na, CHON, CHO Low Na, CHO, fats but high
intake except K CHON and K intake

DKA (Diabetic HHNS (Hyperglycemic

Ketoacidosis) Hyperosmolar Nonketotic
Syndrome)
Acute complication of type1 DM Hyperglycemia w/o ketosis is
due to severe hyperglycemia, commonly on DM type2
leading to CNS depression & coma
Polyuria, Polydipsia, Polyphagia, Hypotension, extreme thirst,
Glycosuria, Pathognomonic dehydration, tachycardia,
Sx: hypokalemia, hyponatremia
>acetone breath– fruity odor
>kussmul’s respiration– rapid,
shallow breathing
Mx: monitor VS; I/O Tx: give insulin, inc. fluid
Meds: Insulin therapy (IV),
counteract acidosis – Na HCO3
Hyperthyroidism (Thyroid Hypothyroidism
Crisis) (Myxedema Coma)
Grave’s Disease; inc. amt. of Dec. T3T4; causes in adult –
T3&T4 myxedema, child cretinism
Inc. appetite – wt. loss due to inc. Dec. appetite – wt. gain due to
metabolism, heat intolerance, all decreased. metabolism, all VS
VS increase, exopthalmos- decrease, decreased menstruation
pathognomonic symptom,
amenorrhea
Inc. caloric diet; watch out for Dec. caloric diet, force fluid
thyrotoxicosis (triad):
a. Tachycardia
b. Hyperthermia
c. agitation
Meds: SSKI (Lugol’s solution), PTU Meds: Levothyroxin (T4) synthroid
prophylthiuracil