Emergency Care: Addisonian Crisis & Adrenal Insufficiency

Addisonian Crisis
Addisonian Crisis is an acute exacerbation of symptoms in someone with Addisons disease (namely adrenal insufficiency) Whereas Cushings syndrome is seen in patients with excess corticosteroids, Addisons disease is seen in someone with a deficiency in corticosteroids.

Addisons Disease
Much like Thyroid disease, Addisons disease is failure of some aspect the complex system of hormones and feedback loops Also, like Thyroid disease, there may be dysfunction as these hormones and messengers interact with the hypothalamus, pituitary and the site of hormone release (in this case the adrenal glands)

The Adrenal Gland releases

Adrenal Function Summary

Androgens (sex hormones) Mineralocorticoids Glucocorticoids Glucocortoicoids Mineralcorticoids (most potent is cortisol) (Aldosterone) Action: anti-inflammatory, Action: Manages growth suppressing, sodium/potassium balance affects sleep patterns & awareness, stress response

Connecting the dots

Addisons Disease
Addisons disease can be a lack of all three hormones or just glucocorticoids and androgren Caused by: Destruction of the adrenal glands by infection Autoimmune attack Mutation in the ACTH receptor on adrenal cells

Addisonian Crisis
Triggered by anything that increases the persons normal stress level: surgery, infection, emotional trauma, physical trauma as well as sudden withdrawal from sterioids or postadrenalectomy The body is unable to release sufficient cortisol to respond appropriately Result is: Hypotension, tachycardia, dehydration, hypoglycemia, hyponatremia, hyperkalemia, fever, weakness & confusion May lead to shock & vascular collapse

Worksheet

Review the provided education sheet from the Addisons Disease Self-Help Group http://www.adshg.org.uk/info/manual/crisisman Review the last three slides Fill in your worksheet

Addisonian Crisis: Education/Nursing Care

Prevention through careful titration of steroids Steroid coverage for stressful events (i.e. preoperatively, hot weather, flu, etc.) Patient, family, friends aware of signs/symptoms of crisis Wallet card/med alert bracelet explaining condition, medications, and how to respond in an emergency

Addisonian Crisis: Education/Nursing Care

Treatment focuses on getting patient the cortisol they need to have their body respond appropriately (PO, IV, IM routes) Patient should always carry emergency dose, usually 100mg IM hydrocortisone Return demonstration with normal saline before discharge

Highly Recommended !!!

Review Corticosteroid Therapy on pp. 1332-1334 Probably dont remember the information from when you were in Pharm Will help you on test and on NCLEX Key information in caring for patients who are taking corticosteroids