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ADDISON’S DISEASE |
CUSHING’S DISEASE |
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Definition
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Hyposecretion of adrenocortical hormones leading to:
- Metabolic disturbances (sugar)
- Fluid and electrolyte imbalances (salt)
- Deficiency of neuromuscular function (salt and sex)
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Hypersecretion of adrenocortical hormone |
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Predisposing Factors
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- Atrophy of the Adrenal gland
- Fungal infections
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- Hyperplasia of Adrenal gland
- Tubercular infection (MILIARY – TB to adjacent organs)
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| Signs and
Symptoms
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- hypoglycemia (TIRED)
- Tremors and tachycardia
- Irritability
- Restlessness
- Extreme fatigue
- Diaphoresis and depression
- Decreased tolerance to stress (d/t decreased cortisol) à Addisonian Crisis
- Hyponatremia
- Hypotension
- Signs of dehydration
- Weight loss
- Hyperkalemia
- Irritability and agitation
- Diarrhea
- Arrhythmias
- Decreased Libido
- Loss of pubic and axillary hair
- Bronze-like skin pigmentation d/t decreased cortisolà stimulation of MSH from pituitary gland
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- Hyperglycemia à can lead to DM
- Polyuria
- Polydipsia
- Polyphagia
- Wt. Gain
- Glucosuria
- Increased susceptibility to infection (Reverse isolation!)
- Hypernatremia
- HPN
- Edema
- Wt. gain
- Moonface appearance, buffalo hump, obese trunk, pendulous abdomen, thin extremities
- Hypokalemia
- Weakness and fatigue
- Constipation
- U wave on ECG tracing
- Hirsutism
- Easy brusing
- Acne and Striae
- increased masculinity in females
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| Diagnostics |
- FBS decreased (N= 80-120 mg/dl)
- Serum Na decreased (N= 135-145)
- Serum K elevated (N=3.5-5.5meq/L)
- Plasma cortisol decreased
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- FBS elevated
- Elevated Na
- Decreased K
- Elevated Cortisol
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Nursing
Management
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- Monitor strictly VS, IO to determine presence of Addisonian crisis which results from acute exacerbation of Addison’s disease characterized by:
- Hyponatremia
- Hypovolemia
- Dehydration
- Severe Hypotension
- Weight lossà Which may lead to progressive stupor à coma.
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- Assist in mech vent, steroids as ordered, forced fluids
- Administer medications as ordered
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- Universal rule: administer 2/3 dose in AM and 1/3 dose in PM to mimic the N diurnal rhythm of the body
- Taper the dose. Withdraw gradually from the drug
- Monitor SE: Cushingoid Sx
- HPN, Increased susceptibility to infection, Weight gain, Hirsutism, Moon face appearance
- Ex: Hydrocortisone, Dexamethasone, Prednisone
- Mineralocorticoids – fluorocortisone
- Forced fluids
- Maintain patent IV line
- Diet: high CHO/calories, Na and CHON, low K
- Meticulous skin care
- Provide health teaching and d/c planning
- Avoidance of precipitating factors leading to addisonian crisis:
- Stress, Infection, Sudden withdrawal to steroids
- Prevent Complications – hypovolemic shock
- Hormonal replacement therapy for life
- Importance of ffup care
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- Monitor IO, VS
- Restrict Na and Fluids
- Weigh pt. daily and assess for pitting edema (ANASARCA – generalized edemaà nephritic syndrome)
- Measure abdominal girth daily, notify MD
- Diet: low CHO, NA, High CHON and K
- Administer medications as ordered
- K-sparing diuretics – Spironolactone (Aldactone); excretes sodium but retains potassium
- Prevent Complications – DM
- Provides meticulous skin care
- Assist in Surgical Procedure – Bilateral Adrenalectomy
- Hormonal replacement for life
- Importance of ffup care
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