Addison’s Disease
Primary adrenal insufficiency with deficient cortisol and aldosterone
Definition
Addison’s disease is a chronic endocrine disorder caused by autoimmune or infectious destruction of the adrenal cortex, leading to insufficient production of cortisol and aldosterone. It contrasts with Cushing’s syndrome, which involves cortisol excess.
Signs and Symptoms
- Fatigue, weakness, weight loss
- Hyperpigmentation ('bronze' skin) of sun-exposed areas and gums
- Hypotension and orthostatic hypotension
- Hyperkalemia and hyponatremia
- Salt craving, nausea, vomiting
- Hypoglycemia
Addisonian Crisis
A life-threatening emergency triggered by stress, illness, trauma, or abrupt steroid withdrawal, such as presents with severe hypotension, shock, hyperkalemia, and possible cardiovascular collapse. Immediate IV hydrocortisone, fluids (0.9% NaCl with D5), and electrolyte correction are required.
Nursing Considerations
Lifelong glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone) replacement. Teach patients to double or triple their dose during illness, surgery, or intense stress ('stress dose'). Instruct never to abruptly stop steroids and to wear medical alert identification.
NCLEX Relevance
Classic electrolyte pattern: high potassium, low sodium, low glucose. Recognize addisonian crisis as a priority emergency.