Addison's disease
"What is Addison's disease ?"
Addison's disease is a rare endocrine disorder characterized by a
severe deficiency of hormones produced in the adrenal cortex.
Addison's affects between 1 and 4 in 100,000 people, including
both men and women within all age groups. The disease tends to
become clinically apparent during periods of metabolic stress or
trauma.
Major disruption and illness can occur if the adrenal glands do not
function properly. Cortisol is a glucocorticoid hormone that plays
a vital role in the [Link] mobilizes nutrients, regulates the
metabolism of proteins, fats and carbohydrates, stimulates the
liver to raise blood sugar levels, acts as an anti- inflammatory
agent and helps the body respond to stress.
Addison's Disease can have a severe effect on all of these bodily
systems .
Addison's disease
What Causes Addison’s Disease?
Approximately 70% of cases of Addison’s disease are as
a result of an auto-immune process.
The body’s immune system produces antibodies
against the cells of the adrenal cortex, and slowly
destroys the healthy cells. This is a slow process
evolving over a long period and can take months, even
years, to become clinically apparent
Famous Addisonians
United States President John
F. Kennedy was one of the
best-known Addison's disease
sufferers and her sister Eunice
Kennedy Shriver.
Osama bin-Laden as he
manifests all the key
symptoms.
Addison's disease
ETIOLOGY:
Primary adrenocortical insufficiency (Addison's disease) - destruction and
subsequent hypofunction of the adrenal cortex, usually caused by
autoimmune process
Secondary adrenocortical insufficiency - ACTH deficiency from pituitary
disease or suppression of hypothalamic-pituitary axis by corticosteroid
treatment for nonendocrine disorders causes atrophy of adrenal cortex
Inadequate aldosterone produces disturbances of sodium,potassium, and
water metabolism
Cortisol deficiency produces abnormal fat, protein, and carbohydrate
metabolism: no cortisol during a period of stress can precipitate addisonian
crisis, an exaggerated state of adrenal cortical insufficiency, and can lead to
death.
Addison's disease
RISK FACTORS:
autoimmune disease
bilateral adrenal tuberculosis
adrenal fungal infections
bilateral adrenal hemorrhages due to meningococcal
septicemia, post partum, patient on anticoagulant
therapy
Addison's disease
SIGNS AND SYMPTOMS:
water loss, dehydration and hypovolemia
muscular weakness, fatigue, weight loss
GI Problems-- anorexia, nausea, vomiting, diarrhea,
constipation, abdominal pain.
hypotension, hypoglycemia, low basal metabolic rate,
increased insulin sensitivity.
Mental Changes-- depression, irritability, anxiety,
apprehension caused by hypoglycemia and hypovolemia.
hyperpigmentation (darkening of an area of skin or nails
caused by increased melanin.)
Addison's disease
PATHOGENESIS:
Addison’s disease occurs when more then 90% of adrenal gland tissue is destroyed
(primary Addison’s disease). The destruction can occur due to various causes:
Most frequently, it is due to autoimmune process, when immune system attacks
adrenal glands.
Tuberculosis as a cause of Addison’s disease is more common in developed
countries.
Rarely, adrenal glands can be destroyed by infections, cancer metastasis,
amyloidosis, or hemorrhage. When pituitary gland fails to produce enough ACTH,
adrenal glands are not stimulated to produce Cortisol and a secondary Addison’s
disease develops.
The idiopathic Addison’s disease is an autoimmune disease
Addison's disease
CAUSES:
•Causes of adrenal insufficiency
can be grouped by the way they
cause the adrenals to produce
insufficient cortisol.
•These are adrenal dysgenesis
(the gland has not formed
adequately during development),
impaired steroidogenesis (the
gland is present but is
biochemically unable to produce
cortisol) or adrenal destruction
(disease processes leading to the
gland being damaged).
Addison's disease
MEDICAL MANAGEMENT:
Restoration of normal fluid and electrolyte balance: high sodium, low-potassium
diet and fluids.
Treatment of glucocorticoids deficiency with such agent as hydrocortisone (Cortef)
or prednisone (Orasone). Patients with chronic obstructive pulmonary disease and
heart failure may require preparations with low mineralocorticoid activity, such as
methylprednisolone (Solu-Medrol), to prevent fluid retention.
Mineralocorticoid deficiency is treated with fludrocortisone (Florinef)
Cardiovascular support if indicated.
Imeediate treatment if addisonian (adrenal) crisis or circulatory collapse if
imminent:
a. I.V. sodium chloride solution to replace sodium ions.
b. Hydrocortisone (Cortef)
c. Injection of circulatory stimulants, such as atropine sulfate (Atropine),
calcium chloride (Calcium), epinephrine (Adrenalin).
Diagnosis and treatment of underlying cause of adrenocortical insufficiency or
addisonian crisis (eg, antibiotic therapy to treat infection if this is a factor in crisis)
Addison's disease
Tests and diagnosis
Blood test.
ACTH stimulation test.
Insulin-induced hypoglycemia test.
Imaging tests.
Addison's disease
Nursing Diagnosis
Deficient fluid volume, related to hypovolemia
secondary to adrenal insufficiency
Ineffective tissue perfusion: Peripheral, related to fluid
volume deficit
Anxiety, related to lack of knowledge about the effects
and treatment of adrenal insufficiency
Addison's disease
NURSING INTERVENTION:
Achieving Normal Fluid and Electolyte Imbalance
Assess fluid intake and output and serial daily weights
Monitor vital signs frequently: a drop in BP may
suggest an impending crisis
Monitor results of serum sodium and potassium
Assess skin turgor and mucous membrane for
dehydration
Addison's disease
Protecting well-being
Minimize stressful situation
Protect patient from infection
a. Control patient's contacts so that infectious organisms
b. Protect patients from drafts, dampness, exposure to cold.
c. Prevent overexertion.
d. Use meticulous hand washing and asepsis
Assess comfort and emotional status of the patient
a. Control the temperature of the room to avoid sharp deviations in patients
temperature.
b. Maintain a quiet, peaceful environment, avoid loud talking
and noisy radios.
Observe and report early signs of addisonians crisis (sudden drop in BP, nausea and
vomiting, fever)
Addison's disease
Increasing Activity tolerance
Assist the patient with ADLs.
Provide for periods of rest and activity to avoid
overexertion
Provide for high-calorie, high-protien diet.
