1. Addison’s Disease
Arielle Howard
Ariel Baker
Brittany Martin

2. O PATHOPHYSIOLOGY
• A chronic condition that results from the
partial or complete destruction of the
adrenal cortex
• Causes deficiencies of the adrenocortical
secretions: glucocorticoids, sex hormones,
and mineral corticoids
 Cortisol, Aldosterone, Androgens and
Estrogens

3. Prevalence and Risk Factors
O Addison’s disease is
rare
O 1/100,000 people
O Effects all age groups
(More common between
ages 30 – 50)
O More prevalent in
women but can effect
men as well
O Primary Adrenal insuff.
O Idiopathic Autoimmune
Dysfunction (majority)
O Tuberculosis
O HIV, Cancer
O Adrenalectomy
O Fungal Infections
O Secondary Adrenal insuff.
O Steroid withdrawal
O Hypophysectomy
O Pituitary neoplasm

4. CLINICAL FINDINGS
Subjective Objective
O Fatigue
O Muscle weakness
O Muscle/joint pain
O Salt craving
O Nausea
O Anorexia
(decrease in
appetite)
O Irritability
O Hyperpigmentation
O Hypotension
O Hypoglycemia
O Hyperkalemia
O Vomiting
O Diarrhea
O Mouth lesions
O Decrease in body
hair

6. O CORTISONE
• Action: Inhibits multiple inflammatory cytokines;
produces multiple glucocorticoid and mineral
corticoid effects.
• Adrenal insufficiency: 25-300mg PO QD-QOD
• Major side effects: Circulatory collapse,
thrombophlebitis, embolism, necrotizing angiitis,
CHF, GI hemorrhage, pancreatitis,
thrombocytopenia
• Nursing Considerations: Monitor BP; weight;
2hr postprandial glucose; chest x-ray if prolonged
tx; Electrolytes (k+); I&O ratio (decreasing output
and increasing edema); Plasma cortisol levels
(norm: 6-23mcg/dL); signs of infection (drug
masks infection); cardiac symptoms (edema,
HTN)

8. Nursing Diagnosis
/Considerations
O Electrolyte Imbalance r/t
vomiting and diarrhea
AEB hyperkalemia and
hyponatremia
O Imbalanced nutrition: less
than body requirements r/t
anorexia AEB 20%
decrease in weight and
inadequate food intake
O Monitor patient frequently for
dysrhythmias
O administer NaCl IV to increase
sodium
O Administer Insulin or
Kayexalate
O Administer an antiemetic as
tolerated by the patient
O Provide high calorie snacks
and finger foods
O Daily weight
O Nutritional supplements

9. Patient Education
O Increase salt intake during hot weather and heavy
exercise
O Never skip a dose. This could lead to an
Addisonian crisis
O Learn to recognize the symptoms of an Addisonian
crisis. Ex: pain in lower back, severe vomiting and
diarrhea , extreme weakness, fainting. Contact
physician immediately.
O Wear Med alert tag
O Frequently monitor weight
O Reframe from stressful activities

10. Pertinent Nursing
•Monitor for fluid deficits and hypernatremia
•Monitor and treat hyperkalemia
 Obtain serum potassium and ECG
 Administer sodium polystyrene sulfonate
(Kayexalate), insulin, calcium, glucose, and sodium
bicarbonate
• Monitor and treat hypoglycemia
 Perform frequent neurologic checks, monitor for S/S of
hypoglycemia, and check serum glucose
 Administer food and/or supplemental glucose
• Maintain a safe environment
 Provide assistance ambulating, raise side rails and prevent falls by
keeping floors clear

11. Addison’s Pictures

13. N-Clex Question
O A nurse is reviewing serum laboratory
results for a client who has Addison’s
disease. Which of the following
findings should the nurse expect?
 Soduim 130mEg/L
 Potassium 5.1 mEg/L
 Calcium 10.6 mEg/L
 Magnesium 2.5 Meg/L
 Glucose 65mg/dL
 Phosphorus 2.4 mg/dL

14. N-Clex Answer
O Sodium 130 (135-145)
O Potassium 5.1 (3.5-5.0)
O Calcium 10.6 (8.0-10.5)
O Glucose 65 (70-110)

15. References
O Lewis, S. M. (2011). Medical-surgical
nursing: Assessment and management of
clinical problems. St. Louis, Mo:
Elsevier/Mosby
O ATI RN Medical Surgical Nursing Edition
8.0 (Chapter 94)
O www.cdc.gov
O http://jama.jamanetwork.com/article.aspx?
articleid=201884