Conclusion

Addison's disease is caused by either a partial or complete failure of the outer layer of a
person's adrenal glands, which produce hormones that control a number of bodily
functions. The disease involves a chronic deficiency of cortisol, aldosterone, and adrenal
androgens. When a person's body is deficient in these hormones they may experience low
levels of salt and high levels of potassium which cause an electrolyte imbalance in their
body.

Addison's disease affects people from all age groups, as well as both men and women.
Addison's disease is often characterized by muscle weakness, fatigue, weight loss, low
blood pressure, and on occasion by a darkening of the person's skin. Addison's disease
happens when a person's adrenal glands do not produce enough cortisol, or in some cases
enough aldosterone. The disease is sometimes referred to as, 'Chronic Adrenal
Insufficiency.' Cortisol is a hormone that affects nearly every organ and tissue in a
person's body.

The most important job cortisol has is to help a person respond to stress; it also assists in
maintaining cardiovascular function, blood pressure, and in slowing a person's immune
system's inflammatory response. Cortisol balances the effects of insulin in breaking down
sugars for energy, regulation of metabolism of proteins, carbohydrates, and fats. The
hypothalamus and pituitary gland regulate cortisol. In fact; one of the main functions of
the pituitary gland is to secrete Adrenocorticotropin (ACTH) – a hormone which
stimulates a person's adrenal glands.

A person's adrenal glands are located right above their kidneys, producing the cortisol
and other hormones called, 'Corticosteroids,' that they need. Some of these corticosteroid
hormones are essential for life. Addison's disease commonly occurs in persons between
the ages of thirty and fifty years, although it can affect people of any age or sex.
The treatment of Addison's disease involves using a combination of glucocorticoids and
mineralocorticoids to replace the ones the person's body is not producing. Cortisol is
replaced with Hydrocortisone tablets that can be taken once or twice each day. If the
person is also experiencing an aldosterone deficiency, they can take a mineralocorticoid
called, 'Fludrocorisone,' once each day. Persons taking Fludrocorisone are many times
advised by their doctor to increase the amount of salt they take in. Persons affected by
secondary adrenal insufficiency usually continue to produce the amount of aldosterone
they need. The amount of these medications are adjusted in order to meet the
requirements of individuals.
People who are experiencing an Addison's crisis accompanied by low blood sugar, low
blood pressure, and high levels of potassium are at great risk of life. Doctors commonly
treat an Addison's crisis with injections of hydrocortisone, saline, and dextrose,
producing quick improvement in the person involved. Once the person can drink fluids
and take oral medications, the amount of hydrocortisone they take is decreased until they
reach a maintenance dose. If they require fludrocortisone, this medication level is
achieved as well.
Doctors are not able to make a reliable diagnosis of Addison's disease while a person is
being treated for an Addison's crisis. A doctor can; however, measure the person's blood
ACTH and cortisol both during the crisis and prior to administration of any
glucocorticoids. These measurements are usually enough to make a diagnosis. Once the
crisis is over and medication related to it have ceased, a doctor commonly waits for up to
a month in order to make an accurate diagnosis.
Recommendation

From the case presented in this study, the researchers have formulated with the
recommendations to the following:

• To the health care providers. Patients should be evaluated annually to judge

adequacy of glucocorticoid and mineralocorticoid replacement. Annual laboratory
examination should include plasma renin activity and potassium levels to monitor
mineralocorticoid replacement.

The nurses should be aware that Glucocorticoid adjustments are made

according to signs and symptoms. Continuance of excessive fatigue and
increasing pigmentation after start of treatment are suggestive of insufficient
glucocorticoid replacement. Conversely, weight gain or facial plethora suggests
glucocorticoid excess.

Mineralocorticoid replacement should be tapered down if the patient

presents with fluid retention, hypertension, decreased renin activity, or
hypokalaemia, and increased if there is presence of postural hypotension,
increased plasma renin activity, or hyperkalemia.

Long-term over-replacement of glucocorticoid may be associated with

decreased bone density. Apparetly, Regular measurements of bone mineral density
are suggested.

• To the Patients with Addison's disease should be instructed to carry a medical

alert (bracelet or card) warning about their condition and what should be done in
case there is loss of consciousness or major trauma, stress, or infection. and
patients are encouraged to be compliant to medical orders that are being made by
health care providers so as to maintain condition and not lead to further
 complications. For proper maintenance, regular visits to a physician are required
to run tests and examinations. There are no specific physical or occupational
restrictions. As long as administered dose replacement medications are taken
everyday, a person suffering from Addison's disease can have normal life
expectancy.

Patients should have syringes with dexamethasone (4 mg) or

hydrocortisone (100 mg). These should be administered in an emergency, and by
family members in case of unconsciousness or major trauma. If available,
prefilled syringes should be provided. Family members may need to receive
training concerning how to administer treatment safely.

Learning Derived

As the researchers studied the case of Addison's Disease, they learned that it is a rare
autoimmune disease of the adrenal gland, the little glands that sit atop each of the kidneys
—that is often misconceived by other student asnurses. With Addison's, the adrenal gland
is unable to produce enough steroid hormones that the body needs to function, also
known as an Adrenal Insufficiency. The initial process of diagnosis might include a 24-
hour urine collection. The urine is then examined for cortisol levels. If the initial test is
inconclusive, further testing might be warranted including adrenal stimulation over time
testing with corresponding blood draws over several hours looking at cortisol levels.

Furthermore, Addison's can develop slowly or can be a sudden, serious attack that is
called as Adrenal Crisis and can happen at any age. The initial symptoms of Addison's
may include fatigue, dizziness, muscle weakness, weight loss, difficulty standing up,
diarrhea, vomiting, headaches, sweating and mood swings.

In addition, Addison's can be a condition on it's own, or can be also part of an underlying
existing condition (secondary condition). Sometimes Addison's can be associated with
tumors, other autoimmune conditions, AIDs, or the overuse or improper use of steroids.
There are some suspicions that Addison's can also be triggered by infection, trauma,
surgery, stress or by patients on Corticosteroids therapy that do not adjust their dose
properly.

While other causes of Addison's may include a rare genetic mutation (Adrenal
Dysgenesis category), and some medications may interfere with the adrenal glands'
ability to produce hormones normally.

Addison's is controllable when diagnosed and treated properly, but there is no cure.