ADDISON’S DISEASE

INTRODUCTION
• Addison's disease is a rare disorder of the adrenal
glands that affects around 1 in 40,000 people in
the UK. The adrenal glands are small, hat-shaped
glands that sit on top of the kidneys, high up
inside the back of the abdominal wall.

• The adrenal glands produce hormones that

control blood pressure, help fight off infections,
and maintain salt and water balance in the body.
There are two adrenal glands, the inner and outer,
which perform separate functions:
The inner area, called the medulla, produces the
hormone adrenaline, and passes it into the
bloodstream. Adrenaline increases the action of
the heart and speeds up metabolism, preparing
the body for shock.
The outer layer, called the cortex, produces
steroid hormones. One of the steroids it produces
is cortisol, which increases the supply of glucose
in the blood. Along with adrenaline, cortisol acts
to help the body cope with stress. Over-
production of cortisol can be harmful to the
immune system. The cortex also produces a
steroid called aldosterone. Aldosterone helps to
maintain blood pressure by keeping sodium (salt)
levels up in the blood. The adrenal cortex also
produces small amounts of the male and female
sex hormones testosterone and oestrogen
• Addison's disease is an endocrine or hormonal
disorder that occurs in all age groups and afflicts
men and women equally. The disease is
characterized by weight loss, muscle weakness,
fatigue, low blood pressure, and sometimes
darkening of the skin in both exposed and
nonexposed parts of the body.

• Addison's disease occurs when the adrenal

glands do not produce enough of the hormone
cortisol and, in some cases, the hormone
aldosterone. The disease is also called adrenal
insufficiency, or hypocortisolism.
 ANATOMY
&
PHYSIOLOGY
• Adrenal cortex : yellowish coloured tissue
forming the outer layer of adrenal.
 Adrenal cortex secrets
3 types of hormones:

1. Glucocorticoids Hormone
2 types : a) Cortisol or hidrocortison
b) Corticosteron

Secretion of glucocorticoid hormone is stimulated by

ACTH hormone from the anterior lobus of the
pituitary gland.
Functions :
^ Formation of new sugar from protein
and fat (gluconeogenesis).
^ Break down fat as source of energy (lypolisis).
^ Stimulate the break down of protein
(catabolism) to form new protein.
^ Stimulate the reabsorbtion of sodium and
water at the renal tubules.
2. Mineralocorticoid Hormone (aldostrone)

Secretion of mineralocorticoid hormone is control

by the potassium level in the blood (more potassium
the secretion aldostrone is more high) and the
action of renin angiotensin- aldostrone system.
Functions :
^ Stimulate the reabsorbtion of sodium
in the renal tubules.
^ Control the secretion potassium in the
uric.
^ Control the balancing of the water in the
body and to control the blood pressure.
3. Androgen (Sex Hormone)

The hormone sex that produce is

androgen which is the hormone sex
for male.
Functions :
^ To influence the puberty process.
DEFINITION
 Definitions of Addison's Disease
on the Web:
• A destructive disease marked by weakness, loss of
weight, low blood pressure, gastrointestinal
disturbances,and brownish pigmentation of the
skin ...
www.allencountyky.com/info/Old_Disease.html

• Disease syndrome caused by abnormally low levels

of cortisol in the body. This life-threatening
condition may be unintentionally induced by
abruptly discontinuing oral steroid administration,
or by the misuse of Cushing's Disease medication.
www.muelleranimalhospital.com/glossary.htm
• A disease marked by the atrophy or destruction of
the adrenal cortex. Most cases of Addison's
disease appear to involve an autoimmune
process.
counsellingresource.com/distress/chronic/cfs/glos
sary.html

• A disease caused by the failure of the adrenal

glands to secrete the adrenocortical hormones,
because the adrenal cortex has been damaged.
This damage commonly used to be caused by
tuberculosis but now it may more often result from
disturbances in the immune system. ...
www.diabetescaretreatment.com/diabetes-
glossary-terms.html
• A condition that occurs when the adrenal
glands (a pair of glands situated on top of
the kidneys) fail to secrete enough
corticosteroid hormones. Without treatment,
the disease can be fatal.
www.allhairloss.com/hair-loss/hair-loss-
glossary.php

• Caused by a deficiency of adrenal cortex

hormones.Symptoms include weight loss,
fatigue and vomiting.
www.dog-breeds.net/Health_Dictionary.htm
TYPES AND EACH
CAUSES
 Primary Adrenal
Insufficiency

• Most cases are caused by the gradual

destruction of the adrenal cortex, the outer layer
of the adrenal glands, by the body's own immune
system.
 Other Causes
Less common causes of primary adrenal
insufficiency are :

• chronic infection, mainly fungal infections

• cancer cells spreading from other parts of the body to the
adrenal glands
• amyloidosis
• surgical removal of the adrenal glands
 Secondary Adrenal
Insufficiency
• This form of adrenal insufficiency is much more common
than primary adrenal insufficiency and can be traced to a
lack of ACTH. Without ACTH to stimulate the adrenals, the
adrenal glands' production of cortisol drops, but not
aldosterone .
• Another cause of secondary adrenal
insufficiency is the surgical removal
of benign, or noncancerous, ACTH-
producing tumors of the pituitary
gland .
• Less commonly, adrenal insufficiency
occurs when the pituitary gland either
decreases in size or stops producing ACTH.
These events can result from:
^ tumors or infections of the area
^ loss of blood flow to the pituitary
^ radiation for the treatment of pituitary tumors
^ surgical removal of parts of the hypothalamus
^ surgical removal of the pituitary gland
 CLINICAL
MANIFESTATION
^ The symptoms of adrenal insufficiency
usually begin gradually. Characteristics of
the disease are :
• chronic, worsening fatigue
• muscle weakness
• loss of appetite
• weight loss
About 50 percent of the time, one will
notice :

• nausea
• vomiting
• diarrhea
^ Other symptoms include
• low blood pressure that falls
further when standing, causing
dizziness or fainting.
• skin changes in Addison's disease, with
areas of hyperpigmentation, or dark tanning,
covering exposed and nonexposed parts of
the body; this darkening of the skin is most
visible on scars; skin folds; pressure points
such as the elbows, knees, knuckles, and
toes; lips; and mucous membranes
COMPLICATION
Complications may result from the
following associated illnesses:
• Diabetes
• Thyrotoxicosis
• Hashimoto's thyroiditis (chronic thyroiditis)
• Hypoparathyroidism
• Pernicious anemia
• Ovarian hypofunction or testicular failure
DIAGNOSIS
 ACTH Stimulation Test

• This is the most specific test for diagnosing Addison's

disease. In this test, blood cortisol, urine cortisol, or both
are measured before and after a synthetic form of ACTH is
given by injection. In the so-called short, or rapid, ACTH
test, measurement of cortisol in blood is repeated 30 to 60
minutes after an intravenous ACTH injection.

• The normal response after an injection of ACTH is a rise in

blood and urine cortisol levels. Patients with either form of
adrenal insufficiency respond poorly or do not respond at
all.
 CRH Stimulation Test
• When the response to the short ACTH test is abnormal, a
"long" CRH stimulation test is required to determine the
cause of adrenal insufficiency.

• In this test, synthetic CRH is injected intravenously and

blood cortisol is measured before and 30, 60, 90, and 120
minutes after the injection.

• Patients with primary adrenal insufficiency have high

ACTHs but do not produce cortisol. Patients with
secondary adrenal insufficiency have deficient cortisol
responses but absent or delayed ACTH responses. Absent
ACTH response points to the pituitary as the cause; a
delayed ACTH response points to the hypothalamus as the
cause.
• In patients suspected of having an addisonian crisis, the
doctor must begin treatment with injections of salt, fluids,
and glucocorticoid hormones immediately.

• Although a reliable diagnosis is not possible while the

patient is being treated for the crisis, measurement of
blood ACTH and cortisol during the crisis and before
glucocorticoids are given is enough to make the diagnosis.

• Once the crisis is controlled and medication has been

stopped, the doctor will delay further testing for up to 1
month to obtain an accurate diagnosis.
Other Tests
• Once a diagnosis of primary adrenal insufficiency has been
made, x-ray exams of the abdomen may be taken to see if
the adrenals have any signs of calcium deposits. Calcium
deposits may indicate TB. A tuberculin skin test also may
be used.

• If secondary adrenal insufficiency is the cause, doctors

may use different imaging tools to reveal the size and
shape of the pituitary gland. The most common is the CT
scan, which produces a series of x-ray pictures giving a
cross-sectional image of a body part. The function of the
pituitary and its ability to produce other hormones also are
tested.
MEDICATION
• MEDICATION :

Solu-cortef
Cortone Acetate
Prednisone
Dexamethasone
Florinef Acetate
 Solu-cortef
Group : Corticosteroid Hormones
Indication :
Anti-inflammatory, Anti-allergic,
Anti-toxic, to replace steroids in
conditions of adrenal insufficiency.
Side effect :
Fluid and electrolyte disturbances,
impaired wound healing, thin fragile skin,
muscle weakness.
Dosage : 20 mg
Route : Oral
 Cortone Acetate
Group : Corticosteroid Hormone
Indication :
Reducing swelling, inflammation and
irritation, also used to treat steroid
deficiency in the body.
Side effect :
Indigestion,increased appetite, decreased
blurred vision, dizziness,increase
sweating,frequent urination.
Dosage : 25 – 30 mg
Route : Oral
 Prednisone
Group : Corticosteroid Hormone
Indication :
As replacement therapy in patient
whose adrenal gland are unable to
produce sufficient amounts of
cortisol.
Side effect :
Retention of sodium and fluid,weight gain,
high blood pressure,headache,and muscle
weakness.
Dosage : 5 – 60mg
Route : Oral
 Dexamethasone
Group : Corticosteroid Hormone
Indication :
Suppression of inflammatory and
allergic disorder.
Side effect :
Thromboembolism, gastric and
intestinal ulcers/bleeding.
Dosage : 4mg
Route : Oral
 Florinef Acetate
Group : Corticosteroid Hormone
Indication :
Adrenal hyperplasia.
Side effect :
Weakness, purpura,osteoporosis,
headache,vertigo.
Dosage : 1 tab
Route : Oral
NURSING CARE PLAN
1. Knowledge Deficit Related To Disease Process
( chronic adrenal cortex insufficiency ) and
treatment of the disease.

2. Fluid volume deficit related to hypovolemia

secondary to adrenal insufficiency.
NURSING CARE PLAN
1
 Knowledge Deficit Related To Disease Process
( chronic adrenal cortex insufficiency ) and treatment
of the disease.

• Supporting Data: Patient keep on asking question

regarding his/her disease process and type of
treatment.

• Goal: Patient’s level of knowledge will be improved

after nursing intervention given and during
hospitalization with evidence patient have better
understanding regarding his/her disease and related
treatment.
 Nursing intervention:

1. Assess patient’s level of knowledge regarding

his/her disease process and the treatment by
asking simple question such as causes of
disease.
® As a baseline data and to plan appropriate
intervention.

2. Reinforce doctor’s explanation regarding

disease process and treatment such as causes
of the disease, related sign and symptom and
treatment that will be implemented to patient in
simple words.
® To make patient more understand.
3. Provide explanation of adrenal cortex’s function
in the body and explain about consequences of
adrenal cortex insufficiency according to
patient’s level of understanding.
® To make patient able to relate the sign and
symptom of the disease that he/she experienced
as the consequences of adrenal cortex
insufficiency.

4. Encourage patient to ask question regarding

his/her disease and treatment provided.
® To increase his/her knowledge.
5. Review dietary/restriction especially in sodium
intake.
® Some patient may experience cravings for salty
foods due to excessive urinary losses of sodium.

6. Advice patient to discuss all medication and

herbal supplement with consultant before
consuming.
® To prevent further complication.

7. Assist patient identify ways to incorporate

changes related to illness and its treatment into
lifestyles.
® Patient can see that his/her life does not have to
revolve around the disease.
8. Provide pamphlets and magazines regarding to
patient’s disease.
® For extra information that can be used for further
clarification at home.

9. Encourage patient to attend follow up and

treatment as scheduled.
® For further medical management.
Evaluation:
• Patient’s level of knowledge had been improved after
nursing intervention given and during hospitalization.

Supporting Data:
• Patient able to understand regarding his/her disease
process and treatment.
NURSING CARE PLAN
2
Fluid volume deficit related to hypovolemia
secondary to adrenal insufficiency.

• Supporting Data:
Patient having dry mucous membrane.
Sunken eye balls.
Poor skin turgor.

• Goal: Patient ‘s fluid volume will be normal within 24

hours after nursing intervention given and during
hospitalization.
 Nursing intervention:
1. Assess patient general condition such as dry
mucous membrane,sunken eye balls and poor
skin turgor.
® As a baseline data and for plan further
interventions.

2. Monitor vital signs such as blood pressure and

pulse every 4 hourly.
® Fluid volume deficit may lead hypotension and
weak pulse.

3. Administer intravenous infusion such as

dextrose saline.
® To replace fluid and electrolyte in the body.
4. Weight patient daily at the same of time,scale
and type of clothing.
® To detect dehydration(manifested by weight loss)

5. Encourage fluid intake 1.5-2.0 liters per day.

® To replace the fluid loss and maintain the fluid
volume.

6. Monitor intake and output chart every shift.

® To maintain fluid and electrolyte in the body.
7. Teach patient’s to sit and stand slowly
and provide assistance as necessary.
® Extracellular fluid volume deficit cause
hypotension,dizziness and possible loss
of consciousness.This increase the risk
of injury from fall.

8. Inform doctor if patient’s condition still

persist.
® For further treatment.
Evaluation:
• Patient’s fluid volume become to normal level
with evidence moist mucous membrane and no
more sunken eye balls.

Supporting Data:
1. Intake and output chart shows
2. balance amount.
THANK YOU….
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Question?