1. Adult Medical-Surgical Nursing Endocrine Module: Adrenal Cortex Hyposecretion: Addison’s Disease

2. Addison’s Disease: Aetiology  Idiopathic auto-immune condition (gradual onset and development)  Post-adrenal surgery  Post-pituitary surgery  Abrupt or premature discontinuation of steroid therapy: (steroid therapy atrophies gland and suppresses normal adrenal cortical secretion)  TB

3. Addison’s Disease: Pathophysiology  Hyposecretion of Corticosteroids:  Hypotension  Hypoglycaemia  Reduced cellular metabolism ( ↓ energy)  Hyposecretion of Aldosterone:  Hyponatraemia  Dehydration  Hyperkalaemia

4. Addison’s Disease: Clinical Manifestations  Depression, apathy, confusion  Muscular weakness, fatigue  Hypoglycaemia, emaciation, anorexia  Dehydration (hyponatraemia)  Hypotension ( ↓ sympathetic stimulation)  GI symptoms: nausea, cramps, diarrhoea, headache ( ↑ K)  Dark skin pigment over joints

5. Addison’s Disease: Diagnosis  Patient history and clinical picture  Hypoglycaemia  Hyponatraemia  Hyperkalaemia  Leukocytosis (neutrophils)  Blood and urine cortisol (low)  ACTH present in blood/ urine to differentiate from pituitary insufficiency; trial of response to ACTH

6. Addison’s Disease: Addisonian Crisis  Occurrence:  A patient with Addison’s disease when subject to stress, fatigue, infection, exposure to cold, fasting  A patient on steroid therapy if rapid withdrawal

7. Addisonian Crisis: Clinical Manifestations  Circulatory collapse and hypotension  Hypovolaemic shock, severe dehydration  Hyperkalaemia → dysrhythmias, rapid, thready pulse  Tachypnoea, cyanosis, pallor, fever  Hypoglycaemia → apprehension, mental apathy, restlessness → coma → death

8. Addisonian Crisis: Management  ICU: emergency treatment of shock  Raise foot of bed  IV fluids (Dextrose 5%/ Saline 0.45%)  *IV Hydrocortisone*  IV vasopressor amines (Dopamine infusion)  IV antibiotics if infection triggered crisis

9. Addisonian Crisis: Nursing Considerations  Strict monitoring of vital signs  BP supine and erect (as able) to assess sympathetic activity  Hourly intake/ output (watch for acute renal failure)  Observe skin turgor  Monitor IV fluids  Care and support to patient and family

10. Addison’s Disease: Longterm Treatment  Lifelong corticosteroid therapy/ Aldosterone  Monitor clinical response/ blood cortisol  ↑ steroids in illness, stress, surgery or dizziness (postural hypotension)  Early antibiotics if infection  Extra salt if vomiting, diarrhoea  Quiet lifestyle, avoid ↑ exercise, stress  Regular screen: DM, osteoporosis, cataract, glaucoma

11. Addison’s Disease: Long-term Nursing Considerations  Patient awareness about steroid therapy:  Do not miss dose; never stop abruptly  Consult doctor at once if ill or vomiting  Advise carefully about extra requirements in stress (and early antibiotics)  Diet: ↓ fat, simple CHO; ↑ protein, calcium  Attend for regular screening (BP, cortisol, blood glucose, eye exam, bone density)  Low-impact exercise; adequate rest/ sleep