NCM 116
ADDISON’S DISEASE
DEFINITION
• Addison's disease, also called adrenal
insufficiency, is an uncommon disorder
that occurs when the body doesn't
produce enough of certain hormones. In
Addison's disease, adrenal glands
produce too little cortisol and, often, too
little aldosterone
INCIDENCE
● Addison's disease occurs:
● All age groups
● Both sexes
● can be life-threatening.
● tension
● In the United States, Addison's
disease affects 1 in 100,000
people.
● It occurs in both men and women
equally and in all age groups,
● But is most common in the 30-50
year-old age range.
CAUSES: PRIMARY
● In an autoimmune disease, your
body's immune system mistakes
any organ or area of the body for a
virus, bacteria, or another outside
invader
● Other causes of primary adrenal
insufficiency include:
● prolonged administration of
glucocorticoids (e.g. prednisone)
● infections in your body
● cancer and abnormal growths
(tumors)
● certain blood thinners used to
control clotting in the blood
RISK FACTORS
● Cancer
● Take anticoagulants (blood
thinners)
● Have chronic infections like
tuberculosis
● Had surgery to remove any part of
your adrenal gland
● Have an autoimmune disease, like
type 1 diabetes or Graves' disease
SECONDARY
● There are also many other causes
of secondary adrenal insufficiency,
including:
● tumors
● medications
● genetics
● traumatic brain injury
SYMPTOMS
● Extreme fatigue
● Weight loss and decreased
appetite
● Darkening of your skin
(hyperpigmentation)
● Low blood pressure, even fainting
● Salt craving
● Low blood sugar (hypoglycemia)
● Nausea, diarrhea or vomiting
(gastrointestinal symptoms)
● Abdominal pain
● Muscle or joint pains
● Irritability
● Depression or other behavioral
symptoms
● Body hair loss or sexual
dysfunction in women
DIAGNOSIS
● Complete history collection &
Physical examination: perform a
physical exam. Dark patches on
your skin might be a clue for your
doctor to consider testing for
Addison's disease.
● Assess serum electrolyte levels:
potassium and sodium levels.
● Blood tests: These will be done to
measure the levels of sodium,
potassium, cortisol and ACTH in
your blood.
 ● ACTH stimulation test: This tests deficiency of antidiuretic hormone
the adrenal glands' response after (ADH), or vasopressin. Great thirst
you are given a shot of artificial (polydipsia) and large volumes of
ACTH. If the adrenal glands dilute urine characterize the
produce low levels of cortisol after disorder.
the shot, they may not be
functioning properly. Types of DI
● X-rays: These may be done to look A) Central diabetes insipidus
for calcium deposits on the adrenal B) Nephrogenic diabetes insipidus
glands.
● Computed tomography (CT scan): Causes
Computed tomography uses A) Central diabetes insipidus :-
computers to combine many X-ray · Head trauma or surgery
images into cross- sectional views. · Pituitary or
A CT scan might be done to hypothalamic tumor
evaluate the adrenals and/or · Intracerebral occlusion
pituitary gland. For example, it can or infection
show if the immune system has
damaged the adrenal glands or if B) Nephrogenic diabetes insipidus
the glands are infected. · Systemic diseases
involving the kidney
Addisonian crisis causes: · Multiple myeloma
● low blood pressure, · sickle cell anemia
· Polycystic kidney
● high potassium in the blood, and
disease
● low blood sugar levels.
· Pyelonephritis
· Medications such as
TREATMENT
lithium
● Hydrocortisone pills to replace
cortisol.
Pathophysiology
● If patient is also lacking A) Central diabetes insipidus :
aldosterone, fludrocortisones
● Loss of vasopressin-producing
acetate pills will be provided.
cells,
● If patient are taking
● Causing deficiency in antidiuretic
fludrocortisones, need to increase
hormone (ADH) synthesis or
salt intake, especially in hot and
release;
humid weather and after exercise.
● Deficiency in ADH, resulting in an
● In emergencies and during
inability to conserve water,
surgery, the medicine is given
● leading to extreme polyuria(urinate
intravenously (directly into a vein).
more than normal) and
polydipsia(excessive thirst).

DIABETES INSIPIDUS B) Nephrogenic diabetes insipidus

Definition ● Depression of aldosterone release
● Diabetes insipidus is a disorder of or inability of the nephrons to
the posterior lobe of the pituitary respond to ADH, causing extreme
gland characterized by a polyuria and polydipsia
 ● Restriction of salt and protein
Signs and symptoms intake
● Polyuria with urine output of 5 to
15 L daily LESGOOO FUTURE RN’S <3
● Polydipsia(excessive thirst),
especially a desire for cold fluids
● Marked dehydration, as evidenced
by dry mucous membranes, dry
skin, and weight loss
● Anorexia and epigastric fullness
● Nocturia(the need for a patient to
get up at night on a regular basis
to urinate) and related fatigue from
interrupted sleep
Diagnostic test results
● High serum osmolality, usually
above 300 mOsm/kg of water
● Low urine osmolarity, usually 50 to
200 mOsm/kg of water;
● low urine-specific gravity of less
than 1.005
● Increased creatinine and blood
urea nitrogen (BUN) levels
resulting from dehydration
● Positive response to water
deprivation test: Urine output
decreases and specific gravity
increases
Goals of management
● The objectives of therapy are
(1) to replace ADH (which is usually a
long-term therapeutic program),
(2) to ensure adequate fluid replacement,
and
(3) to identify and correct the underlying
cause

Treatments
● Replacement vasopressin therapy
with intranasal or I.V. DDAVP
(desmopressin acetate)
● Correction of dehydration and
electrolyte imbalances
Treatment
● A thiazide diuretic to deplete
sodium and increase renal water
reabsorption