GROUP 8

PRESENTATION

ON

ADDISON’S DISEASE
 Objectives
By the end of the presentation, the group wish that every
student will be able to;
Understand the meaning of Addison’s Disease
Understand the overview of the adrenocortical hormones
List the Causes of Addison’s Disease.
List some signs and symptoms of Addison’s Disease.
Prevention of Addison’s Disease
Treatment of Addison’s Disease
Nursing management ofaddison`s disease
 Definition
Addison disease also called Adrenocortical
Insufficiency occurs when the adrenal cortex
function is inadequate to meet the patient’s need for
cortical hormones.
This could be primary due to the distraction of the
cortex of the adrenal gland or secondary Addisons
disease due to insufficient Adrenocorticotropic
Hormone (ACTH) from the pituitary glands,
 Overview of Cortical Hormones
These are hormones produced by the adrenal gland,
specifically in the cortex. They include
glucocorticoids (Hydrocortisone), mineralocorticoids
(Aldosterone) and sex hormones (Androgens).
 Glucocorticoids (Hydrocortisone)
Functions
It raises blood glucose level by breakdown of
glycogen and gluconeogenesis.
Lipolysis – Breakdown down of triglyceride into
fatty acids and glycerol for energy production
thereby increasing circulating level of free fatty
acids.
Stimulate the break down of protein releasing the
amino acids which are used for the synthesis of
other proteins eg. Enzymes or for energy.
Promote absorption of sodium and water from renal
tubules(weak mineralocorticoid effects)
It is regulated by the adrenocorticotropic hormones
from the primary pituitary gland.
Mineralocorticoids (Aldosterone)

This hormones maintain water and electrolytes

balance by stimulating
Reabsorption of sodium (Na+)
Excretion of potassium (K+)
Retention of water
Aldosterone can be regulated in the body by the
Renin Angiotensin Aldosterone system (RAAS) or
potassium levels ie. High potassium level increase the
secretion of aldosterone and low potassium levels
decrease aldosterone secretion.
 Causes of Addison’s Disease
 Autoimmune or idiopathic atrophy of the adrenal
glands is responsible for 80% to 90% of cases.
Tuberculosis are the most common infections that
destroy adrenal gland tissue.
Malignancies or Cancer – Malignant infiltration of
the adrenal cortices as in Hodgkin and non Hodgkin
lymphoma and leukaemia .
Causes Cont….

 Therapeutic use of corticosteroids.

Surgical removal of both adrenal glands.
Inadequate secretion of adrenocorticotropic
hormone from the primary pituitary gland
Allgrove Syndrome – Congenital adrenocortical
unresponsiveness to Adrenocorticotropic hormone
(ACTH)
Signs and Symptoms OF Addison’s Disease

Tiredness
Muscle Weakness
Loss of appetite
Weight loss
Dizziness when standing
GI Symptoms – Vomiting, Nausea, Diarhoea
Dark Pigmentation of the skin and mucus membrane
Hypotension
Low blood glucose (Hypoglycaemia)
Low Serum sodium (Hypernatremia)
High Serum Potassium (Hyperkalaemia)
Depression
 ADDISONIAN CRISIS
This is a medical emergency which develops as the
disease progresses, its
Symptoms include sudden penetrating pain in:
lower back, abdomen or legs
severe vomiting
diarrhoea followed by dehydration
low blood pressure (Hypotension)
loss of consciousness
Shock
Diagnostic Investigation

Early stages of the condition is difficult to diagnose.

Check Cortisol levels – Cortisol level is lower than
normal (<165nmol/L)
ACTH Stimulation Test

Chest X-RAY – The chest x-ray is often normal

except in evidence of TB or fungal infection that
initially cause Addison Disease.
Corticotropin Releasing Hormone (CRH) Stimulation
Test
Abdominal CT Scan – this may show bilateral enlargement of
the adrenal glands if caused by infection. Or adrenal
atrophy in the case of idiopathic auto immune disease

Check Urea and electrolytes – Hypernatremia and

hyperkalaemia
 MEDICAL MANAGEMENT
Restore blood circulation by administering IV fluids
eg. Isotonic sodium chloride solution
Administer IV hydrocortisone followed by 5%
dextrose
Vasopressor amines maybe required if hypotension
persist.
Antibiotics may be administered if infection has
precipitated the adrenal crisis.
If adrenal gland does not regain function, lifelong
replacement of corticosteroids and
mineralocorticoids is required.
Dietary intake should be supplemented with salt during
times of GI loses of fluid during.
 NURSING MANAGEMENT
Assessing The Patient
Complete health history
Baseline weight
Muscle weakness/ fatigue
History of illness
Stress response
Assess glucose levels
Baseline vitals
Skin pigmentation
Skin turger
Assess mood
Assess knowledge of disease
 General Nursing Managment
Monitor and manage Addisonian crisis ie.
a. Monitor for signs and symptoms indicative of
Addisonian crisis which can include shock,
hypotension, rapid and weak pulse, rapid respiratory
rate, pallor and extreme weakness.

b. Quickly administer IV fluids, glucose, and

electrolytes especially sodium
 Advise patient to avoid physical and psychological stressors
such as cold exposure, over exertion, infection and
emotional distress.
Encourage the patient to consume fruits and fluids that
assist in restoring and maintaining fluid and electrolyte
balance
Along with a dietician help patient to select food high in
sodium during GI tract disturbance and in very hot weather
Avoid unnecessary activities and stress that might
precipitate a hypotensive episode

Explain rational for minimizing stress during acute crisis

Give Patient and family explicit verbal and written
instructions about the rational for replacement therapy and
proper dosage.
Teach patient and family signs of excessive or insufficient
hormone replacement
Prevention

• Treat fungal infections

• Treat bacterial infection such as Tuberculosis
• Identify cancer symptoms and treat early to prevent
spread
Complication

• Hypotension
• Dehydration
• Shock
• Death