ADDISON’S DISEASE

GROUP 3
 INTRODUCTION
 Addison’s disease is a rare endocrine condition where the adrenal glands cease to
function, so that your body no longer produces enough of certain essential
hormones, known as steroid hormones.
 The adrenal glands are small triangular shaped glands that sit on top of your
kidneys.
 Their job is to produce the hormones that keep the body functioning properly.
The condition is named after Thomas Addison, the London doctor who first
identified the condition around 1850. (Addison’s disease organization, 2024)
Addison's disease is also known as primary adrenal insufficiency.
Secondary adrenal insufficiency occurs when the pituitary gland in
the brain does not release enough of the hormone that stimulates the
adrenal gland to release cortisol. Addison's disease can make people
feel weak and tired, but it can also be effectively treated with
hormones to replace those that are missing. (Better health, 2021)
(John Hopkins Medicine)
 CAUSES
 Addison disease results from damage to the adrenal cortex. The
damage causes the cortex to produce hormone levels that are too low.
The most common cause of Addison’s disease is an autoimmune
response, which occurs when your immune system attacks healthy
tissues for an unknown reason. With Addison’s disease, your immune
system attacks the outer portion of your adrenal glands (the adrenal
cortex), where there is production of cortisol and aldosterone.
(Cleveland Clinic, 2022)
PREDISPOSING FACTOR
 A history of having a disease or surgery that affects the pituitary gland or
the adrenal glands.
 Certain genetic changes that affect the pituitary or adrenal glands. These
include gene changes that cause the inherited disease congenital adrenal
hyperplasia.
 Other autoimmune endocrine conditions, such as hypothyroidism or type
1 diabetes.
 A traumatic brain injury.
 Infections: Certain infections, particularly those affecting the adrenal
glands such as tuberculosis, fungal infections, and HIV/AIDS, can
damage the adrenal glands and lead to Addison's disease. (Mayo clinic,
2024)
PATHOPHYSIOLOGY
 Addison’s disease is a rare endocrine condition where the adrenal
glands cease to function. Which is caused by a damage on the
adrenal glands leading to inadequate production of cortisol and
often aldosterone as well. This dysfunction can be autoimmune in
nature, with the body's immune system attacking the adrenal
glands. Other causes may include infections (such as tuberculosis
or fungal infections), hemorrhage, genetic disorders, or
medications, which if not treated will lead to adrenal crisis,
hypoglycemia, hyperpigmentation and finally death. (Husebye
and Pearce, 2020)
 TYPES
Adrenal insufficiency occurs when the adrenal glands don’t make enough of
the hormone cortisol. There are 3 types of this disorder.
 The primary type is known as Addison disease. It's rare. It's when the
adrenal glands don’t make enough of the hormones (cortisol and
aldosterone.)
 The secondary type occurs when the pituitary gland doesn’t make enough
of the hormone (ACTH). The adrenal glands then don’t make enough
cortisol.
 The tertiary type occurs when the hypothalamus doesn't make enough
corticotropin-releasing hormone. Then the pituitary gland doesn't make
enough ACTH. As a result, the adrenal glands don't make enough cortisol.
(Cedaris Sinai,2024)
 CLINICAL MANIFESTATION
According to Mayo Clinic, (2024) the signs and symptoms of
Addison’s disease include:
 Low blood sugar, also called
 Extreme fatigue
hypoglycemia
 Weight loss and loss of appetite
 Nausea, diarrhea or vomiting
 Hyperpigmentation of skin
 Abdominal pain
 Low blood pressure, even fainting
 Muscle and joint pain
 Salt craving
 Irritability
 Depression
 Body hair loss or sexual issues in some
people
(News-Medical)
 DIAGNOSIS
 Blood test. This test can measure blood levels of sodium, potassium, cortisol
and adrenocorticotropic hormone (ACTH). A blood test also can measure
antibodies related to autoimmune Addison's disease.
 Adrenocorticotropic hormone (ACTH ) stimulation test. ACTH tells the
adrenal glands to make cortisol. This test measures the level of cortisol in the
blood before and after a shot of human-made ACTH. (Mayo Clinic, 2024)
 Insulin-induced hypoglycemia test. This test is done to find out if the pituitary
gland is causing secondary adrenal insufficiency. The test involves checking
blood sugar and cortisol levels after a shot of insulin.
 Imaging tests, such as ultrasound, computed tomography (CT), and magnetic
resonance imaging (MRI), would be ordered to check for any abnormalities in
the adrenal glands themselves. (Health direct, 2021)
 COMPLICATIONS
1. Adrenal Crisis: Severe deficiency of cortisol can lead to adrenal crisis, a life-
threatening condition characterized by low blood pressure, electrolyte imbalances, and
shock.
2. Hypoglycemia: Inadequate cortisol levels can lead to low blood sugar levels, causing
symptoms like weakness, confusion, and fainting.
3. Hyperpigmentation: Increased production of ACTH can lead to hyperpigmentation,
causing darkening of the skin, especially in sun-exposed areas.
4. Salt Cravings and Dehydration: Decreased aldosterone levels can lead to salt
cravings and dehydration, as aldosterone helps regulate sodium and water balance in the
body.
5. Autoimmune Disorders: Addison's disease is often caused by autoimmune destruction
of the adrenal glands, which may be associated with other autoimmune conditions such
 MEDICAL MANAGEMENT
People with Addison’s disease will need to take daily steroid medication to keep their
bodies functioning well for the rest of their lives. This medication replaces the
hormones that their adrenal glands can no longer make.
Common medications include:
 Hydrocortisone or prednisone is given to replace the cortisol hormone that the
adrenal glands are not producing enough of.
 Fludrocortisone: this medication replaces aldosterone, which helps to regulate
sodium and potassium balance in the body.
 Dehydroepiandrosterone (DHEA): this medication is another hormone that is
produced by the outer layer of the adrenal gland, the cortex. It influences stamina
and libido and is a precursor hormone. DHEA is not taken by everyone living with
Addison's. (Addison’s disease organization,2024)
NURSING MANAGEMENT
1. The following are the nursing management for patients with Addison’s
disease:
2. Administering hormone replacement therapy, such as glucocorticoids and
mineralocorticoids
3. Monitoring electrolyte levels and managing any imbalances
4. Educating patients on the importance of medication adherence and stress
management
5. Monitoring fluid and electrolyte balance
6. Promoting adequate fluid volume
7. Monitoring for hypoglycemia and hypotension
8. Providing and monitoring response to fluid and cortisol replacement therapies
9. Provide a safe environment
[Link] and maintaining nutritional needs .
NURSING DIAGNOSIS
 Fluid and Electrolyte Imbalance related to Adrenal
Insufficiency evidence by loss of skin turgor.
 Decreased activity tolerance related to fatigue, weakness
evidence by patient’s verbalization of exhaustion.
 Decreased Cardiac Output related to Hypotension as
evidenced by patient’s low blood pressure.
 Anxiety related to management of Addison’s disease and
hormone replacement therapy as evidenced by patient being
restless.
THANK YOU FOR LISTENING
 REFERENCE
1. Addison’s disease organization (n.d). Addison’s disease. Retrieved on 22 nd of February, 2024 from:
[Link]
2. Better health (2012). Addison’s disease. Retrieved on 21 February 2024 from:
[Link]
3. Cedaris Sinai (no date), Addison’s disease. Retrieved on 21 February 2024 from: [Link]
library/diseases-and-conditions/a/[Link]
4. Cleveland Clinic (2022). Addison’s disease. Retrieved on 20 th of February, 2024 from:
[Link]
5. Health direct (2021). Addison’s disease. Retrieved on 22 nd of February, 2024 from:
[Link]
6. Husebye, E. S., & Pearce, S. H (2020). Addison’s Disease. New England Journal of Medicine, 383(9), 852-864.
doi;10.1056/NEJMra1917180.
7. Mayo Clinic (2024). Addison’s disease. Retrieved on 21 February 2024 from: [Link]
conditions/addisons-disease/symptoms-causes/syc-20350293#:~:text=Addison's%20disease%2C%20also%20called
%20adrenal%20insufficiency%2C%20is,body%20doesn't%20make%20enough%20of%20certain%20hormones.
8. Matt Vera BSN, R.N. Addison’s disease. Retrieved on 22 nd of February, 2024 from: [Link]
disease-nursing-care-plans/#h-nursing-diagnosis