DEFINITION

Addisons disease is a rare, chronic endocrine disorder where the adrenal glands do not produce sufficient steroid hormones.

1 in 100,000 Any Age, Gender, Or Ethnicity

More common in women

ETIOLOGY

ETIOLOGY

Other causes Tuberculosis Surgical removal of both adrenal glands Inadequate secretion of ACTH Therapeutic use of corticosteroids Sudden cessation of hormone therapy.

Due to any etiological factors Hypofunction of adrenal cortex Lack of pituatory ACTH secretion Decrease secretion of the adrenal corticosteriods.

PATHOPHYSIOLOGY

Destruction of the adrenal tissue

Adissons disease

PATHOPHYSIOLOGY
Due to any etiological factors
Insufficiency of adrenal corticoids

Loss of mineralocorticoids and glucocorticoids

H2O Excretion Metabolic Disturbances

Hyponatremia
Hypovolemia Hypotension cardiac output Shock & death

Hypoglycemia
Secretion of ACTH Adrenal crisis

Hypoglycemia
Muscle weakness dehydration Skin hyper pigmentation

Hypotension

Hyponatremia

Hypovolemia

Hyperkalemia

Psychological disturbance

Adrenal crisis
It is usually seen in an undiagnosed person who undergoes a major stressor, in a person who has abrupt withdrawl of therapeutic glucocorticoids, or in a person with a poorly controlled condition who enters a stressful situation.

BLOOD INVESTIGATIONS ACTH stimulation test Plasma ACTH

BLOOD CHEMISTRY
Hyponatremia (<130mEq/L) Hyperkalemia (>5mEq/L) Low fasting blood glucose level (<50mg/100mL) Elevated BUN (>20mg/100mL ) Decreased serum cortisol level (<165nmol/L) Leukocytosis.

HEMATOLOGY Lymphocytosis Increased eosinophils Hemoconcent

Urine tests Urine 17ketosteroids

Other tests Electrogram Abdominal x-ray Abdominal CT scan

Treatment of cause

Administering fluids

Administration of glucose

Recumbent position

Glucocorticoids Mineralocorticoids Administration of vasopressors Antibiotics

Nursing Diagnoses Deficient Fluid Volume related to renal losses of sodium and water Risk for Injury related to ineffective stress response Activity Intolerance related to decreased cortisol production and fatigue

Nursing Management Nursing assessment Nursing diagnoses

Nursing Diagnoses
Deficient Fluid Volume related to renal losses of sodium and water Risk for Injury related to ineffective stress response Activity Intolerance related to decreased cortisol production and fatigue

Health Education

Instruct about the necessity for long-term therapy

Inform that therapy must be continued throughout his life span. Instructed to never stop steroid medications Always carry identification card