Addison's Disease

  1. General information
    1. Primary adrenocortical insufficiency; hypofunction of the adrenal cortex causes decreased secretion of the mineralocorticoids, glucocorticoids, and sex hormones
    2. Relatively rare disease caused by
      1. Idiopathic atrophy of the adrenal cortex possibly due to an autoimmune process
      2. Destruction of the gland secondary to tuberculosis or fungal infection
  2. Assessment findings
    1. Fatigue, muscle weakness
    2. Anorexia, nausea, vomiting, abdominal pain, weight loss
    3. History of frequent hypoglycemic reactions
    4. Hypotension, weak pulse
    5. Bronzelike pigmentation of the skin
    6. Decreased capacity to deal with stress
    7. Diagnostic tests: low cortisol levels, hyponatremia, hyperkalemia, hypoglycemia
  3. Nursing interventions
    1. Administer hormone replacement therapy as ordered.
      1. Glucocorticoids (cortisone, hydrocortisone): to stimulate diurnal rhythm of cortisol release, give 2/3 of dose in early morning and 1/3 of dose in afternoon
      2. Mineralocorticoids: fludrocortisone acetate (Florinef)
    2. Monitor vital signs.
    3. Decrease stress in the environment.
    4. Prevent exposure to infection.
    5. Provide rest periods; prevent fatigue.
    6. Monitor I&O.
    7. Weigh daily.
    8. Provide small, frequent feedings of diet high in carbohydrates, sodium, and protein to prevent hypoglycemia and hyponatremia and provide proper nutrition.
    9. Provide client teaching and discharge planning concerning
      1. Disease process; signs of adrenal insufficiency
      2. Use of prescribed medications for lifelong replacement therapy; never omit medications
      3. Need to avoid stress, trauma, and infections, and to notify physician if these occur as medication dosage may need to be adjusted
      4. Stress management techniques
      5. Diet modification (high in protein, carbohydrates, and sodium)
      6. Use of salt tablets (if prescribed) or ingestion of salty foods (potato chips) if experiencing increased sweating
      7. Importance of alternating regular exercise with rest periods
      8. Avoidance of strenuous exercise especially in hot weather