Angelite Nurses: Addison's Disease

Addison's Disease

General information

Primary adrenocortical insufficiency; hypofunction of the adrenal cortex causes decreased secretion of the mineralocorticoids, glucocorticoids, and sex hormones
Relatively rare disease caused by

Idiopathic atrophy of the adrenal cortex possibly due to an autoimmune process
Destruction of the gland secondary to tuberculosis or fungal infection

Assessment findings

Fatigue, muscle weakness
Anorexia, nausea, vomiting, abdominal pain, weight loss
History of frequent hypoglycemic reactions
Hypotension, weak pulse
Bronzelike pigmentation of the skin
Decreased capacity to deal with stress
Diagnostic tests: low cortisol levels, hyponatremia, hyperkalemia, hypoglycemia

Nursing interventions

Administer hormone replacement therapy as ordered.

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
Mineralocorticoids: fludrocortisone acetate (Florinef)

Monitor vital signs.
Decrease stress in the environment.
Prevent exposure to infection.
Provide rest periods; prevent fatigue.
Monitor I&O.
Weigh daily.
Provide small, frequent feedings of diet high in carbohydrates, sodium, and protein to prevent hypoglycemia and hyponatremia and provide proper nutrition.
Provide client teaching and discharge planning concerning

Disease process; signs of adrenal insufficiency
Use of prescribed medications for lifelong replacement therapy; never omit medications
Need to avoid stress, trauma, and infections, and to notify physician if these occur as medication dosage may need to be adjusted
Stress management techniques
Diet modification (high in protein, carbohydrates, and sodium)
Use of salt tablets (if prescribed) or ingestion of salty foods (potato chips) if experiencing increased sweating
Importance of alternating regular exercise with rest periods
Avoidance of strenuous exercise especially in hot weather

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