Now we're going to discuss Addison's disease.
We have a picture of an American
president, JFK up there,
because he actually suffered from this disease.
We weren't as efficient at
treating it when he had it,
but Addison's disease is adrenal insufficiency.
That means that your adrenal gland is not
able to put out those adrenal hormones.
Now, in Addison's disease, you have that because
you've had some type of autoimmune disorder,
but I'm going to tell you why
it's important that nurses
who are giving corticosteroids
Now, under normal conditions,
a healthy adrenal gland will put out
cortisol and aldosterone and adrenaline.
In Addison's disease, that adrenal
gland has kind of been eaten up.
It's been destroyed by some
type of autoimmune disorder,
so there are insufficient
amounts of these hormones.
There's not enough for what the body needs.
When the body's adrenal gland has been
eaten by that autoimmune disease process,
then it's called Addison's disease.
Again, you're thinking, "Why are we talking about
a disease when we're studying corticosteroids?"
Well, an adrenal gland that's been
destroyed by an autoimmune disease,
and sadly, about 90% of it gets destroyed before
we realize or often recognize what's going on,
is similar to what happens to a
patient who's on corticosteroids
and then abruptly stops taking them.
Okay, now, let's go back to the
disease for just a minute.
The primary cause is the adrenal gland gets
knocked out by some autoimmune disease.
The secondary cause is the anterior
pituitary doesn't produce enough ACTH
to stimulate the adrenal glands.
Okay, this is a great place for a question.
Let's see if you can think back if
you've watched our other video series.
What are the glands and organs involved
in going from the hypothalamus
to the adrenal gland secreting those hormones?
So stop the video for just a minute,
and see if you can write down the process from
hypothalamus to those adrenal hormones.
Okay, now take a look at your answer.
Remember, the hypothalamus puts out CRH.
Its target is the anterior pituitary.
Now, if the anterior pituitary receives that CRH,
it's supposed to send out ACTH
whose target is the adrenal gland.
So a secondary cause of Addison's
disease is an anterior pituitary gland
that doesn't produce enough ACTH.
Because it doesn't produce enough ACTH,
it doesn't stimulate the adrenal gland
to secrete enough of its hormones.
But let's go back and review.
Primary cause of Addison's disease
is an adrenal gland malfunction,
usually caused by an autoimmune disorder.
The secondary cause, we don't see it as often,
is the anterior pituitary gland isn't
producing enough of that hormone
that stimulates the adrenal gland.
Remember, we're talking about Addison's
disease because it looks just like a patient
who's been taking corticosteroids
and didn't wean them.
They stopped it abruptly.
So, let's talk about why adrenal
insufficiency or Addison's disease,
why this is a problem in your body.
This is going to be the opposite of
what people experience in Cushing's.
They don't have mood swings because
they're too tired to care.
They're going to have tachycardia
because unlike Cushing's where you
might have extra volume on board,
these patients are going to
have less volume on board.
And 1 way you'll notice that is that they'll have
a lower blood pressure and a faster heart rate.
That's the tachycardia and low BP.
That's caused from the dehydration.
Remember, one of the hormones of
your adrenal gland is aldosterone.
That's the one that tells your body to
hang on to sodium and water follows.
Somebody with Addison's disease doesn't have
that, so that's why they're dehydrated.
Their body doesn't know to hang on
to that sodium and it can't respond,
which is why they have less volume
in their intravascular space.
Less volume in your intravascular
space means a lower blood pressure,
so your body tries to move it around faster,
that's why you have the tachycardia.
So, the less sodium you have, means
you'll hang on to potassium.
Those levels will be higher.
They kind of have that imbalance.
So, for a patient who has Addison's disease,
this is when they're getting into trouble.
This is when they don't have
enough hormone replacement.
It's the same thing when someone
who has taken corticosteroids,
their adrenal gland has
become a little suppressed.
Their adrenal gland is also not
going to be able to put out
the right amount of hormones
because it's been suppressed.
So they'll crave salty foods.
I mean, most of us like salty foods,
but they're just flat low in sodium,
and so their body will be screaming for it.
You start messing with someone's sodium level,
and then we get into things
like nausea and vomiting.
They even might have some diarrhea.
That's a bad news because they --
losing fluid already, they're
and if they end up with diarrhea,
they're going to lose even more fluid.
So these people might be really
dizzy, have a hard time walking,
increased risk for falls
and hurting themselves.
And lastly, remember that you had
high blood sugar in Cushing's,
you're going to have the opposite in
Addison's, so you have low blood sugar.
So, really, once you think through these symptoms,
what excess is is just going
to be the complete opposite
when we're looking when a
patient doesn't have enough.
Now, they're gonna have muscle weakness.
Again, we have that electrolyte imbalance.
I mean, there is so much going
on in both of these situations.
But don't let it get you confused.