Addison's Disease and its Systemic Effects (Nursing)

00:01 Now we're going to discuss Addison's disease.

00:04 We have a picture of an American president, JFK up there, because he actually suffered from this disease.

00:11 We weren't as efficient at treating it when he had it, but Addison's disease is adrenal insufficiency.

00:18 That means that your adrenal gland is not able to put out those adrenal hormones.

00:23 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 understand Addison's.

00:35 Now, under normal conditions, a healthy adrenal gland will put out cortisol and aldosterone and adrenaline.

00:43 In Addison's disease, that adrenal gland has kind of been eaten up.

00:47 It's been destroyed by some type of autoimmune disorder, so there are insufficient amounts of these hormones.

00:54 There's not enough for what the body needs.

00:57 When the body's adrenal gland has been eaten by that autoimmune disease process, then it's called Addison's disease.

01:05 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.

01:30 Okay, now, let's go back to the disease for just a minute.

01:34 The primary cause is the adrenal gland gets knocked out by some autoimmune disease.

01:38 The secondary cause is the anterior pituitary doesn't produce enough ACTH to stimulate the adrenal glands.

01:47 Okay, this is a great place for a question.

01:49 Let's see if you can think back if you've watched our other video series.

01:54 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.

02:18 Okay, now take a look at your answer.

02:20 Remember, the hypothalamus puts out CRH.

02:24 Its target is the anterior pituitary.

02:27 Now, if the anterior pituitary receives that CRH, it's supposed to send out ACTH whose target is the adrenal gland.

02:35 So a secondary cause of Addison's disease is an anterior pituitary gland that doesn't produce enough ACTH.

02:42 Because it doesn't produce enough ACTH, it doesn't stimulate the adrenal gland to secrete enough of its hormones.

02:50 But let's go back and review.

02:53 Primary cause of Addison's disease is an adrenal gland malfunction, usually caused by an autoimmune disorder.

03:00 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.

03:10 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.

03:20 They stopped it abruptly.

03:22 So, let's talk about why adrenal insufficiency or Addison's disease, why this is a problem in your body.

03:29 This is going to be the opposite of what people experience in Cushing's.

03:33 They don't have mood swings because they're too tired to care.

03:40 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.

03:49 And 1 way you'll notice that is that they'll have a lower blood pressure and a faster heart rate.

03:55 That's the tachycardia and low BP.

03:58 That's caused from the dehydration.

04:00 Remember, one of the hormones of your adrenal gland is aldosterone.

04:05 That's the one that tells your body to hang on to sodium and water follows.

04:09 Somebody with Addison's disease doesn't have that, so that's why they're dehydrated.

04:15 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.

04:23 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.

04:31 So, the less sodium you have, means you'll hang on to potassium.

04:36 Those levels will be higher.

04:38 They kind of have that imbalance.

04:40 So, for a patient who has Addison's disease, this is when they're getting into trouble.

04:46 This is when they don't have enough hormone replacement.

04:50 It's the same thing when someone who has taken corticosteroids, their adrenal gland has become a little suppressed.

04:57 Their adrenal gland is also not going to be able to put out the right amount of hormones because it's been suppressed.

05:05 So they'll crave salty foods.

05:07 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.

05:15 You start messing with someone's sodium level, and then we get into things like nausea and vomiting.

05:19 They even might have some diarrhea.

05:21 That's a bad news because they -- losing fluid already, they're already dehydrated, and if they end up with diarrhea, they're going to lose even more fluid.

05:31 So these people might be really dizzy, have a hard time walking, increased risk for falls and hurting themselves.

05:38 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.

05:48 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.

05:58 Now, they're gonna have muscle weakness.

05:59 Again, we have that electrolyte imbalance.

06:01 I mean, there is so much going on in both of these situations.

06:07 But don't let it get you confused.