Addison's Disease and its Systemic Effects (Nursing)

by Prof. Lawes

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    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.

    About the Lecture

    The lecture Addison's Disease and its Systemic Effects (Nursing) by Prof. Lawes is from the course Endocrine Medications (Nursing). It contains the following chapters:

    • Causes of Addison's Disease
    • Systemic Effects of Adrenal Insufficiency/Addison's

    Included Quiz Questions

    1. Adrenal gland malfunction, often as a result of autoimmune disease
    2. The anterior pituitary overproducing ACTH
    3. The effects of Cushing's syndrome long term as a result of autoimmune disease
    4. The posterior pituitary underproducing ACTH
    1. A client on high-dose glucocorticoid therapy who abruptly stops treatment without weaning
    2. A client on high-dose glucocorticoid therapy who slowly weans off treatment
    3. A client on low-dose glucocorticoid therapy who abruptly stops treatment
    4. A client on low-dose glucocorticoid therapy who slowly weans off treatment
    1. Nausea, vomiting, tachycardia, hypotension, dehydration, low sodium, and high potassium
    2. Nausea, vomiting, bradycardia, hypertension, and elevated sodium and potassium
    3. Acute hypertensive crisis, sweating, fluid overload, low sodium, and high potassium
    4. Nausea, vomiting, hypotension, bradycardia, high sodium, and low potassium

    Author of lecture Addison's Disease and its Systemic Effects (Nursing)

     Prof. Lawes

    Prof. Lawes

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