Addison's Disease and Adrenal Crisis

Addison's disease results from adrenal cortex hormone deficiency (cortisol and aldosterone), causing hypotension, hyponatremia, hyperkalemia, hypoglycemia, weight loss, fatigue, and bronze skin hyperpigmentation from elevated ACTH. Addisonian crisis is a life-threatening emergency triggered by stress, infection, or abrupt steroid withdrawal, presenting with severe hypotension, shock, vomiting, and hyperkalemia-related dysrhythmias; treatment requires immediate IV hydrocortisone, IV fluids with dextrose, and correcting electrolytes. Patients must never abruptly stop corticosteroid therapy, as this can precipitate crisis by suppressing the adrenal gland's own recovery.

Cushing's Syndrome

Cushing's syndrome results from cortisol excess, either from a pituitary or adrenal tumor or, most commonly, prolonged corticosteroid therapy. Findings include moon face, buffalo hump, truncal obesity with thin extremities, purple striae, thin fragile skin that bruises easily, hyperglycemia, hypertension, hypokalemia, and increased infection risk from immunosuppression — essentially the opposite of Addison's electrolyte and body composition pattern. Nursing priorities include monitoring glucose, protecting fragile skin from injury, assessing for infection since fever may be blunted, and fall precautions due to osteoporosis and muscle wasting.

Steroid Therapy Teaching and Tapering

Any patient on long-term corticosteroids must never stop the medication abruptly because it suppresses the hypothalamic-pituitary-adrenal axis, leaving the body unable to produce adequate endogenous cortisol; doses must always be tapered gradually. Teach patients to take oral steroids with food to reduce GI irritation, monitor blood glucose, report signs of infection promptly since steroids mask fever and inflammation, and carry medical alert identification. Stress dosing (temporarily increased steroid doses) is required during illness, surgery, or significant physical stress to prevent precipitating adrenal crisis.