Addisons vs Cushing's Disease for NCLEX RN

Summary

This educational video from SimpleNursing.com delves into Addison's and Cushing's diseases, focusing on the effects of steroid imbalances. It explains the contrasting symptoms of each condition, such as the frail appearance in Addison's and the round, hairy body in Cushing's. The video uses mnemonic devices like 'ADD and CUSH' to aid memorization of key points, emphasizing the importance of cortisol and its role in stress response. It also covers the pathophysiology behind these conditions, common causes, and treatment strategies, including hormone replacement therapy and the management of stress during treatment.

Takeaways

• 🌟 Addison's disease is characterized by the absence of steroids, leading to symptoms such as low blood pressure, weight loss, cold intolerance, and hyperpigmentation.
• 🏋️‍♂️ Cushing's syndrome is marked by an excess of steroids, resulting in symptoms like high blood pressure, weight gain, and a round, hairy appearance.
• 🔍 The 'double Ps' for Addison's are pigmentation and potassium, with high potassium levels (over 5.0) causing muscle spasms and EKG changes.
• 📈 For Cushing's, key indicators include a 'big belly' or trunkal obesity, moon face, buffalo hump, and hirsutism (excessive hair growth).
• 🧠 The hypothalamus initiates the production of steroids via a chain reaction involving the pituitary gland and adrenal cortex, primarily controlling sugar, salt, and sex hormones.
• 💊 Treatment for Addison's involves hormone replacement with steroids like prednisone or hydrocortisone, especially during times of stress.
• ⚠️ Cushing's treatment requires addressing the cause, whether it's reducing steroid medication or removing tumors causing hormonal imbalances.
• 🚫 Abrupt cessation of steroid medication can lead to an Addisonian crisis, a potentially fatal condition characterized by extremely low blood pressure.
• 📚 Education is crucial for patients on lifelong hormone replacement therapy, as these conditions are managed rather than cured with medication.
• 🔑 Memory aids like 'ADD and CUSH' can help differentiate between the diseases, with 'A' for added symptoms in Addison's and 'C' for cushion-like symptoms in Cushing's.
• 🛡️ Long-term steroid use requires precautions, including monitoring for side effects like weight gain, increased blood pressure, and risk of infections.

Q & A

What is the primary difference between Addison's and Cushing's disease in terms of steroid levels?

Addison's disease is characterized by an absence or insufficient production of steroids, leading to symptoms such as low blood pressure, weight loss, and weakness. In contrast, Cushing's disease is marked by an excess of steroids, resulting in symptoms like weight gain, moon face, and buffalo hump.

What are the 'double Ps' associated with Addison's disease?

The 'double Ps' for Addison's disease are pigmentation (hyperpigmentation or bronze pigmentation) and potassium (high levels over 5.0, also known as hyperkalemia).

How can one remember the symptoms of Cushing's disease?

Cushing's disease can be remembered by the acronym 'CUSH-C': Cushion of fat (truncal obesity), Unusual hair growth (hairsuitism), Skin with stretch marks (Purple striae), High sugar, High blood pressure, and High weight gain.

What is the role of cortisol in the body, and how does it relate to the symptoms of Cushing's and Addison's disease?

Cortisol is the stress hormone that helps control sugar, salt, and sex hormones. In Cushing's, there is an excess of cortisol leading to symptoms like high blood pressure and sugar levels. In Addison's, there is a deficiency of cortisol, causing low blood pressure, hypoglycemia, and other symptoms.

What are the typical presentations of a patient with Addison's disease?

Patients with Addison's disease typically present as small, skinny, frail, and weak with an odd tan. They may also exhibit low blood pressure, low body temperature (cold intolerance), hair loss, depression, and hyponatremia.

What is the significance of the acronym 'ADDIE' in treating Addison's disease?

The acronym 'ADDIE' stands for Addison's disease, Diet (high in protein, carbs, and sodium), Dosage increase during stress, and Education about the lifelong hormone replacement therapy. It also includes the importance of not abruptly stopping the medication to avoid an Addisonian crisis.

What are the common causes of Addison's disease?

Addison's disease is often caused by an autoimmune response where the body attacks the adrenal glands or pituitary (primary cause), or secondary causes such as diseases like cancer, infections like TB, or trauma to the adrenals.

How are Cushing's disease and Addison's disease related to the hypothalamic-pituitary-adrenal (HPA) axis?

The HPA axis is responsible for the production of steroids. In Cushing's disease, there is an overproduction of cortisol due to either exogenous causes like high steroid medication or endogenous causes like tumors. In Addison's disease, there is an underproduction of cortisol due to adrenal failure.

What are the potential complications of abruptly stopping steroid medication in a patient with Cushing's disease?

Abruptly stopping steroid medication in a patient with Cushing's disease can lead to an Addisonian crisis, characterized by dangerously low blood pressure (shock), which can be life-threatening.

What are the 'seven S's of steroids' and why are they important for nursing considerations?

The 'seven S's of steroids' are Swelling, Sepsis, Sugar, Skinny muscles and bones, SES (cataracts), and Slow tapering off. These are important nursing considerations because they highlight the side effects and precautions needed when administering steroid medications to patients.

How should a nurse prioritize actions during an Addisonian crisis?

During an Addisonian crisis, the nurse's first priority is to increase the blood pressure by administering IV push of zone steroids like hydrocortisone or prednisone. After stabilizing blood pressure, the nurse should address low fluids and sugar levels with IV normal saline and dextrose solutions.