Pathology
A rare, long-term disorder in which the adrenal glands do not produce enough cortisol and aldosterone, most commonly due to an autoimmune destruction of the adrenal cortex.
What is ADDISONS DISEASE
Moon face, buffalo hump, purple striae, HTN, diabetes
What is CUSHING’S SYNDROME
Labs:
↑ Cortisol
↑ Glucose
↓ Potassium
↑ Sodium
↑ WBC (but immune suppressed)
What is CUSHING’S SYNDROME
Hormone replacement therapy with hydrocortisone and sometimes fludrocortisone is essential for this disorder.
What is ADDISONS DISEASE
A nurse is teaching a client with Addison’s Disease about self-management at home. Which statement by the client indicates correct understanding?
A. “I only need to carry my steroid emergency kit if I feel unwell.”
B. “I should wear a medical alert bracelet and always keep my steroid emergency kit with me.”
C. “I only need the medical alert bracelet when I travel outside the country.”
D. “I can skip carrying my kit if my family knows about my condition.”
What is...
B. “I should wear a medical alert bracelet and always keep my steroid emergency kit with me.”
*Patients with adrenal insufficiency are at risk for adrenal crisis, which can be life-threatening if glucocorticoids are not available immediately.
*Medical alert identification ensures first responders and healthcare providers are aware of the condition in an emergency.
A rare but serious condition that develops when the body is exposed to persistently elevated cortisol levels. It is most often caused by pituitary or adrenal tumors, or prolonged use of corticosteroid medications.
What is CUSHING SYNDROME
Bronze skin, weight loss, hypoglycemia, sodium 122, potassium 6.2, BP 88/50.
What is ADDISON’S DISEASE
Labs:
↑ Plasma metanephrines
↑ Urine catecholamines
What is PHEOCHROMOCYTOMA
The nurse is caring for a client following an bilateral adrenalectomy. Which priority complication should the nurse closely monitor for?
Sudden drop in cortisol levels which can lead to acute adrenal insufficiency
A 38-year-old client with Addison’s Disease calls the clinic reporting fatigue, dizziness, and lightheadedness after a mild flu. The client mentions they have not adjusted their diet or medications during this illness.
Which intervention should the nurse prioritize?
A. Advise the patient to increase fluid intake only.
B. Instruct the patient to maintain a high-sodium diet and take stress-dose steroids as prescribed.
C. Tell the patient to rest at home and resume normal diet after recovery.
D. Schedule an outpatient follow-up in one week.
What is...
B. Instruct the patient to maintain a high-sodium diet and take stress-dose steroids as prescribed.
*High-sodium intake helps maintain blood pressure, and stress-dose steroids prevent life-threatening hypotension.
A rare, typically benign (noncancerous) tumor of the adrenal medulla that results in excessive release of catecholamines (epinephrine and norepinephrine), causing episodes of severe hypertension, tachycardia, diaphoresis, and intense headaches.
What is PHEOCHROMOCYTOMA
Paroxysmal headache, sweating, and tachycardia alongside severe hypertension.
What is PHEOCHROMOCYTOMA
Labs:
↓ Cortisol
↓ Sodium
↑ Potassium
↓ Glucose
What is ADDISON’S DISEASE
Medications like ketoconazole or metyrapone can reduce cortisol production when surgery isn’t an option for this disorder.
What is CUSHINGS SYNDROME
A post-adrenalectomy patient becomes hypotensive and having severe vomiting/diarrhea.
The nurse notes which medication(s) should be administered immediately?
What is IV hydrocortisone and IV fluids
A sudden, life-threatening complication of Addison’s disease. Requires immediate, emergency, high-dose intravenous (IV) hydrocortisone and fluids.
What is ADDISONIAN/ADRENAL CRISIS
Client reports Sudden headache, BP 230/120, sweating, and palpitations.
The nurse should anticipate which diagnosis?
What is PHEOCHROMOCYTOMA
Hyperglycemia + severe hypertension + catecholamines elevated.
Which condition is most consistent with these findings?
What is PHEOCHROMOCYTOMA
The nurse has a client who will be preparing for a adrenalectomy for treatment of pheochromocytoma.
The nurse notes that patient will be prescribed what type of medications?
What are ALPHA-ADRENERGIC BLOCKERS and BETA BLOCKERS
During preoperative teaching for a patient with Addison’s Disease, the nurse notices the patient has forgotten to bring their steroid emergency kit and is due for a stressful procedure
What is the most appropriate nursing action?
A. Remind the patient to call family for backup supply.
B. Administer a stress-dose glucocorticoid immediately.
C. Document and proceed with standard pre-op protocol.
D. Re-teach about carrying the kit at home.
B. Administer a stress-dose glucocorticoid immediately.
*Patients with adrenal insufficiency are at risk for adrenal crisis under stress (surgery).
A life-threatening, emergency state caused by a sudden, massive release of catecholamines. Requires IV antihypertensives, cardiac monitoring, and reducing stimuli.
What is PHEOCHROMOCYTOMA HYPERTENSIVE CRISIS
A client who has been taking long-term prednisone reports experiencing severe hypotension at home after abruptly stopping the medication.
Which condition should the nurse anticipate?
What is Addisonian/Adrenal crisis
A patient presents with fatigue, palpitations, and headache. Labs reveal:
*Cortisol: 28 µg/dL (high)
*Sodium: 140 mEq/L (normal)
*Potassium: 3.2 mEq/L (low)
*Plasma metanephrines: 6.0 nmol/L (high)
Which of the following should the nurse recognize as highest priority?
A. High cortisol: monitor for hyperglycemia
B. Low potassium: start replacement therapy
C. Elevated metanephrines: risk for hypertensive crisis
D. Normal sodium: no action needed
C. Elevated metanephrines: risk for hypertensive crisis
*Elevated plasma metanephrines indicate pheochromocytoma, putting the patient at risk for life-threatening hypertensive crises.
During a teach-back session, a client preparing for an adrenalectomy states, “I will start my propranolol on day one and then add phenoxybenzamine on day three.”
Which response by the nurse is most appropriate?
What is that Preoperative management includes alpha-blockers and beta-blockers to prevent intraoperative hypertensive crises.
It is important to start the alpha-blockage (Phenoxybenzamine) FIRST to reduce the risk of intraoperative hypertensive crises by preventing excessive vasoconstriction. Then propranolol may be added AFTERWARDS to control tachycardia.
A patient recovering from Cushing’s Syndrome surgery reports weakness, nausea, and dizziness. Labs reveal low sodium and high potassium. Which interventions should the nurse anticipate? (Select all that apply)
Answer Options:
A. Administer IV hydrocortisone
B. Initiate fluid resuscitation with 0.9% NS
C. Restrict potassium intake
D. Notify the provider immediately
E. Encourage bedrest only
What is:
A. Administer IV hydrocortisone
B. Initiate fluid resuscitation with 0.9% NS
D. Notify the provider immediately
*Bedrest alone or potassium restriction without addressing cortisol deficiency is inadequate.