Addison's crisis

Question 1

Addison’s Disease: Review

Answer 1

Disease of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones:

1. Glucocorticoids (Cortisol)
2. Mineralocorticoids (Aldosterone)
3. Testosterone

Question 2

AD: Etiology

Answer 2

Idiopathic or Autoimmune

Question 3

AD: Primary: Pathogenesis

Answer 3

Adrenal gland destroyed

Symptoms when 90% non-functional

Adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts

Question 4

AD clinical manifestations:

Answer 4

1. Hypoaldosteronism:
   - Dec Vascular tone
   - Dec CO (Low fluid/blood volume)
   - Dec Blood volume
2. Salt Craving
   - Dec Na+ levels
   - Inc Serum K levels
   - Dehydration
3. Hypocortisolism
   - Hypoglycemia
   - Weakness & fatigue
4. Unsuppressed ACTH
   - Hyperpigmentation

Question 5

AD: Pharmacotherapy

Answer 5

Requires lifelong steroid replacement

All patients require glucocorticoid

• Hydrocortisone**
• Prednisone
• Dexamethasone

Some patients require mineralocorticoid
-Fludrocortisone (works like aldosterone)

Question 6

AD: Pharmacotherapy (Important issues)

Answer 6

Dosing mimics natural release of hormones

• Timing is important
• Doses are small

NEVER abruptly stop

Dose will need to be increased during stress 3x3
-Surgery, trauma, infection

Always maintain emergency supply
-IM + PO supply

Wear med alert bracelet

Question 7

Addisonian (adrenal) crisis: Complication

Answer 7

MEDICAL EMERGENCY

Sudden insufficiency of serum corticosteroids

Results from:

1. Sudden loss of adrenal gland
2. Sudden increase in stress in chronic condition
3. Sudden cessation of steroid drug therapy

Question 8

Addisonian (adrenal) crisis: Symptoms

Answer 8

• Sudden penetrating pain in lower back, abdomen, and legs (HYPERNATREMIA)
• Severe V/D
• Dehydration
• Low BP
• CNS: loss of consciousness, confusion, slurred speech
• Hyperkalemia + Hyponatremia

If left untreated: DEATH

Question 9

Addisonian (adrenal) crisis: Treatment

Answer 9

1. IV:
   - Hydrocortisone
   - Initial IV bolus 100mg, then IV 50mg q 6hrs
2. Saline
3. Dextrose

When client is able, switch to PO meds and fluids
-Taper dose until maintenance dose is achieved

Question 10

Hydrocortisone has….

Answer 10

Glucocorticoid + Mineralocorticoid actions