ADDISONIAN CRISIS

DISEASE: ADDISONIAN CRISIS – a life threatening disorder caused by acute adrenal insufficiency. Crisis precipitated by stress, infection, trauma or surgery. It can cause hyponatremia, hyperkalemia, hypoglycemia and shock.

SIGNS & SYMPTOMS: Severe headache, severe abdominal, leg and lower back pain, Generalized weakness, Irritability and confusion, Severe hypotension, Shock.

PATIENT TEACHINGS: Maintain bed rest and provide a quiet environment.

 TREATMENTS: Prepare to administer glucocorticoids intravenously as prescribed; hydrocortisone sodium succinate(Solu-Cortef) usually is prescribed initially. Following resolution of the crisis, administer glucocorticoid and mineralocorticoid orally as prescribed. Monitor vital signs, particularly BP. Monitor neurological status, noting irritability and confusion. Monitor I & O. Monitor lab values, particularly sodium, potassium and blood glucose. Administer IV fluids as prescribed to restore electrolyte balance. Protect the client from infection.

DIETS AND DRUGS: High protein, carbohydrate, & sodium intake. Dexamethasone, Hydrocortisone and Fludrocortisone.

CUSHINGS DISEASE

DISEASE: CUSHINGS – is a condition of hypersecretion of glucocorticoids from adrenal cortex. Can be caused by increased pituitary secretion of ACTH, pituitary adenoma, or adrenal adenoma.

SIGNS & SYMPTOMS: Truncal obesity with thin extremities, moonface, buffalo hump, supraclavicular fat pads, generalized muscle wasting & weakness, fragile skin that bruise, reddish-purple striae on abdomen & upper thigh, hirsutism, hypertension, elevated blood glucose,sodium and WBC, decreased calcium and potassium

PATIENT TEACHINGS: Monitor VS, BP, I&O, weight, lab.values particularly blood glucose,WBC,Na,K,Ca. Provide good skin care.

 TREATMENTS: Prepare client for hypophysectomy or radiation if condition is caused by pituitary tumor. Prepare client for adrenalectomy if condition is caused by adrenal tumor or hyperplasia.

DIETS AND DRUGS: Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone).

In some cases, the tumor or its treatment will cause other hormones produced by the pituitary or adrenal gland to become deficient and your doctor will recommend hormone replacement medications.

Provide diet low in calories & sodium and high in protein, potassium, calcium and vitamin D.