Addison’s Disease vs Cushing’s Syndrome Nursing

Cushing’s and Addison’s Disease. An endocrine NCLEX review on how to differentiate between Cushing’s Syndrome/Disease vs Addison’s and Addisonian Crisis. In this video, I will discuss the pathophysiology, signs & symptoms, and nursing interventions for these endocrine disorders of the adrenal cortex and pituitary glands.

 

Addison’s Disease and Cushing’s Syndrome/Disease review notes for nursing school and NCLEX exam. In nursing school and for the NCLEX exam, you will need to know how to provide care to a patient with either Addison’s Disease or Cushing’s.

However, many students get these two endocrine disorders confused, but these review notes will help you differentiate between them.

These NCLEX review notes will cover:

  • Signs and Symptoms of Addison’s Disease vs Cushing’s
  • Causes of Addison’s Disease and Cushing’s
  • Nursing Management of Addison’s Disease and Cushing’s

After reviewing these notes, don’t forget to take the Addison’s Disease vs Cushing’s Quiz.

Addison’s Disease vs Cushing’s

Major Players in these endocrine disorders:

  • Adrenal Cortex
  • Steroid Hormones
    • Corticosteroids (specifically Aldosterone (mineralocorticoid) & Cortisol (glucocorticoid)

Role of Adrenal Cortex: releases steroid hormones and sex hormones

Role of Aldosterone: regulates blood pressure through renin-angiotensin-aldosterone system, helps retain sodium and secretes potassium (balances sodium and potassium levels).

Role of Cortisol: “STRESS Hormone” helps the body deal with stress such as illness or injury, increases blood glucose though glucose metabolism, break downs fats, proteins, and carbs, regulates electrolytes.

Cushing’s (Syndrome & Disease)

Cushing’s: hyper-secretion of CORTISOL (watch video for clever ways to remember this)

Cushing’s Syndrome vs Cushing’s Disease

Cushing’s Syndrome: caused by an outside cause or medical treatment such as glucocorticoid therapy

Cushing’s Disease: caused from an inside source due to the pituitary gland producing too much ACTH (Adrenocorticotropic hormone) which causes the adrenal cortex to release too much cortisol.

Signs & Symptoms of Cushing’s

Remember the mnemonic: “STRESSED” (remember there is too much of the STRESS hormone CORTISOL)

Skin fragile

Truncal obesity with small arms

Rounded face (appears like moon), Reproductive issues amennorhea and ED in male(due to adrenal cortex’s role in secreting sex hormones)

Ecchymosis, Elevated blood pressure

Striae on the extremities and abdomen (Purplish)

Sugar extremely high (hyperglycemia)

Excessive body hair especially in women…and Hirsutism (women starting to have male characteristics), Electrolytes imbalance: hypokalemia

Dorsocervical fat pad (Buffalo hump), Depression

Causes of Cushing’s

  • Glucocorticoid drug therapy ex: Prednisone
  • Body causing it: due to tumors and cancer on the *pituitary glands or adrenal cortex, or genetic predisposition

Nursing Management for Cushing’s Syndrome

  • Prep patient for Hypophysectomy to remove the pituitary tumor
  • Prep patient for Adrenalectomy:
    • If this is done educate pt about cortisol replacement therapy after surgery
  • Risk for infection and skin breakdown
  • Monitor electrolytes blood sugar, potassium, sodium, and calcium levels

Addison’s Disease

Addison’s: Hyposecretion of Aldosterone & Cortisol (watch the video for a clever way on how to remember this and not get it confused with Cushing’s)

Signs & Symptoms of Addison’s Disease

Remember the phrase: “Low STEROID Hormones” (remember you have low production of aldosterone & cortisol which are STEROID hormones)

Sodium & Sugar low (due to low levels of cortisol which is responsible for retention sodium and increases blood glucose), Salt cravings

Tired and muscle weakness

Electrolyte imbalance of high Potassium and high Calcium

Reproductive changes…irregular menstrual cycle and ED in men

lOw blood pressure (at risk for vascular collapse)….aldosterone plays a role in regulating BP

Increased pigmentation of the skin (hyperpigmentation of the skin)

Diarrhea and nausea, Depression

Causes of Addison’s Disease

  • Autoimmune due to the adrenal cortex becoming damaged due to the body attacking itself:
    • Tuberculosis/infections
    • Cancer
    • Hemorrhaging of the adrenal cortex due to a trauma

Nursing Management of Addison’s Disease

  • Watching glucose and K+ level
  • Administer medications to replace the low hormone levels of cortisol and aldosterone
  • For replacing cortisol:
    • ex: Prednisone, Hydrocortisone
      • Education: Patient needs to report if they are having stress such as illness, surgery, or extra stress in life ( will need to increase dosage), take medication exactly as prescribed….don’t stop abruptly without consulting with MD.
  • For replacing aldosterone:
    • ex: Fludrocortisone aka Florinef
      • Education: consume enough salt..may need extra salt
  • Wearing a medical alert bracelet
  • Eat diet high in proteins and carbs, and make sure to consume enough sodium
  • Avoid illnesses, stress, strenuous exercise

Watch for Addisonian Crisis

This develops when Addison’s Disease isn’t treated.

In addisonian crisis, the patient has extremely LOW CORTISOL levels (life threatening).

Remember the 5 S’s

  1. Sudden pain in stomach, back, and legs
  2. Syncope (going unconscious)
  3. Shock
  4. Super low blood pressure
  5. Severe vomiting, diarrhea and headache
  • NEED IV Cortisol STAT:
    • Solu-Cortef and IV fluids (D5NS to keep blood sugar and sodium levels good and fluid status)
  • Watch for risk for infection, neuro status (confusion, agitation), electrolyte levels (sodium and potassium, glucose)

Addison’s vs Cushing’s Quiz

 

From http://www.registerednursern.com/addisons-disease-vs-cushings-review-notes-for-nclex/

Johns Hopkins surgeon ‘Dr. Q’ to get Hollywood treatment

DrQ

 

Brad Pitt’s production company Plan B has teamed up with Disney to develop a movie based on the life of Alfredo Quiñones-Hinojosa, the head of brain tumor surgery at Johns Hopkins Hospital.

Quiñones-Hinojosa’s path to becoming a physician started in an unlikely place: a cotton field. He had come to the United States in 1987 from his native Mexico at the age of 19, penniless and unable to speak English. Driven to have a better life than the one he would have had in Mexico, he took jobs picking cotton, painting, and welding to pay for his tuition at San Joaquin Delta Community College in Stockton, California.

“These very same hands that now do brain surgery, right around that time they had scars everywhere from pulling weeds. They were bloody,” he told CNN correspondent Sanjay Gupta in a 2012 interview.

After earning his medical degree from Harvard Medical School and training in both general surgery and neurosurgery at the University of California, San Francisco, Quiñones-Hinojosa came to Johns Hopkins in 2005 and became a faculty member and surgeon. He specializes in brain cancer and pituitary tumors. His autobiography Becoming Dr. Q: My Journey from Migrant Farm Worker to Brain Surgeon was published in 2011 and received the International Latino Book Award in 2012.

Feeling like an outsider helped keep Quiñones-Hinojosa focused and “at the top of his game,” he told CNN. In the keynote speech delivered at Johns Hopkins University’s 2013 commencement ceremony, he elaborates, weaving together memories of his own brush with death in a work accident with his experience operating on a patient with a massive brain tumor that unexpectedly ruptured during surgery. Quoting the migrant farm worker and civil rights activist Cesar Chavez, he says, “If you are afraid, you will work like crazy.”

Plan B began developing the project—titled Dr. Q, the nickname for Quiñones-Hinojosa adopted by his patients—in 2007 after hearing a radio broadcast about the doctor and his background.

Matt Lopez, author of the popular Civil War play The Whipping Man and a former staff writer for HBO’s The Newsroom, will write the script.

According to The Hollywood Reporter, Disney expects Dr. Q to be a modestly-budgeted inspirational drama. Plan B executives Pitt, Dede Gardner, and Jeremy Kleiner won Best Picture Oscars two years ago for their production work on 12 Years a Slave and were nominated this year for their work on The Big Short.

From http://hub.jhu.edu/2016/03/07/brad-pitt-disney-dr-q-movie

 

A History of the Pituitary — Sylvia Asa, MD

2015 California Pituitary Conference
Dr. Sylvia Asa discusses the discoveries that have shaped our understanding of the pituitary gland, its significant and the diseases associated with it.

Endoscopic Pituitary Surgery – Remission Rates and Gland Preservation – Daniel F. Kelly, MD

2015 California Pituitary Conference

Dr. Daniel Kelly discusses the outcomes of endoscopic pituitary surgery with regards to endocrine function. He analyzes the current literature and the Pacific Brain Tumor Center’s experience with remission rates of hormone secreting tumors. He also evaluates the rate of pituitary dysfunction following pituitary tumor surgery.

The Voices of Cushing’s Disease, Part III: Finding Strength in Numbers

Part III of The Voices of Cushing’s Disease video series discusses the importance of support for people living with Cushing’s disease.

 

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