Now this is Addison's disease.
We just talked about Cushing's disease and syndrome.
That was excess of the steroids. Addison's disease is an insufficiency.
Not enough. We've got a picture of President Kennedy there
because he's a very famous person who also happen to have Addison's disease.
So sometimes people remember this by Addison's disease
means we need to add steroids because that's how we treat this disease.
You have to replace all those steroids, those hormones that the adrenal gland
would normally produce if it was functioning.
So if I have Addison's disease, I don't have enough cortisol, aldosterone, or adrenaline.
So look at all the processes that will affect. Yeah, a lot of them.
But see, that's the cool part about the endocrine system.
If Cushing's has these symptoms, then Addison's is gonna be the exact opposite.
So see, it's really straightforward.
People often times complain about the endocrine system
but I think it's one of the simplest yet complex things that you'll learn in nursing school.
Now, how does someone end up with Addison's disease?
Usually it's autoimmune.
The sad part is, we don't pick up the clinical symptoms
until the patient's autoimmune system has really knocked out almost all of the gland.
Like, up to 90% of it but that's normally the cause of Addison's disease.
Now, there's a secondary cause.
If the anterior pituitary doesn't put out enough ACTH,
this can also be a cause of Addison's disease.
You'll likely see -- if you see Addison's disease, you'll see number one most often.
Now, the reason we're talking about this is not cuz we have all the time in the world.
It's because this is what happens in Addisonian crisis.
It's what happens when someone with Addison's disease
doesn't have enough hormones to respond to stress.
It also happens when someone who's had Cushing syndrome,
they received lots of corticosteroids,
their adrenal gland has become suppressed, and now it can't respond
because that patient stopped taking the medications.
So that's why we're looking at Addison's disease and Cushing's.
So the systemic effects of adrenal insufficiency or Addison's disease are the exact opposite of Cushing's.
Remember in Cushing's, mood swings and all that stuff.
No, these people are so tired. They don't have the energy to have mood swings.
They have chronic fatigue all the time if they're not receiving enough replacement hormone.
So now let's think about well, we know what happened in Cushing's cardiovascularly.
Oh, because of the aldosterone, you might have extra volume on board, extra volume and hypertension.
So what would we see in Addison's? If it's the opposite, you would see low blood pressure.
Right. So we know that we'd have low blood pressure.
What do you think the impact would be on the heart rate?
Well, any time I have low blood pressure, how does my body respond in heart rate?
Oh, yeah, it goes faster so you'll have tachycardia.
So you've got low blood pressure and tachycardia because of low volume.
You have low volume cuz we don't have appropriate amounts of aldosterone.
Whether I'm in Addison's disease or an Addisonian-like crisis because my adrenal gland
has been suppressed by corticosteroids over a long period of time and it can't respond.
So when a patient with Addison's disease or suppressed adrenal gland undergo stress,
they need extra hormone replacement.
Now, fluid volume, we already talked about this
so you know that they're gonna be dehydrated.
How their electrolytes are gonna be is the opposite of Cushing's.
Cushing's was increased sodium because aldosterone tells you to hang on to sodium.
So in Addison's, it's gotta definitely be decreased sodium and therefore, increased potassium.
So see, now you could look at electrolyte lab values
and know which one was likely Cushing's and which one was likely Addison's. Good work.
Now, they crave salty foods. That seems kind of obvious, right?
Because they don't have the aldosterone, they're not hanging onto sodium, they have lower sodium.
That's one of the ways my body will protect itself.
When I have hyponatremia, it's gonna tell me to eat or ingest more salt.
Now I also have some GI weird ones that are not very fun.
They have nausea, vomiting, and diarrhea which could be very problematic
if you start thinking about fluid and electrolyte balance
because you're gonna end up throwing that off
if you have pretty extreme nausea and vomiting and diarrhea.
Blood sugar in Cushing's was high so what do you think it would be in Addison's?
It's gotta be the opposite, right? So it's low. Hypoglycemia.
So we've talked about comparing these system by system. Cushing's, mood swings.
Addison's, too tired for that, right? Volume in Cushing's, up.
Hypertension. In Addison's, it's the opposite. Volume down. Hypotension, fast heart rate.
Blood sugar up in Cushing's, blood sugar low in Addison's.
You also have a muscle weakness and think about that with the electrolyte imbalance.
That's part of the problem. So head to toe, we've looked at adrenal insufficiency or Addison's.
We looked at this because it's the mirror image of Cushing's.
Good. And that also means it applies to patients that have Cushing's syndrome
because they've been on long term higher dose corticosteroid therapy
and their adrenal gland has been suppressed
and an Addisonian-like crisis is similar to when someone who has an adrenal gland
that been suppressed and they stopped taking their medication too quickly.