ADDISON’ S DISEASE.pdf

Addison disease

1. ADDISON’ S DISEASE
Presented by
Karana ram
MSc.(n) 1
st year

2. INTRODUCTION
•Addison’s disease or adrenocortical
insufficiency, occurs when adrenal cortex
function is inadequate to meet the patient’s
need for cortical hormones.
• Addison’s disease occurs when more than
90% of adrenal gland tissue is destroyed
(primary Addison’s disease.)

3. NORMAL ANATOMY AND PHYSIOLOGY
OF ADRENAL GLAND
•Also called as suprarenal
gland/ life saving gland/ B.P.
regulating gland /fight and
flight gland.
•weight -4 to 5 gm
• colour and shape.
•blood supply.

4. Part of adrenal gland
•It have two parts outer parts adrenal cortex and
inner part adrenal medulla
•Adrenal cortex
•It is a largest part of adrenal gland
•It have three layer.

5. Glucocorticoids
•It is a main cortical harmone relies by
zona fasciculate layer of adrenal
cortex.
•Glucocorticoids is main steroid
harmone which is three types.

6. Function of glucocorticoids
•Glucocorticoids is catabolic harmone.
•It is life saving harmone because it is a potent anti
inflamatery agent in the body by phospholipage
inhibitors ,decrease capillary permeability ,coat
forming around the lysosome. So prevent cell death.
•It maintain pleasureness of mood.
•It decrease the epiphysial plate of bone growth.
•It is a potent immunosuppresent by inhibiting T
lymphocyte.
•It decrease collegen protein synthesis so cause moon
like face.

7. Contd…
•Cortisole act as a weak menaralocorticoids.
•Delay the wound healing by preventing migration of
neutrophils, hyperglycemia ,immunosuppresent and
anemia.
•Steroid help in fetal lung maturation.
•Steroid also increase androgen harmone secration so
cause hirsutism .
•It is responsible for distribution of fat from periphery
to central
•Steroid also decrease the absorption of calcium from
GIT.
•Steroid increase the secration of HCL from GIT.

8. Mineralocorticoids/aldesterone
•It release by zona glomerulus layer of adrenal
cortex.
•It is a two type-
– Aldesterone (90%)
–Dicorticostone
•Function of mineralocorticoids
•It help in maintenance of blood pressure by sodium
and water reabsorption and vasoconstriction by
renin angiotensinogen aldosterone system and
excreate potassium.

9. Androgen harmone
•These are release by zona reticularies layer of
adrenal cortex
•These is two types- testosterone , estrogen
•Function- It is responsible for secondary
sexual characteristic development in both
male and female.

10. Adrenal medulla
•It is a small part of adrenal gland
•It is developed from neural crest
•It consist of special type cell called as
chromaffin/pheochromocytes cell
•It is only gland of body which is control by
nervous system
•It release catecholamine epinephrine /
adrenaline ,norepinephrine /
noradrenaline ,dopamine/PIH

11. Function of catecholamine
•Catecholamine act as a sympathetic nervous system
•Increase heart rate
•Increase blood pressure
•Increase cardiac output
•Perspiration
•Tachypnea
•Constipation
•Anorexia
•Dry mouth
•Pupil dilation
•Hyperglycaemia

12. ADDISON’ S DISEASE
• Definition –– it is a condtion
characterized by decrease secration of
glucocorticoids, minaralocorticoids,and
androgen harmone evidenced by
hypoglycemia ,hyponatremia,and libido

13. Cause
•Inhibitory tumor of hypothalamus pitutory, and adrenal cortex
•Decrease CRH
•Secondary adrenal insufficiency -Decrease ACTH
•Adrenectomy
•High dose of prolong steroids therapy.
•Infection of adrenal gland (tuberculosis is most common
infection destroyed adrenal gland)
• Cessation of Exogenous adrenocortical hormonal therapy.
•Removal of pituitary gland
•Inadequate secretion of ACTH from the pituitary gland
•Taking glucocorticoids for more than 3 weeks with sudden
cessation

15. CLINICAL MANIFESTATIONS
•Hyper pigmentation of skin (bronzed )
•Decrease salt (hyponatremia)
•Decrease sex (libido)
•Decrease sugar (hypoglycemia)
–Lethargy
–Fatigue
–Weakness
–Excessive sleepness
–Irritability
–Weight loss
•Excessive sweating/perspiration

16. Continue…
•Infertility
•Abnormal menstrual cycle
•Hyperkalemia
•Cardiac dysrythmia
•Hypercalcemia
•Hypotension
•Weak and thread pulse
•Depression
•Chronic dehydration

17. DIAGNOSTIC EVALUATION
•History collection-
•-History of recent infection, steroid use, or adrenal
or pituitary surgery.
•-History of craving for salt or intolerance to cold.
•-Presence of altered menses in females and
impotence in males
•Physical examination-Assess the patient for signs
of dehydration such as tachycardia, altered level of
consciousness, dry skin with poor turgor, dry
mucous membranes, weight loss, and weak
peripheral pulses. Check for postural hypotension

18. Contd..
•Serum cortisol and aldosterone-
•Computed Tomography (CT) scan and
Magnetic Resonance Imaging (MRI)
•Electrocardiography
•Other laboratory finding will be decrease
glucose level, decrease serum sodium level

20. question
•The nurse should assess a client with
Addison's disease forwhich of the following?
•A. Weight gain.
•B. Hunger.
•C. Lethargy.
•D. Muscle spasms.

21. MEDICAL MANAGEMENT
•Immediate treatment is directed towards treating
circulatory shock: restoring blood circulation,
administering fluids and corticosteroids,
monitoring vital signs, and placing the patient in a
recumbent position with legs elevated.
•Corticosteroids therapy-
•Antibiotics- If infection has precipitated adrenal
crisis in a patient with chronic adrenal insufficiency.

22. Continue…
•Oral intake may be initiated as soon as tolerated. IV
fluids are gradually decreased after oral fluid intake
is adequate to prevent hypovolemia
•If the adrenal gland does not regain function, the
patient needs lifelong replacement of
corticosteroids and mineralocorticoids to prevent
recurrence of adrenal insufficiency.
•The patient may need to supplement dietary intake
with salt during GI losses of fluids through vomiting
and diarrhoea

23. NURSING MANAGEMENT
•Monitor vital signs (particularly for hypotension), for weight loss,
and intake and output.sssssss
•Corticosteroid replacement will need to be increased during times of
stress.
• Avoid strenuous exercise and stressful situations.
• Avoid over-the-counter medications.
•Diet should be high in protein and carbohydrates; clients taking
glucocorticoids should be prescribed calcium and vitamin D
supplements to maintain normal levels and to protect against
corticosteroid-induced osteoporosis; some clients taking
mineralocorticoids may be prescribed a diet high in sodium.
•Report signs and symptoms of complications, such as
underreplacement and overreplacement of corticosteroid
hormones.

24. Continue..
•If vomiting or diarrhoea occurs, as may happen with influenza,
notify the health care provider immediately because
electrolyte replacement and parenteral administration of
cortisol may be necessary
•It is critical that the patient wear an identification bracelet
and carry a wallet card stating the patient has Addison’s
disease so that appropriate therapy can be initiated in case of
an emergency.
•The patient should carry an emergency kit at all times with
100 mg of IM hydrocortisone, syringes, and instructions for
use
•Observe for addisonian crisis caused by stress, infection,
trauma, or surgery.

26. COMPLICATIONS
•Addisonian crisis- An acute adrenal insufficiency,
a life-threatening emergency caused by
insufficient adrenocortical hormones or a sudden
sharp decrease in these hormones Precipitated
by stress, infection, trauma, surgery, or abrupt
withdrawal of exogenous corticosteroid use Can
cause hyponatremia, hyperkalemia,
hypoglycemia, and shock, Severe hypotension
( rapid, weak pulse; rapid respiratory rate)

27. question
•An emergency nurse cares for a client who is
experiencing anacute adrenal crisis. Which
action should the nurse take first?
•A. Obtain intravenous access.
•B. Administer hydrocortisone succinate.
•C. Assess blood glucose.
•D. Administer insulin and dextrose.

28. question
•The nurse is instructing a young adult with
Addison's disease how to adjust the dose of
glucocorticoids. The nurse shouldexplain that the
client may need an increased dosage
ofglucocorticoids in which of the following
situations?
•A. Completing the spring semester of school.
•B. Gaining 4 pounds.
•C. Becoming engaged.
•D. Undergoing a root canal.

29. RESEARCH ARTICLES
•Bone mineral density in patients with Addison disease on replacement
therapy with prednisolone.
•Chandy DD, Bhatia E conducted a cross-sectional study to determine
BMD and its relation with therapy in patients on physiologic doses of
prednisolone replacement.Forty-one consecutive patients, receiving
prednisolone were studied. BMD was evaluated by dual-energy X-ray
absorptiometry and compared with an age- and sex-matched reference
group of healthy Indian subjects.Among males, BMD Z-scores at lumbar
spine, femoral neckand total hip were significantly lower than the reference
population. Z-scores in female patients did not differ from controls. Among
postmenopausal females and males >50 years, 43% had osteoporosis, as
compared with 25% in the reference group. A high proportion of males had
low serum testosterone, but there was no correlation between testosterone
and BMD.It concluded that male patients receiving physiologic
prednisolone replacement had a small but significant diminution in
BMD at all sites.

30. SUMMARY AND CONCLUSION
•As discussed throughout the presentation, learning
about Addison’s disease and its management will
help nurses to care for patients with Addison’s
disease.
•Nurses can do assessment of patients with
Addison’s disease, observe the sign and symptoms,
provide the necessary nursing care and support the
patient psychologically.
•Nurses can also csounsel the patients and their
family for various options available in treatment for
Addison’s disease.

31. REFERENCES
•1.Lewis. Medical Surgical Nursing Assessment and Management of
clinical problems.2015. New Delhi. Elsevier. 2nd Edition. Volume II.
Pg. no.983-985, 1264-1266.
•2.Brunner and Suddartsh’s Textbook of Medical Surgical Nursing.
2015. New Delhi. Wolters Kluwer.13th Edition. Volume 2. Pg. no.
1494-1496.
•3.Joyce M. Black, Jane Hokanson Hawks. Medical Surgical Nursing
Clinical Management of Positive Outcomes.2015. New Delhi. Reed
Elsevier India Private Limited. Volume II. Pg. No.1040- 1044.
•4. Chandy DD, Bhatia E.Bone mineral density in patients with addison
disease on replacement therapy with prednisolone.EndocrPract.
2016 Apr;22(4):434-9. doi: 10.4158/EP151014.OR. Epub 2015 Dec 18.
•https://www.mdmag.com/medical-news/new-device-helps-addison-
disease-patients-access-lifesaving-treatment