When it comes to endocrine disorders, it can take quite a lot of head-scratching when trying to understand Cushing’s and Addison’s disease. As a preview, both of these diseases involve the adrenal glands and they’re the complete opposite of each other.
This study guide will help you learn about the difference between Cushing’s and Addison’s.To understand better, this guide will cover the causes, signs and symptoms, and the medical management of both Cushing’s and Addison’s disease.
The Anatomy and Physiology: Cushing’s vs. Addison’s Disease
Both these diseases involve the adrenal glands. The adrenal glands are located next to the kidneys and are responsible for secreting several hormones.
The two major parts are the (1) Adrenal Cortex and the (2) Steroid Hormones. The adrenal cortex is responsible for releasing the sexual and steroid hormones. The steroid hormones involved are Aldosterone (Mineralocorticoid) and Cortisol (Glucocorticoid).
- Aldosterone: Aldosterone is responsible for regulating the blood pressure through the Renin-Angiotensin-Aldosterone-System (RAAS), to help in retaining the sodium levels in the body, and secretes the potassium.
- Cortisol: While cortisol is the hormone that deals with any stress experienced by the body, like an injury or illness. That’s why it’s also known as the “Stress Hormone”. The cortisol hormone also helps in the metabolism of glucose (thus increasing the blood glucose), breakdown of fats, proteins, carbohydrates, and regulates the electrolyte.
Cushing’s (Disease & Syndrome)
There are two types of Cushing’s – the disease and syndrome. Both have the hypersecretion of the hormone cortisol but they differ in its causes.
- Cushing’s Syndrome: The hypersecretion of cortisol is caused by medical treatment such as Glucocorticoid Therapy (Prednisone)
- Caused from the outside
- Cushing’s Disease: The hypersecretion of cortisol is caused by the pituitary gland producing too much Adrenocorticotropic hormone (ACTH). This may be caused by tumors or cancer in the adrenal cortex and pituitary glands or genetic predisposition.
- Caused from the inside
Signs & Symptoms of Cushing’s (Disease & Syndrome)
Since the hormone cortisol deals with STRESS experienced by the body, remember the signs and symptoms: “STRESSED”
- Skin is Fragile
- Truncal Obesity in the Arms
- Round face (like a moon), Reproductive issues (Amennorhea and Erectile Dysfunction)
- Ecchymosis and Elevated Blood Pressure
- Striae in the abdomen and extremities (Purplish)
- Sugar is High (Hyperglycemia)
- Excessive body hair (Hirsutism), Electrolyte Imbalance (Hypokalemia)
- Dorsocervical Fat Pad (Buffalo Hump) & Depression
Nursing Management Cushing’s (Disease & Syndrome)
- Hypophysectomy – the removal of the pituitary tumor
- Adrenelectomy – the removal of adrenal glands
- Cortisol Replacement Therapy – after the Adrenelectomy
- Skin care and avoid the risk for infection
- Risk for infection and skin breakdown
- Monitor electrolytes blood sugar, potassium, sodium, and calcium levels
As we’ve learned earlier, Cushing’s is the HYPERSECRETION of cortisol. Its complete opposite is Addison’s disease. Addison’s disease is the HYPOSECRETION of the hormones cortisol and aldosterone.
Causes of Addison’s Disease
Addison’s disease is caused by autoimmune disorders where the adrenal cortex becomes damaged, and the body attacks itself. Usual causes are:
- Adrenal cortex hemorrhage (caused by trauma)
Signs & Symptoms of Addison’s Disease
Since Addison’s Disease is classified as the “low STEROID hormone disease”, because of the HYPOSECRETION of the hormones cortisol and aldosterone, simply follow the easy-to-remember acronym “STEROID” for the signs and symptoms.
- Sodium is low, Sugar is low and Salt Cravings
- Tired all the time and muscle weakness
- Electrolyte imbalance (high potassium and high calcium)
- Reproductive difficulties (Irregular menstrual cycle and Erectile dysfunction)
- LOw blood pressure
- Increased skin pigmentation or hyperpigmentation of the skin
- Diarrhea, nausea and Depression
Due to decreased cortisol levels, the result is low sugar and low sodium. Cortisol is the hormone responsible for sodium retention and increased blood glucose levels.
Since aldosterone levels are low too, it is expected that a person with Addison’s disease will show signs of low blood pressure. Note that aldosterone is responsible for regulating blood pressure.
Nursing Management of Addison’s Disease
- Monitor electrolyte levels (especially sodium and potassium)
- Monitor blood glucose levels
- Lifelong cortisol and aldosterone replacement therapy
- Cortisol replacement therapy: Prednisone and Hydrocortisone
- Aldosterone replacement therapy: Fludrocortisone
- Diet: High protein, high carbohydrates, high sodium
- Avoid stress and strenuous physical activities
- Boost the immune system to avoid getting sick
- Watch out for Addisonian crisis
When Addison’s disease is not managed promptly, it may develop into Addisonian crisis and is life-threatening. It is also known as acute adrenal insufficiency or the adrenal crisis. It happens rarely, but it is a fatal condition that may indicate that the renal glands have stopped working properly. It also indicates that cortisol levels dropped at a potentially alarming rate.
Addisonian crisis is triggered by many predisposing factors, such as:
- Traumatic events, injury leading to physical shock (i.e. vehicular accident)
- Severe allergic reactions
- Hypoglycemia especially in people with diabetes
- Long term use of steroid medications
- Abruptly stopping the use of steroid medications
- Any surgery involving the adrenal glands
- The pituitary gland ay not be working properly
- Complications during pregnancy
- General Anesthesia
Just watch out for the signs of low cortisol levels, remember the 5S:
- Sudden pain: back, stomach and legs
- Super low blood pressure
- Severe: Diarrhea, vomiting, and headache
Nursing Management of Addisionian Crisis:
- IV STAT D5NS to keep sodium and blood sugar levels in normal level
- Medication: Solu-Cortef
- Monitor for the neuro status (especially for signs of agitation and confusion)
- Monitor for electrolyte imbalance (glucose, sodium and potassium)
To summarize Cushing’s and Addison’s, here are some study tips worth noting:
- Cushing’s: HYPERsecretion of cortisol = body parts are on HYPER mode because of the Buffalo Hump, round face, truncal obesity, elevated blood pressure, and excessive body hair = Signs and Symptoms remember the acronym STRESSED, because cortisol is the stress hormones
- Addison’s: HYPOsecretion of cortisol and adrenal hormones = sodium, blood glucose, and blood pressure is on HYPO mode = the acronym to remember the signs and symptoms is STEROID
- Both disorders need the electrolytes, blood pressure and blood glucose to be monitored. Here is a summarized table to remember:
With this simple and comprehensive study guide for Cushing’s and Addison’s disease, you’ll get a better chance of acing that endocrine exam. For sure, you’ll make good use of this in your clinical practice too!