ADDISON'S DISEASE is a disorder that occurs

when your body produces insufficient amounts of

certain hormones produced by your adrenal glands.
In Addison's disease, your adrenal glands produce
too little cortisol and often insufficient levels of
aldosterone as well.
Also called adrenal insufficiency, Addison's disease
occurs in all age groups and affects both sexes.
Addison's disease can be life-threatening.
Treatment for Addison's disease involves taking
hormones to replace the insufficient amounts being
made by your adrenal glands, in order to mimic the
beneficial effects produced by your naturally made
hormones.
ANATOMY AND PHYSIOLOGY
The endocrine system is considered as one
of the bodys most complex systems. It affects
functions of the different organs or organ system. It
is greatly interrelated with the function of the
nervous system, to coordinate body processes.
Alterations in function of the endocrine
system result in a variety of physiologic changes,
which may be very serious and fatal, but at times
may require minimal hospital care.
The end result of most pathologic processes
affecting the endocrine system is hypersecretion or
hyposecretion of hormones.
The endocrine system is composed of an
interrelated complex of glands (pituitary, adrenals,
thyroid, parathyroids, islets of Langerhans of the
pancreas, thymus, pineal gland, ovaries, and
testes) that secrete a variety of hormones directly
into the bloodstream.
Although the nervous and endocrine systems act
together to coordinate functions of all body
systems, their means of control are different.
Exocrine glands (exo- outside) secrete
their products into ducts that carry the secretions
into body cavities, into lumen of an organ, or to the
outer surface of the body.
Endocrine glands, by contrast, secrete
their products (hormones) into the interstitial fluid
surrounding the secretory cells, rather than into
ducts.

Functions:
Maintenance and regulation of vital
functions
Response to stress and injury
Growth and development
Energy metabolism
Reproduction
Fluid, electrolyte, and acid-base balance
Adrenal Gland
Two small glands, one above each kidney
Regulates sodium and electrolyte balance
Affects carbohydrate, fat, and protein
metabolism
Influences the development of sexual
characteristics
Sustains the flight or fight response
Consist of two sections:
ADRENAL CORTEX (OUTER PORTION)
o The outer shell of the adrenal gland
o Produces mineralocorticoids
Aldosterone: regulates electrolyte balance
by promoting sodium retention and potassium
excretion.

Your doctor will also suggest a temporary

Produces Glucocorticoids
Cortisol, Cortisone, and

Corticosterone
o

Produces sex hormones govern

development of certain secondary sex
characteristics. Secretion of adrenal
androgens is controlled by ACTH.

ADRENAL MEDULLA (INNER PORTION)

o

The inner core of the adrenal gland

Works as part of the sympathetic nervous

system

Produces two catecholamines: epinephrine

(also called as adrenalin), norepinephrine
(sometimes called noradrenalin).

increase in your dosage if you're facing a

stressful situation, such as an operation, an
infection or a minor illness.
ADDISONS CRISIS

MEDICAL AND SURGERY MANAGEMENT

HORMONE REPLACEMENT THERAPY

Treatment of Addison's disease involves

replacing, or substituting, the hormones that
the adrenal glands are not making.
Cortisol
is
replaced
orally
with
hydrocortisone
tablets,
a
synthetic
glucocorticoid, taken once or twice a day.
If aldosterone is also deficient, it is replaced
with oral doses of a mineralocorticoid called
fludrocortisone acetate (Florinef), which is
taken once a day.
An
ample
intake
of
sodium
is
recommended, especially during heavy
exercise, when the weather is hot, or if you
have gastrointestinal upsets, such as
diarrhea.

Standard therapy involves intravenous

injections of hydrocortisone, saline (salt
water), and dextrose (sugar).
This treatment usually brings rapid
improvement.
When the patient can take fluids and
medications by mouth, the amount of
hydrocortisone is decreased until a
maintenance dose is achieved.
If aldosterone is deficient, maintenance
therapy also includes oral doses of
fludrocortisone acetate.
SURGERY
Patients with Addison's disease who need surgery
with general anesthesia are treated with injections
of hydrocortisone and saline. Injections begin on
the evening before surgery and continue until the
patient is fully awake and able to take medication
by mouth. The dosage is adjusted until the

maintenance dosage given before surgery is

reached.

NURSING INTERVENTIONS/CARE
MANAGEMENT

Monitor vital signs, especially BP

Monitor intake and output closely.
Take and record weight at the same time
daily.
Monitor electrolytes, and report abnormal
results.
Provide small, frequent feedings.

Decrease stress in the environment.

Prevent exposure to infection.
Provide rest periods to prevent fatigue.
Provide diet high in protein, Na and
carbohydrates; low K
Administer steroids after meals or with milk.
Provide written and verbal instructions on
administering steroids
Monitor neurological status, noting irritability
and confusion.
Administer IV fluids (5% dextrose in saline,
plasma) as ordered to treat vascular
collapse
Administer IV glucocorticoids as ordered