NCM116 Addison Disease

NCM 116: Management of Client with Addison Disease
Prepared by:
Dr. Ada B. Bonina
Professor
Learning Outcomes
Upon completion of the lesson, the learners should be able;
1. Review the functions of the adrenal gland.

2. Define what is Addison Disease.
3. Identify those risk factors that can trigger the disease.
4. Explain the pathophysiology of the disease.
5. Discuss the pharmacological and non-pharmacological
management
What is Addison's disease?
Addison’s disease is a chronic condition in which your

adrenal glands don’t produce enough of the hormones
cortisol and aldosterone.
Cortisol is a hormone that helps your body respond to stress,

including the stress of illness, injury or surgery. It also helps
maintain your blood pressure, heart function, immune system
and blood glucose (sugar) levels. Cortisol is essential for life
Aldosterone is a hormone that affects the
balance of sodium (salt) and potassium in your
blood. This in turn controls the amount of fluid
your kidneys remove as urine (pee), which
affects blood volume and blood pressure.
Addison’s disease is also called primary adrenal

insufficiency. A related disorder, secondary
adrenal insufficiency, happens when your pituitary
gland doesn’t release enough adrenocorticotropic
hormone (ACTH), which activates your adrenal
glands to produce cortisol.
Who does Addison’s disease affect?
People who have the following autoimmune disease are

also at higher risk of developing the autoimmune (most
common) form of Addison's disease:
₣ Type I diabetes.
₣ Pernicious anemia.
₣ Graves' disease.
₣ Chronic thyroiditis.
₣ Dermatitis herpetiformis.
₣ Vitiligo.
₣ Myasthenia gravis
What are the symptoms of Addison’s disease?
Symptoms of Addison’s disease include:
₣ Steadily worsening fatigue (most common

symptom).
₣ Patches of dark skin (hyperpigmentation),

especially around scars and skin creases and
on your gums.
₣ Abdominal pain.
₣ Nausea and vomiting.

₣ Diarrhea.
₣ Loss of appetite and unintentional weight loss.
₣ Muscle pain, muscle spasms and/or joint pain.
₣ Dehydration.
₣ Low blood pressure, which can cause
lightheadedness or dizziness upon standing.
₣ Changes in mood and behavior, such as
irritability, depression and poor concentration.
₣ A craving for salty food.
₣ Low blood sugar (hypoglycemia)
What causes Addison’s disease?
The most common cause of Addison’s disease is an

autoimmune response, which occurs when your immune
system attacks healthy tissues for an unknown reason.
With Addison’s disease, your immune system attacks the

outer portion of your adrenal glands (the adrenal cortex),
where they make cortisol and aldosterone. Symptoms don’t
usually develop until 90% of the adrenal cortex has been
damaged, which can take several months to years.
Approximately 75% of cases of Addison’s disease are
due to an autoimmune attack.
Autoimmune Addison’s disease may happen by itself or

as part of a rare, inherited syndrome, specifically
autoimmune polyendocrine syndromes I (APS type-1)
and II (Schmidt syndrome).
Causes of Addison’s disease include:
₣ Tuberculosis
₣ Repeated infections, including HIV/AIDS-related

infections and fungal infections.
₣ When cancer cells from another part of your body invade

your adrenal glands.
₣ Bleeding (hemorrhaging) into your adrenal glands.
₣ Surgical removal of your adrenal glands.
₣ Amyloidosis (a condition in which amyloid proteins build

up in vital organs, causing damage).
How is Addison’s disease diagnosed?
Healthcare providers often “accidentally” discover

Addison’s disease when a routine blood test, such as a
basic metabolic panel, shows low levels of sodium or
high levels of potassium.
Dark patches on your skin are another common

symptom that signals healthcare providers to test for
Addison’s disease.
What tests will be done to diagnose Addison’s disease?
To determine if you have Addison’s disease, your

healthcare provider may order the following tests:
Blood tests: measure the levels of sodium, potassium,

cortisol and ACTH in your blood.
ACTH stimulation test: This test measures your adrenal

glands’ response after you’re given a shot of artificial
ACTH. If your adrenal glands produce low levels of cortisol
after the shot, they may not be functioning properly.
Con’t…
Insulin-induced hypoglycemia test:

Test is done to determine if your symptoms are due to
problems with your pituitary gland (secondary adrenal
insufficiency) instead of your adrenal glands.
This test measures blood sugar (glucose) levels before

and after the injection of fast-acting insulin, which
should lead to a drop in blood sugar (hypoglycemia) and
a rise in cortisol.
Con’t…
Computed tomography (CT scan): maybe ordered a CT

scan to evaluate your adrenal glands and/or pituitary
gland. For example, it can show if your immune
system has damaged your adrenal glands or if the
glands are infected.
How is Addison’s disease treated?
Addison’s disease is treated by replacing the missing

hormones, cortisol and aldosterone, with synthetic
versions of them.
Cortisol is replaced by the drug hydrocortisone, and

aldosterone is replaced by the drug fludrocortisone.
Addison’s disease is a chronic condition, so you’ll need to
take medication for the rest of your life.
What is the prognosis for Addison’s disease?
The prognosis for Addison’s disease is generally good.
The dosages of these medications, however, need to be

closely monitored to prevent over- or under-treatment. Over-
treatment with glucocorticoids (hydrocortisone) may result in
obesity, Type 2 diabetes and osteoporosis. Over-treatment
with fludrocortisone can cause high blood pressure
(hypertension).
Up to 50% of people with Addison’s disease develop another

autoimmune condition.
Reference:
Cleveland Clinic (2022). Addison Disease.

https://my.clevelandclinic.org/health/diseases/15095-addisons-disease
Addison's disease (Adrenal insufficiency): Symptoms, Causes and Treatments

https://www.powershow.com/view0/878b6e-MzRiN/Addisons_disease_
Adrenal_insufficiency__Symptoms_Causes_and_Treatments_powerpoint_ppt_presentation

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NCM 116: Management of Client with Addison Disease

Upon completion of the lesson, the learners should be able;

1. Review the functions of the adrenal gland.

Addison’s disease is a chronic condition in which your

Cortisol is a hormone that helps your body respond to stress,

Addison’s disease is also called primary adrenal

People who have the following autoimmune disease are

₣ Steadily worsening fatigue (most common

₣ Patches of dark skin (hyperpigmentation),

₣ Nausea and vomiting.

The most common cause of Addison’s disease is an

With Addison’s disease, your immune system attacks the

Autoimmune Addison’s disease may happen by itself or

₣ Repeated infections, including HIV/AIDS-related

₣ When cancer cells from another part of your body invade

₣ Surgical removal of your adrenal glands.

₣ Amyloidosis (a condition in which amyloid proteins build

Healthcare providers often “accidentally” discover

Dark patches on your skin are another common

To determine if you have Addison’s disease, your

Blood tests: measure the levels of sodium, potassium,

ACTH stimulation test: This test measures your adrenal

Insulin-induced hypoglycemia test:

This test measures blood sugar (glucose) levels before

Computed tomography (CT scan): maybe ordered a CT

Addison’s disease is treated by replacing the missing

Cortisol is replaced by the drug hydrocortisone, and

The prognosis for Addison’s disease is generally good.

The dosages of these medications, however, need to be

Up to 50% of people with Addison’s disease develop another

Cleveland Clinic (2022). Addison Disease.

Addison's disease (Adrenal insufficiency): Symptoms, Causes and Treatments

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