1. Emergency Care: Addisonian Crisis & Adrenal Insufficiency

2. Addisonian Crisis • Addisonian Crisis is an acute exacerbation of symptoms in someone with Addison’s disease (namely adrenal insufficiency) • Whereas Cushing’s syndrome is seen in patients with excess corticosteroids, Addison’s disease is seen in someone with a deficiency in corticosteroids.

3. Addison’s Disease • Much like Thyroid disease, Addison’s disease is failure of some aspect the complex system of hormones and feedback loops • Also, like Thyroid disease, there may be dysfunction as these hormones and messengers interact with the hypothalamus, pituitary and the site of hormone release (in this case the adrenal glands)

4. Adrenal Function Summary The Adrenal Gland releases… Androgens (sex hormones) Mineralocorticoids Glucocorticoids Glucocortoicoids (most potent is cortisol) Action: anti-inflammatory, growth suppressing, affects sleep patterns & awareness, stress response Mineralcorticoids (Aldosterone) Action: Manages sodium/potassium balance

5. Connecting the dots…

6. Addison’s Disease Addison’s disease can be a lack of all three hormones or just glucocorticoids and androgren Caused by: • Destruction of the adrenal glands by infection • Autoimmune attack • Mutation in the ACTH receptor on adrenal cells

7. Addisonian Crisis • Triggered by anything that increases the person’s normal stress level: surgery, infection, emotional trauma, physical trauma as well as sudden withdrawal from sterioids or post-adrenalectomy • The body is unable to release sufficient cortisol to respond appropriately • Result is: Hypotension, tachycardia, dehydration, hypoglycemia, hyponatremia, hyperkalemia, fever, weakness & confusion • May lead to shock & vascular collapse

8. Worksheet • Review the provided education sheet from the Addison’s Disease Self-Help Group • http://www.adshg.org.uk/info/manual/crisismanagement.pdf • Review the last three slides • Fill in your worksheet

9. Addisonian Crisis: Education/Nursing Care • Prevention through careful titration of steroids • “Steroid coverage” for stressful events (i.e. preoperatively, hot weather, flu, etc.) • Patient, family, friends aware of signs/symptoms of crisis • Wallet card/med alert bracelet explaining condition, medications, and how to respond in an emergency

10. Addisonian Crisis: Education/Nursing Care • Treatment focuses on getting patient the cortisol they need to have their body respond appropriately (PO, IV, IM routes) • Patient should always carry emergency dose, usually 100mg IM hydrocortisone • Return demonstration with normal saline before discharge

11. Highly Recommended !!! • Review Corticosteroid Therapy on pp. 1332-1334 • Probably don’t remember the information from when you were in Pharm • Will help you on test and on NCLEX • Key information in caring for patients who are taking corticosteroids