Cushings and Addisons Nursing | Addison's Disease vs Cushing's Syndrome Nursing | Endocrine NCLEX



hey everyone its ears register nurse Orion comm and in this video I'm going to be going over the differences between Addison's disease and Cushing's this is part of our endocrine series that we're going to be doing for an NCLEX review so what I want to do for you is I'm going to break this material down I'm going to go over the causes the signs and symptoms and the nursing interventions and I'm going to go over the things specifically you need to know for the ink Lexx exam and your nursing lecture exams and give you some clever mnemonics on how to remember these things now after this video be sure to go to my website register nurse Orion calm and take the free quiz that will test your knowledge on Cushing's versus versus Addison's and a card should be popping up where you can access that quiz so let's get started let's begin by talking about the key players in these two endocrine disorders the key players are the adrenal cortex and steroid hormones specifically aldosterone and cortisol okay so let's talk about the function of each of these key players because if you can see what they normally do in the body then the signs and the symptoms and the nursing interventions will all make sense so let's talk about the role of the adrenal cortex the adrenal cortex is located on top of the kidneys in their Drina glands this purple area right here is your adrenal glands and inside that is adrenal cortex and the adrenal cortex releases these steroid hormones it releases corticosteroids such as aldosterone and cortisol aldosterone is also known as a mineral corticoid and cortisol is also known as a glucocorticoid and it also releases sex hormones so your adrenal cortex releases your corticosteroids and texts hormones now let's look at the function about aldosterone and quarters all those that is what we are most interested in in these two endocrine problems okay what's the function of aldosterone aldosterone regulates our blood pressure through the renin-angiotensin-aldosterone system so it keeps our blood pressure nice and regulated and if anything happens to your old dosterone levels if I salt that whole system so you're going to either have high blood pressure or low blood pressure it also throne plays a role in retaining sodium so if you have too much aldosterone you're going to be retaining way too much sodium and vice versa if you have too low and it also secretes potassium so aldosterone is regulating our potassium and sodium level so anything that's thrown your aldosterone off is going to throw those levels off now let's look at the function of cortisol cortisol is known as the stress hormone commit that to memory whenever you get stressed your body releases cortisol so it helps your body deal with stress for instance any illnesses you have which is stress on your body or even external stress going on in your life cortisol is our stress hormone it helps us and it also increases blood glucose by metabolites by metabolizing sugars that you eat and it breaks down fats proteins and carbs and it regulates electrolytes so if you have any problems with too high cortisol levels or too low these things are going to be thrown out of whack for instance if you have high cortisol levels you're going to have crazy high blood sugars elevated glucoses and here a second whenever we go over Cushing's and Addison's you will see why you are having them based on the production of each steroid hormone but first let's go over this real fast because I want you to see this because this plays a role in especially Cushing's syndrome this is the negative feedback control now we talked about this in SIADH and diabetes insipidus a little bit but here is the negative feedback control and what you have all this works together in secreting your steroid hormones and if you have a little glitch somewhere up the line it's going to mess up how cortisol and those other hormones are released so let's go over that real fast so you can be familiar with it okay in your brain you have your hypothalamus and your hypothalamus releases cr8 which is a corticotropin release then whenever it releases that the pituitary gland releases an ACTH so commit that to memory because we're going to go over that a little bit later and that is your adrenocorticotropic hormone which causes the adrenal cortex to release cortisol so that is just the negative feedback of how everything works now let's go over the differences between Cushing's and Addison's disease the biggest thing that really confuses people on Cushing's and Addison's is knowing which hormone is elevated which hormones not elevated and what's going on in it so what I want to do is I want to break it down for you and give you some ways on how to remember that because that's the biggest thing that will really confuse people on a test okay so let's look at Cushing's Cushing starts with a C and in Cushing's you have an increased secretion of cortisol what was cortisol again it was that stress hormone how I remember this is Cushing starts with C and it's only dealing with one thing and it's dealing with cortisol aldosterone does not play a role in this just cortisol so just commit that to memory cortisol cortisol starts with C and Cushing starts with C and it's just dealing with one of them and you have an increased secretion and think of Cushing's cushion you have a cushion there's two you have a lot of padding you have a lot going on so remember that you have an increased secretion of cortisol now let's flip it over to Addison's disease this is where you have a lower hypo secretion of cortisol and aldosterone so you're dealing with both cortisol the stress hormone and aldosterone how I remember this is um Addison's you have the word ad the first three letters ad D and um you're dealing with to stress for us two steroid hormones so you had to add some Addison's add some you had to add a steroid hormone in there which is aldosterone and it starts with an A and so does Addison so both of these deal with cortisol but this one Addison's because you added one deals with aldosterone okay so what causes Cushing's now you have probably heard of Cushing's syndrome and Cushing disease they both present with the same the same signs and symptoms but they are a little bit different based on what is causing it so let me go over that for you real fast okay touching syndrome Cushing syndrome is you have this whenever there is an outside cause meaning that there is something causing the body to produce too much cortisol and this is usually due with due to a medication treatment of glucocorticoids like prednisone the patients on a prednisone therapy and it causes them to go into Cushing syndrome now you have Cushing's disease whenever it's caused by an inside source or something wrong inside the body for instance like the pituitary gland is producing too much of that ACTH hormone so that's why I wanted to go over that negative feedback thing so um what happens is that your pituitary gland produces the adrenocorticotropic hormone the HC th and whenever you have too much of that being to crease secreted that causes your cortisol levels to shoot up to produce too much so that would be an inside source pituitary gland is causing that so that is the difference between those now causes of Addison's disease typically this is an autoimmune disorder this is where your body is just attacking that adrenal cortex on top of in the adrenal gland and this can be due to cancer tuberculosis or hemorrhaging due to like a car accident trauma something and dramatically affected the adrenal glands okay so now let's go over the signs and symptoms this is what you really really need to know for NCLEX and for your nursing lecture exams because it's going to give you scenarios and say which of the following patients is presenting with Cushing's or how to sense or something like our which thing is not a sign of symptom of this disorder for Cushing's syndrome let's remember the word stress because with this you have increased secretion of cortisol that stress hormone so for the first s they will have a skin that is fragile it'll bruise easily it'll tear so you wanna provide meticulous skincare tea they'll have the truncal obesity with really small arms and legs they'll be really thick up in their abdomen and back area are they will have a round face they term it as the moon face where their face is really really full especially in the cheek areas another are they will have reproductive issues females will not have a ministration and males could have a rectal dysfunction efore ecchymosis they bruise easy goes back to the skin is fragile and the other either they'll have hypertension elevated blood pressure as for striae on the extremities this sort of looks like stretch marks and it's purplish they will have it on their arms and on their abdomen and the key with that is that it looks purplish in color and other s they will have sugars will be very high they will have hyperglycemia because remember cortisol deals with metabolizing your glucose so if you have way too much cortisol levels you're going to have a lot of glucose metabolizing and you're gonna have increased sugars efore excessive body hair females will have a start to take on male characteristics and will have facial hair back hair as males and the D last part D they'll have the door so cervical fat pad which is known as the Buffalo Hump and it's where on the back they accumulate a lot of fat and it appears to be a buffalo hump on an animal and the last day they will have depression mainly due to everything that's going on those high cortisol levels but also because of their appearance of what's going on with the cortisol levels causing them to accumulate fat in places you normally don't keep me like that okay now let's look at the signs and symptoms of Addison's disease okay with this remember you had hypo secretion of cortisol and aldosterone so we have low steroid hormones so what we're going to remember we're going to remember the phrase low steroid hormone specifically steroid so um how they will have first s they will have and sugar levels will be very low and again that goes back to your cortisol cortisol plays a role in metabolizing the glucose you have low levels of it you're not going to really be metabolizing glucose so you're not going to have a lot of sugar so you're gonna have hypoglycemia and your sodium aldosterone remember plays a role in retaining sodium so if you don't have a lot of adèle aldosterone in the body you're going to have low sodium levels so you're going to have hyponatremia and another s they will have salt cravings because their sodium levels are so low so they'll actually be craving salt okay t4 tired and they'll be tired to have muscle weakness efore electrolyte imbalances and again that just goes back to your aldosterone they have low levels of adèle dosterone aldosterone plays a role in regulating the sodium and potassium levels so they'll have high potassium hyperkalemia and hyponatremia and they can also have high calcium levels because in our electrolyte video series we talked about how hyperkalemia and hypokalemia go hand-in-hand with one another okay are they will also have reproductive changes where women will have periods but they'll be very irregular scattered and males will also have erectile dysfunction as well oh and the word low the oh and low low blood pressure and these patients are very much at risk for vascular collapse going into shock and again that plays a role with that renin-angiotensin-aldosterone system an eye for increased pigmentation of the skin so they're going to have like a brownish hyperpigmentation of the skin remember that that's one of the hallmark signs of this Addison's and in Cushing's remember they had the purple stripe on their skin and D for diarrhea and depression nausea okay this is another important section that you'll want to remember just like the signs and symptoms because this is where a lot of test questions come from so what I'm going to do is highlight the things that you need to know okay so let's look at the Cushing's syndrome what are we going to do for Cushing disease Cushing's syndrome or the nursing interventions okay remember before we talked about Cushing disease how the pituitary gland was really seen too much of that ACTH hormone which is causing that cortisol to shoot up so typically you will be prepping the patient for a hypo physik t'me which will remove that pituitary tumor which will help cure that and bring those cortisol levels down or if it's with and due to a tumor on the Drina l– glen they will go for an adrenal ectomy where they'll actually remove the adrenal gland now with this remember this very important whatever patients have this procedure done they usually have to go on therapy for cortisol treatment because they're not going to be producing it by themselves anymore because their adrenal gland produces it so they'll have to go on some type of hormone replacement therapy with that so educate them about that and it's something that they're going to have to be taking okay also with these patients you'll want to watch further increased blood shares we monitoring that routinely their low potassium level so looking at those electrolytes watching them for signs and symptoms of infection because their body is really stressed out they got a lot of cortisol going on their skin breakdown and most importantly the emotional support and this is mainly due to an appearance due to that moonface the Buffalo Hump things like that so just being there for them emotionally with what's going on now let's look at the nursing interventions for Addison's disease where you going to do for this patient okay you want to make sure you're monitoring them for hypoglycemia and hyperkalemia because those are going to be out of whack I'm a big part that you definitely want to remember is the pharma logical aspect of that because what's going on with this patient is that they have low cortisol and aldosterone levels so we need to give that to them synthetically so they can have those hormones so they have low cortisol levels so we're going to replace cortisol levels and generally that's in the drug form of prednisone or hydrocortisone education pieces because as a nurse you're always educating the patient about their medications you want to let them know that if all of a sudden they get sick they're going to have surgery or they're having extra external stress in their life they need to know notify the doctor because remember cortisol is our stress hormone it helps us deal with stress and dr. may have to increase their dosage prednisone how to cortisone just to help them cope during those times because they can't produce that themselves also let them know it's very important you take this medicine regularly you just do not abruptly stop that you take them regularly you don't take them as Anita just take them according to the dosing schedule okay for replacing aldosterone generally the doctors may prescribe fluorine f and an education piece with that is that they just need to make sure that they consume adequate salt levels because their sodium's are already the sodium levels already low so they want to make sure while they're taking this drug that they're consuming enough salt okay other things as to go along with this you need to make sure that they get a medic alert bracelet because these patients are at risk if they're not complying with their medicines or their dosage isn't high they can go in to add a sodium crisis which will go here in a second pass out someone can find them don't know what's wrong with them but they have the bracelet and tells them that they have Addison's then the help EMT everyone provide better care to them also another important thing is their diet they need to eat a diet high in protein and carbs and normal sodium sodium because remember your cortisol is responsible for breaking down those fats and proteins and carbs so they have low levels of cortisol so they need to make sure that they are consuming a great diet in that they need to avoid stress and strenuous exercise and illness again that goes back to because they're low in cortisol and cortisol is our stress hormone and they can't tolerate that now as a nurse you need to watch out for the at Estonian crisis which is known as an adrenal gland crisis and this happens whenever either the patient hasn't taken their medication properly or and they just haven't had enough dosage and what's happened is that there is absolutely barely any cortisol levels left so they are low and this is life-threatening so remember the five s is to help you remember this all of a sudden they will get sudden pain specifically in their abdomen the stomach the back or the legs syncope they'll be unconscious shock chok they'll have really low blood pressures there at vascular collapse the other s super low blood pressure and then the last s severe vomiting diarrhea and a headache now treatment for this okay so think of this why did they go into this because their cortisol levels are like nothing so what do they need they need cortisol the best and fastest way to give that to them is IV cortisol ASAP and typically that is called Saul you quart F and the physician will order that for you to give IV you'll give that IV push and start on IV fluids that is because they're literally they have a low blood pressure they're on vascular collapse and they are going into shock they have low sugar and so that typically what they prescribe is d5 normal saline which will help increase that sugar increase that sodium increase fluid size increase that blood pressure and these patients who are in this are definitely at risk for infection so you'll want to watch that so that is the differences between Addison's and Cushing's now going to take that free quiz on my website registered nurse Orion comm and check out my other videos on the endocrine system for Inc Lex review and thank you so much for watching and consider subscribing to this YouTube channel

27 comments

  1. Hey Everyone! Thank you for watching! Don't forget:

    Quiz: https://www.registerednursern.com/addisons-disease-vs-cushings-syndrome-disease-nclex-quiz/

    Notes: https://www.registerednursern.com/addisons-disease-vs-cushings-review-notes-for-nclex/

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  2. I'm only here because I have Addison's disease and my doctor keeps quizzing me about it and is mad I don't know anything 😂

  3. hi Sara!! thank you so much for all your great videos.. in 3 days we will test for our own nclex here in Israel and Iv'e learned so much from you. thank you!!!!!!

  4. I am an LPN so I was doing home care visits and listening to your videos for content review for my exit hesi and thanks to you I PASSED!!! Love your videos

  5. Thank you so much, I cannot emphasize enough how much you have helped me understand these complicated topics numerous time while in Nursing School, I am forever grateful!. Keep up the amazing work 🙂

  6. you are my hero!. I have been out of nursing for 30years and have decided to return by retaking the NCLEX exam to reinstate. Your videos and tips are the best!!

  7. Just let you know your name comes up a lot. Pretty much everyone I talk to watches your videos. I watch you pretty much, listen to you while I drive haha. Thanks for your help. =)

  8. I don’t understand why u have only 400k subbies u need more cause all of your videos have helped me soooooooo much through my nursing school journey

  9. I have been misdiagnosed pan hypo pituitary for 30 years I have suffered terrible pain and all of the symptoms you mentioned for Addison crisis. The medicos here don’t know enough about this disease. I did my research and then got tested holistically recently and now I’m on cortisol and I’m way better but still struggling with fatigue and illness, and depression. It’s a tough gig to have to deal with, but I’m still trying to have a normal life.

  10. Thank you so much for all your videos! They are amazing and they really help me to understand tough subjects like the endocrine system. I'm only a few months away from taking my NCLEX-LPN and I know that everything you do will be a huge help!!!! Thank you!

  11. I love all your videos, I am currently in a BSN program and watching your videos has helped me soooo much. I really appreciate the work that you do. I'm sure you're just as great of a nurse.

  12. When I pass my last few semesters and the NCLEX I am going to send you a fruit basket… or scotch your call

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