00:01
Now we're going to discuss Addison's disease.
00:04
We have a picture of an American
president, JFK up there,
because he actually suffered from this disease.
00:11
We weren't as efficient at
treating it when he had it,
but Addison's disease is adrenal insufficiency.
00:18
That means that your adrenal gland is not
able to put out those adrenal hormones.
00:23
Now, in Addison's disease, you have that because
you've had some type of autoimmune disorder,
but I'm going to tell you why
it's important that nurses
who are giving corticosteroids
understand Addison's.
00:35
Now, under normal conditions,
a healthy adrenal gland will put out
cortisol and aldosterone and adrenaline.
00:43
In Addison's disease, that adrenal
gland has kind of been eaten up.
00:47
It's been destroyed by some
type of autoimmune disorder,
so there are insufficient
amounts of these hormones.
00:54
There's not enough for what the body needs.
00:57
When the body's adrenal gland has been
eaten by that autoimmune disease process,
then it's called Addison's disease.
01:05
Again, you're thinking, "Why are we talking about
a disease when we're studying corticosteroids?"
Well, an adrenal gland that's been
destroyed by an autoimmune disease,
and sadly, about 90% of it gets destroyed before
we realize or often recognize what's going on,
is similar to what happens to a
patient who's on corticosteroids
and then abruptly stops taking them.
01:30
Okay, now, let's go back to the
disease for just a minute.
01:34
The primary cause is the adrenal gland gets
knocked out by some autoimmune disease.
01:38
The secondary cause is the anterior
pituitary doesn't produce enough ACTH
to stimulate the adrenal glands.
01:47
Okay, this is a great place for a question.
01:49
Let's see if you can think back if
you've watched our other video series.
01:54
What are the glands and organs involved
in going from the hypothalamus
to the adrenal gland secreting those hormones?
So stop the video for just a minute,
and see if you can write down the process from
hypothalamus to those adrenal hormones.
02:18
Okay, now take a look at your answer.
02:20
Remember, the hypothalamus puts out CRH.
02:24
Its target is the anterior pituitary.
02:27
Now, if the anterior pituitary receives that CRH,
it's supposed to send out ACTH
whose target is the adrenal gland.
02:35
So a secondary cause of Addison's
disease is an anterior pituitary gland
that doesn't produce enough ACTH.
02:42
Because it doesn't produce enough ACTH,
it doesn't stimulate the adrenal gland
to secrete enough of its hormones.
02:50
But let's go back and review.
02:53
Primary cause of Addison's disease
is an adrenal gland malfunction,
usually caused by an autoimmune disorder.
03:00
The secondary cause, we don't see it as often,
is the anterior pituitary gland isn't
producing enough of that hormone
that stimulates the adrenal gland.
03:10
Remember, we're talking about Addison's
disease because it looks just like a patient
who's been taking corticosteroids
and didn't wean them.
03:20
They stopped it abruptly.
03:22
So, let's talk about why adrenal
insufficiency or Addison's disease,
why this is a problem in your body.
03:29
This is going to be the opposite of
what people experience in Cushing's.
03:33
They don't have mood swings because
they're too tired to care.
03:40
They're going to have tachycardia
because unlike Cushing's where you
might have extra volume on board,
these patients are going to
have less volume on board.
03:49
And 1 way you'll notice that is that they'll have
a lower blood pressure and a faster heart rate.
03:55
That's the tachycardia and low BP.
03:58
That's caused from the dehydration.
04:00
Remember, one of the hormones of
your adrenal gland is aldosterone.
04:05
That's the one that tells your body to
hang on to sodium and water follows.
04:09
Somebody with Addison's disease doesn't have
that, so that's why they're dehydrated.
04:15
Their body doesn't know to hang on
to that sodium and it can't respond,
which is why they have less volume
in their intravascular space.
04:23
Less volume in your intravascular
space means a lower blood pressure,
so your body tries to move it around faster,
that's why you have the tachycardia.
04:31
So, the less sodium you have, means
you'll hang on to potassium.
04:36
Those levels will be higher.
04:38
They kind of have that imbalance.
04:40
So, for a patient who has Addison's disease,
this is when they're getting into trouble.
04:46
This is when they don't have
enough hormone replacement.
04:50
It's the same thing when someone
who has taken corticosteroids,
their adrenal gland has
become a little suppressed.
04:57
Their adrenal gland is also not
going to be able to put out
the right amount of hormones
because it's been suppressed.
05:05
So they'll crave salty foods.
05:07
I mean, most of us like salty foods,
but they're just flat low in sodium,
and so their body will be screaming for it.
05:15
You start messing with someone's sodium level,
and then we get into things
like nausea and vomiting.
05:19
They even might have some diarrhea.
05:21
That's a bad news because they --
losing fluid already, they're
already dehydrated,
and if they end up with diarrhea,
they're going to lose even more fluid.
05:31
So these people might be really
dizzy, have a hard time walking,
increased risk for falls
and hurting themselves.
05:38
And lastly, remember that you had
high blood sugar in Cushing's,
you're going to have the opposite in
Addison's, so you have low blood sugar.
05:48
So, really, once you think through these symptoms,
what excess is is just going
to be the complete opposite
when we're looking when a
patient doesn't have enough.
05:58
Now, they're gonna have muscle weakness.
05:59
Again, we have that electrolyte imbalance.
06:01
I mean, there is so much going
on in both of these situations.
06:07
But don't let it get you confused.