Addison Disease (Primary Adrenal Insufficiency)

Addison disease is primary adrenal insufficiency: the adrenal cortex cannot produce enough cortisol and, when aldosterone secretion is also lost, cannot maintain normal sodium and water balance. Cortisol supports vascular responsiveness, glucose availability, and the response to physiological stress. Aldosterone normally promotes sodium retention and potassium excretion. Deficiency therefore creates a recognizable pattern of fatigue, weakness, weight loss, low blood pressure or postural symptoms, salt craving, hyponatremia, hyperkalemia, and sometimes hypoglycemia. Increased ACTH caused by loss of cortisol feedback can produce hyperpigmentation, which supports a primary rather than central cause. The immediate nursing question is not whether every diagnostic criterion has been completed; it is whether an adrenal crisis may be developing. Crisis can present with circulatory shock or collapse, low blood pressure, confusion or another altered mental state, marked weakness, feverishness, abdominal pain, vomiting or diarrhea, hypoglycemia, hyponatremia, hyperkalemia, or failure to improve with initial treatment. If crisis is suspected, activate the emergency or rapid response team and notify the physician or nurse practitioner immediately. Give prescribed or protocol-directed parenteral hydrocortisone and isotonic fluid without waiting for confirmatory results,...