If you or a loved one faces an endocrine disorder, it is important to understand the various choices available for treatment. Cushing’s and Addison’s disease are two endocrine disorders that share many characteristics but also have differences.
While typical symptoms tend to overlap – including fatigue, muscle weakness, weight loss/gain, mood swings – there are distinct distinctions in diagnosis tests and treatments when looking at Cushing’s Disease versus Addison’s Disease. Understanding these diseases can help determine your best course of action when it comes to finding relief from their debilitating symptoms.
In this blog post, we will discuss the overviews of both Cushing’s and Addison’s with distinct comparison points so you can make informed decisions should either one ever affect your life or that of someone close to you.
Table of Contents
What is Addison’s Disease?
Addison’s Disease is a rare but serious condition that is caused by the adrenal glands not producing enough hormones. These hormones are essential to many bodily functions, including regulating blood pressure and controlling blood sugar levels. Without them, a person can experience a range of symptoms, such as fatigue, weight loss, and muscle weakness.
The disease is named after Thomas Addison, the physician who first described it in the mid-19th century. While it can be challenging to diagnose, treatment options are available, including hormone replacement therapy. If you or someone you know experiences symptoms of Addison’s Disease, seeking medical attention is essential.
Causes
- Autoimmune diseases
- Tuberculosis
- Neoplasms
- Inflammatory necrosis
- Amyloidosis
- Hemochromatosis
- Waterhouse-Friedrichsen syndrome following the meningococcal septicemia
- Bilateral adrenalectomy
What is Cushing’s Disease?
Cushing’s Disease is a disorder resulting from an excess production of cortisol, which is a hormone that helps regulate blood sugar and stress levels. It can be caused by either an overactive adrenal gland or a tumor in the pituitary gland. Symptoms vary widely but can include weight gain, fatigue, and muscle weakness.
Cushing’s Disease is typically diagnosed through a blood test or urine test that measures the levels of cortisol in the body. Treatment options include medications and/or surgery to correct the underlying cause of the disease.
Causes
- Adrenal adenomas
- ACTH independent macronodular hyperplasia
- Iatrogenic causes, such as the long-term administration of glucocorticoids
- Malignancies such as bronchial carcinomas, adrenal carcinomas, and small cell lung carcinomas
- Alcohol excess
- Pituitary adenomas – when the clinical characteristics are due to a pituitary adenoma, that condition is named the Cushing disease
- Depressive ailments
- Primary obesity
Key Difference – Cushing’s vs Addison’s disease
It is essential to recognize the distinction between Addison disease and Cushing syndrome in order to appropriately diagnose and treat them. These two endocrine disorders share one main difference –
Addison disease involves a hormonal deficiency of cortisol and aldosterone whereas Cushing syndrome is characterized by an elevated level of cortisol.
Consequently, the treatment for each condition varies significantly and should be tailored to meet individual needs. Therefore, it is important to be aware of the differences between these two conditions in order to receive accurate diagnosis and successful treatment.
Now let’s take a look at how these diseases compare:
Addisons vs Cushings Diagnosis Tests Difference
While both conditions can be diagnosed through blood and urine tests, Cushing’s Disease requires more specific testing to provide an accurate diagnosis.
Addison’s Diseases Diagnosis Tests
- FBS decreased (N= 80-120 mg/dl)
- Serum Na decreased (N= 135-145)
- Serum K elevated (N=3.5-5.5meq/L)
- Plasma cortisol decreased
Cushing’s Diseases Diagnosis Tests
- FBS elevated
- Elevated Na
- Decreased K
- Elevated Cortisol
Cushing’s vs Addison’s Predisposing Factors Difference
Addison Predisposing Factors
- Atrophy of the Adrenal gland
- Fungal infections
Cushing Predisposing Factors
- Hyperplasia of Adrenal gland
- Tubercular infection (MILIARY – TB to adjacent organs)
Cushing vs Addisons Treatment Difference –
While both diseases require hormone replacement therapy, the treatments for each condition differ. Addison’s Disease is typically treated with oral hormones whereas Cushing’s may require surgical intervention in addition to medication.
Addison’s vs Cushing’s Symptoms Difference –
Both diseases share similar symptoms, including fatigue, weight loss/gain, and mood swings. However, Cushing’s Disease is more likely to cause facial hair growth in women and easy bruising in both men and women.
Nursing Consideration For Addisons Disease
Nursing Assessment
Assess for the following subjective and objective data:
- Fatigue and weakness
- Chronic or recurrent muscle aches and pains
- Decreased appetite or weight loss
- Nausea or vomiting
- Abdominal pain or discomfort
- Dizziness or lightheadedness
- Salt cravings
- Mood changes or depression
- Darkening of the skin (hyperpigmentation)
- Hypotension, tachycardia
- Dehydration signs, such as dry mucous membranes or decreased skin turgor
- Weight loss or low body mass index (BMI)
- Low levels of cortisol and aldosterone
Nursing Diagnosis
- The risk for infection related to immunocompromise as evidence by fever
- The risk for volume depletion related to salt wasting as evidenced by low serum sodium
- Alteration in perfusion related to hypotension as evidenced by low blood pressure
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with Addison’s disease may include:
1. Managing Fluid Volume: Monitor and document vital signs, intake/output, urine specific gravity and electrolytes.
2. Administering Medications: Give prescribed hormone replacement therapy in the morning to replace the hormones that are deficient due to Addison’s disease.
3. Monitoring Labs: Monitor cortisol levels as well as electrolyte levels on a regular basis, as they may vary with Addison’s disease.
4. Teaching Patient Self-Care: Provide education to the patient and family about lifestyle changes that can help prevent exacerbations of the condition, such as eating a balanced diet and avoiding extreme stress.
5. Monitoring for Infections: Monitor for any signs or symptoms of infection, as immunocompromised patients are more prone to infection.
6. Encouraging Physical Activity: Encourage physical activity or exercise at a level the patient is comfortable with, as this can help to manage stress levels and maintain muscle strength.
7. Managing Stress: Help patients learn to identify and manage activities that increase their stress levels in order to reduce risk factors for exacerbations of the condition.
8. Monitoring for Complications: Monitor for any signs or symptoms of possible complications associated with Addison’s disease, such as adrenal crisis.
9. Providing Supportive Care: Provide supportive care and emotional support to the patient and their family during this difficult time.
10. Referrals: Make referrals to other healthcare professionals, such as dietitians or psychologists, if needed.
11. Providing Follow-up Care: Arrange for follow-up appointments with the patient’s primary healthcare provider to discuss any changes in symptoms or medication requirements.
Nursing Consideration For Cushing Disease
Nursing Assessment
Assess for the following subjective and objective data:
- Weight gain (especially in trunk, face and neck) with thinning arms and legs
- Skin changes such as striae (red or purple stretch marks), easy bruising, hirsutism (excess hair growth), acne, poor wound healing
- Bone pain and muscle weakness
- Mood swings, depression, irritability
- Headaches and dizziness
- Excessive sweating
- Decreased libido
- Adrenal hyperplasia or adenoma on imaging studies
- High levels of cortisol and ACTH
Nursing Diagnosis
Alteration in comfort related to physical changes caused by Cushing’s disease as evidenced by patient reports of bone pain and muscle weakness.
Alteration in thought processes related to anxiety caused by Cushing’s disease as evidenced by patient verbalization of mood swings and irritability.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with Cushing’s Disease may include:
1. Administering Medications: Administer prescribed hormone replacement therapy as ordered.
2. Monitoring Hormone Levels: Monitor cortisol and ACTH levels regularly to assess the effectiveness of treatment, as levels may vary with Cushing’s Disease.
3. Education Patient Self-Care: Educate the patient and family about lifestyle changes that can help prevent exacerbations of the condition, such as eating a balanced diet and avoiding extreme stress.
4. Teaching Stress Management Strategies: Assist patients in identifying activities that increase their stress levels in order to reduce risk factors for exacerbations of the condition.
5. Monitoring for Complications: Monitor for any signs or symptoms of possible complications associated with Cushing’s disease, such as infection, bone fractures or MILIARY – TB to adjacent organs.
6. Providing Follow-up Care: Arrange for follow-up appointments with the patient’s primary healthcare provider to discuss any changes in symptoms or medication requirements.
7. Referral to Other Healthcare Professionals: Make referrals to other healthcare professionals, such as dietitians or psychologists, if needed.
8. Providing Supportive Care: Provide supportive care and emotional support to the patient and their family during this difficult time.
9. Monitoring for Weight Changes: Monitor patient’s weight and nutrition intake in order to ensure they are receiving adequate nutrition and calories to support their activities of daily living.
10. Encouraging Exercise: Encourage physical activity or exercise at a level the patient is comfortable with, as this can help to manage stress levels and maintain muscle strength.
11. Assessing Skin Integrity: Assess skin integrity for any signs of infections or bruising due to air growth in women and easy bruising in both men and women.
12. Identifying High Risk Patients: Identify patients who may be at high risk for complications from Cushing’s Disease, such as those with diabetes mellitus or hypertension. These patients should be monitored more closely.
13. Providing Education on Risk Factors: Provide education to the patient and family about risk factors for Cushing’s Disease, such as stress, alcohol consumption, smoking and exposure to certain medications or chemicals.
14. Monitoring for Hypokalemia: Monitor for any signs of hypokalemia including fatigue, muscle weakness, cramping, nausea or vomiting due to excess cortisol production associated with Cushing’s disease.
15. Monitoring for Hyperglycemia: Monitor for any signs of hyperglycemia which may include increased thirst, frequent urination and fatigue due to excess cortisol production associated with Cushing’s disease.
16. Assessing Cognitive Function: Assess for any changes in cognitive function and memory which may occur due to Cushing’s disease.
17. Assessing Mental Status: Monitor patient for signs of depression or mood swings associated with the condition.
18. Providing Encouragement and Support: Provide encouragement and emotional support to the patient and their family as they navigate through this difficult experience.
19. Promoting Healthy Habits: Promote healthy habits such as adequate rest, balanced diet, regular exercise, relaxation techniques and stress management strategies to help manage symptoms of Cushing’s Disease.
20. Reviewing Treatment Options: Discuss available treatments for Cushing’s Disease, including medication, surgery or radiation therapy to reduce cortisol levels.
21. Referring to Support Groups: Make referrals to support group programs or online resources that can provide additional assistance and information for the patient and their family.
Final Words
Addison vs. Cushing’s disease can be confusing and difficult to distinguish. Nurses need to understand each condition’s different signs and symptoms to provide timely, appropriate care. With the right assessment, diagnosis, interventions, and follow-up care, patients with Cushing’s Disease can lead healthier lives.
The key for nurses is effective communication with all healthcare team members, including physicians and other specialists, to ensure accurate diagnosis and treatment of Cushing’s Disease.
Nurses should also strive to provide mental health support for their patients as this illness is often accompanied by depression or anxiety, which may need further management through counseling or therapy sessions. It is also essential for nurses to discuss available treatment options with their patients for them to make informed decisions about their care.
Finally, nurses should provide follow-up care and monitor for any changes in symptoms while encouraging emotional support to the patient and family members throughout the process.
References
https://my.clevelandclinic.org/health/diseases/15095-addisons-disease#:~:text=What’s%20the%20difference%20between%20Addison’s,too%20much%20cortisol%20(hypercortisolism).
https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.