Editing Medical-Surgical Nursing (section)

=== Adrenal Disorders ===

Addison disease is adrenocortical insufficiency, producing fatigue, weakness, anorexia and weight loss, hypotension, salt craving, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypovolemia. Addisonian crisis is precipitated by stress, infection, or abrupt withdrawal of corticosteroids and presents with profound hypotension and shock; treatment is immediate intravenous fluids with sodium and glucose and intravenous hydrocortisone.

Cushing syndrome results from cortisol excess, producing truncal obesity with thin extremities, a moon face and buffalo hump, purple striae, thin fragile skin with easy bruising, hyperglycemia, hypertension, hypokalemia, osteoporosis, muscle wasting, and impaired immunity.

Nursing application: patients on long-term corticosteroids never stop them abruptly, need increased doses during physiologic stress, should take them with food, and require monitoring for hyperglycemia, infection, and gastrointestinal bleeding.

Pheochromocytoma, a catecholamine-secreting tumor, causes severe episodic hypertension with headache, palpitations, and diaphoresis. Do not palpate the abdomen, because palpation can trigger a hypertensive crisis.