Commonly confused in nursing
Addison's Disease vs Cushing's Syndrome
The NCLEX hands you a lab panel — K+ 5.8, Na+ 130, glucose 58, BP 82/50 — and asks which adrenal disorder fits. Every value in Addison's flips in Cushing's. Reversing the electrolyte or glucose direction sends you to the wrong answer and the wrong intervention.
Which One Is It?
1 / 4 · score 0The finding: Bronze hyperpigmentation (↑ ACTH)
Side-by-side comparison
Side-by-side2 compared
Focus
Dimension
Addison's Disease
Cushing's Syndrome
Pathophysiology & risk
- ↓ Cortisol + ↓ aldosterone
- Autoimmune adrenal destruction (#1)
- Crisis trigger: steroid stop, illness
- Cortisol excess
- exogenous steroids #1 cause
- Pituitary or adrenal tumor
Signs & symptoms
- ★Bronze hyperpigmentation (↑ ACTH)
- Weight loss, fatigue
- salt craving, orthostasis
- ★Purple striae, easy bruising
- Central obesity, moon face, buffalo hump
- Thin limbs, muscle wasting
Diagnostics & labs
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol
- No cortisol rise on ACTH stim test
- Hypernatremia + hypokalemia
- Hyperglycemia
- Cortisol not suppressed by dexamethasone
Nursing priorities
- Prevent adrenal crisis
- monitor for shock
- Monitor for hyperkalemia, hypoglycemia
- Infection surveillance (masked signs)
- Fall precautions (osteoporosis)
- Monitor for hyperglycemia
Treatment & meds
- Lifelong hydrocortisone + fludrocortisone
- Stress-dose steroids for illness/surgery
- Taper exogenous steroids slowly
- Surgery/radiation for tumor source
Patient teaching
- Never skip hydrocortisone doses
- carry emergency hydrocortisone
- Double dose in fever/stress
- Wear medical alert ID
- Avoid crowds/infection exposure
- Low-Na, high-K, high-protein diet
- Calcium + vitamin D for bones
Red flags — escalate
- ★Addisonian crisis: shock, ↓ glucose
- Give IV hydrocortisone + NS STAT
- Masked infection then sepsis
- Hyperglycemic crisis
- pathologic fracture
Complications
- Circulatory collapse
- hyperkalemic dysrhythmia
- Osteoporosis, diabetes, HTN
- Immunosuppression, poor wound healing
Pathophysiology & risk
Addison's Disease
- ↓ Cortisol + ↓ aldosterone
- Autoimmune adrenal destruction (#1)
- Crisis trigger: steroid stop, illness
Cushing's Syndrome
- Cortisol excess
- exogenous steroids #1 cause
- Pituitary or adrenal tumor
Signs & symptoms
Addison's Disease
- ★Bronze hyperpigmentation (↑ ACTH)
- Weight loss, fatigue
- salt craving, orthostasis
Cushing's Syndrome
- ★Purple striae, easy bruising
- Central obesity, moon face, buffalo hump
- Thin limbs, muscle wasting
Diagnostics & labs
Addison's Disease
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol
- No cortisol rise on ACTH stim test
Cushing's Syndrome
- Hypernatremia + hypokalemia
- Hyperglycemia
- Cortisol not suppressed by dexamethasone
Nursing priorities
Addison's Disease
- Prevent adrenal crisis
- monitor for shock
- Monitor for hyperkalemia, hypoglycemia
Cushing's Syndrome
- Infection surveillance (masked signs)
- Fall precautions (osteoporosis)
- Monitor for hyperglycemia
Treatment & meds
Addison's Disease
- Lifelong hydrocortisone + fludrocortisone
- Stress-dose steroids for illness/surgery
Cushing's Syndrome
- Taper exogenous steroids slowly
- Surgery/radiation for tumor source
Patient teaching
Addison's Disease
- Never skip hydrocortisone doses
- carry emergency hydrocortisone
- Double dose in fever/stress
- Wear medical alert ID
Cushing's Syndrome
- Avoid crowds/infection exposure
- Low-Na, high-K, high-protein diet
- Calcium + vitamin D for bones
Red flags — escalate
Addison's Disease
- ★Addisonian crisis: shock, ↓ glucose
- Give IV hydrocortisone + NS STAT
Cushing's Syndrome
- Masked infection then sepsis
- Hyperglycemic crisis
- pathologic fracture
Complications
Addison's Disease
- Circulatory collapse
- hyperkalemic dysrhythmia
Cushing's Syndrome
- Osteoporosis, diabetes, HTN
- Immunosuppression, poor wound healing
★ marks the fact that sets a column apart.
Clinical Pearl
Addison's = ADD cortisol, ADD salt. Cushing's = CUSHION of excess. Table shows which values flip.
Play this as a game — free
Drill Addison's Disease vs Cushing's Syndrome in Swipe Right & Speed Sort. Free to start, no card required.
More commonly confused pairs
Keep going
- ComparisonAddison's vs Cushing's: Too Little vs Too Much Cortisol — The Adrenal OppositesThe NCLEX hands you a lab panel — K+ 5.8, Na+ 130, glucose 58, BP 82/50 — and asks which adrenal disorder fits. Every value in Addison's flips in Cushing's. Reversing the…
- SubjectEndocrineDiabetes mellitus, thyroid disorders, adrenal disorders, and hormonal regulation.
- GuideCompare and Contrast: Stop Mixing Up Look-Alike Nursing ConceptsDI vs SIADH, hypo vs hyper, look-alike drugs: the fix is the one difference, the cue that reveals it, and sorting practice until it is automatic. A side-by-side example and why comparison works.
- GuideHypo vs Hyper: How to Tell Electrolyte Symptoms Apart With One RuleCalcium and magnesium are the brakes: low means hyperexcitable (tingling, tetany, seizures), high means suppressed (weakness, hyporeflexia, lethargy). Potassium sets the resting potential and both directions end in weakness, so the ECG decides. Sodium is water and acts on the brain. The whole chart, derived.
- QuizNursing study gamesSort look-alike conditions and drugs against the clock — the fast way to stop mixing them up.
- TopicAddison's Disease — Adrenal InsufficiencyA patient presents with hyperpigmented skin creases, salt cravings, and fatigue that worsens with stress. The skin color isn't a tan — it's a warning sign the adrenals are failing.