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.
Side-by-side comparison
- Adrenal insufficiency: ↓ cortisol + ↓ aldosterone
- Autoimmune; trigger: abrupt steroid stop, illness
- Cortisol excess; exogenous steroids #1 cause
- Pituitary adenoma (Cushing disease), tumor
- ★Bronze hyperpigmentation (↑ ACTH)
- Weight loss, fatigue; salt craving, orthostasis
- ★Purple striae, thin fragile skin, bruising
- Central obesity, moon face, buffalo hump; wasting
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol; ACTH stim fails
- Hypernatremia + hypokalemia
- Hyperglycemia; + dexamethasone suppression
- Prevent adrenal crisis; monitor for shock
- Daily weights, I&O, BP trends
- Infection surveillance (masked signs)
- Fall precautions; glucose monitoring
- Lifelong hydrocortisone + fludrocortisone
- Stress-dose steroids for illness/surgery
- Taper exogenous steroids slowly
- Surgery/radiation for tumor source
- Never skip doses; carry emergency hydrocortisone
- Double dose in fever/stress; MedicAlert
- Avoid crowds/infection exposure
- Low-Na, high-K, high-protein diet; bone health
- ★Addisonian crisis: shock, fever, severe ↓ glucose
- Give IV hydrocortisone + NS STAT
- Masked infection → sepsis
- Hyperglycemic crisis; pathologic fracture
- Circulatory collapse; hyperkalemic dysrhythmia
- Osteoporosis, diabetes, HTN
- Immunosuppression, poor wound healing
Addison's Disease
- Adrenal insufficiency: ↓ cortisol + ↓ aldosterone
- Autoimmune; trigger: abrupt steroid stop, illness
Cushing's Syndrome
- Cortisol excess; exogenous steroids #1 cause
- Pituitary adenoma (Cushing disease), tumor
Addison's Disease
- ★Bronze hyperpigmentation (↑ ACTH)
- Weight loss, fatigue; salt craving, orthostasis
Cushing's Syndrome
- ★Purple striae, thin fragile skin, bruising
- Central obesity, moon face, buffalo hump; wasting
Addison's Disease
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol; ACTH stim fails
Cushing's Syndrome
- Hypernatremia + hypokalemia
- Hyperglycemia; + dexamethasone suppression
Addison's Disease
- Prevent adrenal crisis; monitor for shock
- Daily weights, I&O, BP trends
Cushing's Syndrome
- Infection surveillance (masked signs)
- Fall precautions; glucose monitoring
Addison's Disease
- Lifelong hydrocortisone + fludrocortisone
- Stress-dose steroids for illness/surgery
Cushing's Syndrome
- Taper exogenous steroids slowly
- Surgery/radiation for tumor source
Addison's Disease
- Never skip doses; carry emergency hydrocortisone
- Double dose in fever/stress; MedicAlert
Cushing's Syndrome
- Avoid crowds/infection exposure
- Low-Na, high-K, high-protein diet; bone health
Addison's Disease
- ★Addisonian crisis: shock, fever, severe ↓ glucose
- Give IV hydrocortisone + NS STAT
Cushing's Syndrome
- Masked infection → sepsis
- Hyperglycemic crisis; pathologic fracture
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. 14-day free trial, no card required.