side by side comparison
Addison's vs Cushing's: Too Little vs Too Much Cortisol — The Adrenal Opposites
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.
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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.
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Clinical Pearl
Addison's = ADD cortisol, ADD salt. Cushing's = CUSHION of excess. Table shows which values flip.
Component Topics
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Go further
- Commonly confusedAddison's Disease vs Cushing's SyndromeToo little vs too much cortisol — the adrenal opposites.
- 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.
- TopicCushing's SyndromeA patient gains 30 pounds in two months, bruises from a blood pressure cuff, and has a blood glucose of 248 — but they don't have diabetes. Cortisol is running the show.
- SimulatorDKA SimulatorFluids. Then potassium. Then insulin. Treat one patient in diabetic ketoacidosis, one decision at a time. Every wrong move runs before you rewind it.