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.
Comparison
Side-by-side2 compared
Dimension
Addison's Disease
Cushing's Syndrome
Pathophysiology & risk
- Adrenal insufficiency: ↓ cortisol + ↓ aldosterone
- Autoimmune; trigger: abrupt steroid stop, illness
- Cortisol excess; exogenous steroids #1 cause
- Pituitary adenoma (Cushing disease), tumor
Signs & symptoms
- ★Bronze hyperpigmentation (↑ ACTH)
- Weight loss, fatigue; salt craving, orthostasis
- ★Purple striae, thin fragile skin, bruising
- Central obesity, moon face, buffalo hump; wasting
Diagnostics & labs
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol; ACTH stim fails
- Hypernatremia + hypokalemia
- Hyperglycemia; + dexamethasone suppression
Nursing priorities
- Prevent adrenal crisis; monitor for shock
- Daily weights, I&O, BP trends
- Infection surveillance (masked signs)
- Fall precautions; glucose monitoring
Treatment & meds
- Lifelong hydrocortisone + fludrocortisone
- Stress-dose steroids for illness/surgery
- Taper exogenous steroids slowly
- Surgery/radiation for tumor source
Patient teaching
- 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
Red flags — escalate
- ★Addisonian crisis: shock, fever, severe ↓ glucose
- Give IV hydrocortisone + NS STAT
- Masked infection → sepsis
- Hyperglycemic crisis; pathologic fracture
Complications
- Circulatory collapse; hyperkalemic dysrhythmia
- Osteoporosis, diabetes, HTN
- Immunosuppression, poor wound healing
Pathophysiology & risk
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
Signs & symptoms
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
Diagnostics & labs
Addison's Disease
- ★Hyponatremia + hyperkalemia
- Hypoglycemia, ↓ cortisol; ACTH stim fails
Cushing's Syndrome
- Hypernatremia + hypokalemia
- Hyperglycemia; + dexamethasone suppression
Nursing priorities
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
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 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
Red flags — escalate
Addison's Disease
- ★Addisonian crisis: shock, fever, severe ↓ glucose
- Give IV hydrocortisone + NS STAT
Cushing's Syndrome
- Masked infection → 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.
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