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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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 then 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 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.

Component Topics

Addison's Disease — Adrenal InsufficiencyCushing's Syndrome

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