Adrenal Glands Disorder Review: Cushing’s vs Addison’s

Probably one of the most requested topics, Cushing’s and Addison’s Disease are two adrenal gland disorders that are both confusing and difficult to identify.

A lot of people, especially nursing students, usually get the two diseases mixed up. When discussing Cushing’s Syndrome and Addison’s Disease, you will be talking about a lot of hormones involved. For that reason, SimpleNursing.com is cutting out the confusing parts and will be focusing on what really matters and what will come out in your NCLEX^® exams.

The Gist

The contrasting factor between Cushing’s and Addison’s is cortisol; one is too much, and other is too little.

• Cushing’s Syndrome – increased cortisol
• Addison’s Disease – decreased cortisol

To better understand how the two diseases occur, we first need to know how cortisol is produced inside the body.

The Starting Point

All hormone regulation starts in the pituitary gland. The pituitary gland consists of the anterior pituitary and the posterior pituitary. Between the two, it’s the anterior pituitary that’s responsible for secreting the hormone that is responsible for Cushing’s and Addison’s – the adrenocorticotrophic hormone (ACTH). So, that is what we’ll be focusing on.

The ACTH is like a domino hormone that triggers the adrenal release of steroids. You can think of ACTH as a messenger that goes to your adrenal glands (the glands sitting on top of your kidneys) and says, “Hey adrenals, release some hormones.”

Message Received

Once your adrenals receive the message, it will produce MAC. What does M-A-C stand for?

• M – Mineral steroids (aldosterone)
• A – Androgens (hair and sex)
• C – Corticosteroids

Mineral Steroids

One of the notable mineral steroids that the adrenal glands produce is the aldosterone or what Mike likes to call “Aldos Tyrone.” Think of Aldos Tyrone as a bouncer who stands at the door of a nightclub (kidneys). What this bouncer does is he holds back sodium from getting out of the kidneys and because of that, water is also retained.

What happens if there is increased water retention?

• Increased pressure in the vascular beds or vascular system
• Increased blood pressure

If Aldos Tyrone is eliminated using an aldosterone blocker (Spironolactone), it will decrease or eliminate sodium from the body and water will follow; thus, decreasing blood pressure.

Androgens

Androgens, like testosterone, are mainly responsible for the production of hair and sex hormone. Therefore, if you have increased androgens in your body, you will produce a lot of hair, and your sex drive will be heightened.

Corticosteroids

This is where Addison’s Disease and Cushing’s Syndrome come in. Corticosteroids are your cortisol. Cortisol a natural hormone produced in the body where Prednisone, a known corticosteroid, is derived from.

What are the functions of corticosteroids?

Think of your corticosteroids as your airbags. What is the primary function of an airbag? To protect you from harm caused by vehicular accidents. Corticosteroids are produced to act like an airbag to protect you from the inflammation caused by stress.

Adverse Effects of Corticosteroids

Though corticosteroids help in relaxation, it also triggers water retention. Fluid retention can cause:

• Increased potassium level
• Weight gain
• High blood pressure

Going back to the airbag concept, yes, airbags are great because they save your life, but take up a lot of space; same with corticosteroids. Corticosteroids decrease stress and inflammation but will eventually smother you and add extra weight. Therefore, long-term Prednisone intake can cause water retention and high blood pressure.

Cushing’s versus Addison’s

Taking cortisol as the primary regulatory factor, you can now quickly enumerate the difference between Addison’s Disease and Cushing’s Syndrome.

Addison’s Disease – too little cortisol that leads to:

• Weight loss
• Low blood pressure
• Hair loss
• Sexual dysfunction

Cushing’s Syndrome – too much cortisol that leads to:

• Weight gain
• High blood pressure
• Thinning of hair
• Decreased libido and fertility
• “Smothering” effect

In our next lecture, we will be going into the nitty-gritty details of the signs and symptoms of Cushing’s Syndrome and Addison’s Disease. See you there!