Mrs. Cohen has primary adrenal insufficiency (Addison's disease). The practical nurse assessing Mrs. Cohen should anticipate which of the following manifestations?

Mrs. Cohen has primary adrenal insufficiency (Addison's disease). The practical nurse assessing Mrs. Cohen should anticipate which of the following manifestations?

• A. Exophthalmos and goitre
• B. Polydipsia and polyuria
• C. Moon face and buffalo hump
• D. Bronze pigmentation and hypotension

Answer: (D)

In Addison’s disease the adrenal cortex isn’t producing enough cortisol and aldosterone. This leads to high ACTH levels, which stimulate melanin production in the skin, causing Bronze pigmentation, and to a lack of aldosterone that results in salt wasting, dehydration, and low blood pressure. So you would expect the patient to exhibit skin darkening and hypotension. Hyponatremia and hyperkalemia often accompany these changes, contributing to weakness and fatigue. The other patterns—exophthalmos and goitre (thyroid disease), polydipsia and polyuria (diabetes), or a moon face with a buffalo hump (Cushing’s)—do not fit primary adrenal insufficiency.

In Addison’s disease the adrenal cortex isn’t producing enough cortisol and aldosterone. This leads to high ACTH levels, which stimulate melanin production in the skin, causing Bronze pigmentation, and to a lack of aldosterone that results in salt wasting, dehydration, and low blood pressure. So you would expect the patient to exhibit skin darkening and hypotension. Hyponatremia and hyperkalemia often accompany these changes, contributing to weakness and fatigue. The other patterns—exophthalmos and goitre (thyroid disease), polydipsia and polyuria (diabetes), or a moon face with a buffalo hump (Cushing’s)—do not fit primary adrenal insufficiency.