👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: low cortisol · adrenal insufficiency · Addison's · underactive adrenals · not enough cortisol
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Use this quick-reference guide to spot, treat, and prevent Addison Disease (Adrenal Insufficiency) on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🩺 Signs
Bronze skin hyperpigmentation
Hypotension, wt loss, fatigue
Salt craving, N/V, weakness
🧪 Labs
↓ Na, ↑ K, ↓ glucose, ↓ cortisol
↑ ACTH (primary cause)
✅ Do
Lifelong hydrocortisone/fludrocort
↑ steroid dose with stress/illness
↑ Na diet, fluids, daily weight
🚩 Report
Addisonian crisis: shock, ↓ Na
Give IV hydrocortisone + saline STAT
📚 Addison Disease (Adrenal Insufficiency) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Addison disease is primary adrenal insufficiency with deficient cortisol and aldosterone, often from autoimmune destruction of the adrenal cortex. Cortisol deficiency impairs stress response and glucose regulation, while aldosterone deficiency causes sodium loss and potassium retention. Memory aid: it is essentially the opposite of Cushing syndrome, with hyperpigmentation ('bronzing') as a classic primary sign. Abrupt steroid withdrawal or stress can trigger life-threatening Addisonian crisis.
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Key points
Understand these first
Hallmark findings are fatigue, muscle weakness, weight loss, anorexia, nausea, and hypotension.
Hyponatremia, hyperkalemia, and hypoglycemia result from aldosterone and cortisol deficiency.
Bronze hyperpigmentation of the skin and mucous membranes is classic in primary disease.
Salt craving, orthostatic hypotension, and dehydration are common.
Stress, infection, surgery, or stopping steroids abruptly can precipitate Addisonian crisis with profound hypotension and shock.
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Nursing priorities
What to do, in order
Administer lifelong glucocorticoid and mineralocorticoid replacement as ordered, increasing the dose during physiologic stress.
What are the priority nursing interventions for Addison Disease (Adrenal Insufficiency)?
Administer lifelong glucocorticoid and mineralocorticoid replacement as ordered, increasing the dose during physiologic stress. Monitor blood pressure (orthostatics), fluid status, electrolytes, and blood glucose closely. Provide a high-sodium diet as appropriate, and ensure adequate hydration. Reduce stressors and protect from infection; cluster care to conserve energy.
What are the warning signs of Addison Disease (Adrenal Insufficiency) a nurse must report?
Severe hypotension, profound weakness, confusion, and shock signal Addisonian crisis, a life-threatening emergency. Never abruptly stop corticosteroid therapy, which can precipitate adrenal crisis. Report fever, vomiting, or any illness, as stress doses of steroids are needed immediately.
What do I need to know about Addison Disease (Adrenal Insufficiency) for the NCLEX?
Hallmark findings are fatigue, muscle weakness, weight loss, anorexia, nausea, and hypotension. Hyponatremia, hyperkalemia, and hypoglycemia result from aldosterone and cortisol deficiency. Bronze hyperpigmentation of the skin and mucous membranes is classic in primary disease. Salt craving, orthostatic hypotension, and dehydration are common.
What patient teaching is important for Addison Disease (Adrenal Insufficiency)?
Take replacement hormones for life and never skip or stop doses; double or increase the dose during illness or stress as directed. Wear medical alert identification and carry an emergency injectable hydrocortisone kit. Report illness, vomiting, dizziness, or inability to keep medication down immediately.
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Quick Tip
Hallmark findings are fatigue, muscle weakness, weight loss, anorexia, nausea, and hypotension.