ADRENOCORTICAL INSUFFICIENCY 
DEFINITION
NURSING DIAGNOSIS
PHARMACOLOGICAL THERAPY
NURSING CARE PLAN
DIAGNOSTIC TESTS
PATHOPHYSIOLOGY
CAUSES
CLINICAL MANIFESTATIONS
Insufficient production of the hormone cortisol.
Injury to the hypothalums
Deficiency of adrenocorticotropic hormone
CLASSIFFICATION
Primary adrenal insufficiency
Secondary adrenal insufficiency
Damage to the adrenal cortex occurs.
Insufficient production of cortisol results.
Also called Addison's disease.
Insufficient production of ACTH occurs.
Pituitary gland fails to produce adrenocorticotropic hormone.
Loss of blood supply to pituitary gland
Tumor located on the pituitary gland
Severe head injury
Stabbing abdominal pain
Low blood sugar levels
Hypotension due to shock
Dehydration
Loss of consciousness
ACTH stimulation test measuring cortisol levels.
Insulin-induced hypoglycaemia test.
Blood tests measuring adrenocorticotropic hormone levels.
No ACTH to signal adrenal glands to release cortisol.
Computerized tomography scan of adrenal cortex.
Fludrocortisone to replace aldosterone.
Corticosteroids to replace cortisol
Prednisone
Hydrocortisone [cortef]
Low glucose levels
Gastrointestinal problems eg. nausea, vomiting
Hyperpigmentation
Damage to the adrenal glands
Inadequate aldosterone production results.
Sodium, potassium and water metabolism is disturbed.
This causes atrophy of adrenal cortex.
Cortisol deficiency occurs resulting to:
This is caused by:
This is caused by autoimmune processes.
Destruction and subsequent hypofunction of adrenal cortex occurs.
Suppression of hypothalamic-pituitary axis.
Corticosteroid treatment for non-endocrine disorders.
Pituitary disease
Abnormal fat, protein and carbohydrate metabolism.
Addisonian crisis during periods of stress.
Death
Adrenocorticotropic deficiency occurs.
Complete blood count showing increased lymphocytes.
24 hour urinalysis .
Risk of injury due to ineffective stress response.
Activity intolerance due to reduced cortisol.
Deficient fluid volume due to loss of sodium and water.
Protecting the affected individual.
Increasing activity tolerance.
Controlling normal fluid and electrolyte balance.
Encourage diet rich in sodium.
Administer prescribed glucocorticoids and mineralocorticoids.
Assess skin turgor and mucous membranes for dehydration.
Administer intravenous infusions of glucose, sodium, water etc
Daily monitoring of fluid intake and output.
Assess emotional status of the patient
Control temperature of the room to avoid deviations.
Implement sterile techniques to prevent infection.
Observe for early signs of Addisonian crisis.
Avoid and minimize stressful situations.
Monitor vital signs frequently.
Avoid overexertion by providing periods for rest and activity.
Provide diet high in calories and proteins.
Assist patient with daily living activities.