Addison Disease (Primary Adrenal Insufficiency)

Addison disease is failure of the adrenal cortex, not simply an isolated low-cortisol state. Because the damaged cortex cannot produce adequate cortisol or aldosterone, the nurse should connect two patterns: poor vascular tone and poor stress tolerance from cortisol deficiency, plus renal sodium and water loss with potassium retention from aldosterone deficiency. Infection, vomiting, trauma, surgery, or abrupt withdrawal of chronic glucocorticoids can overwhelm the patient’s limited reserve and trigger adrenal crisis. When crisis is suspected, treatment takes priority over confirmation. Draw baseline cortisol and ACTH samples alongside treatment when feasible, but do not delay hydrocortisone while awaiting results. Restore circulating volume with 0.9% sodium chloride, then monitor perfusion, glucose, electrolytes, cardiac rhythm, and mental status. Long-term protection depends on correctly timed hormone replacement, fludrocortisone for primary disease, sick-day dosing, medical-alert identification, and a trained emergency injection plan.