National Adrenal Diseases Foundation

Guidelines for Caregivers

  1. What is adrenal disease?
    1. Adrenal Gland Disorders from RN-BSN online.
    2. Recent Best Practices by Susan S. Braithwaite, MD Presentation from recent literature.
    3. What is Addison's by English Self Help Group
    4. Medical lectures on Addison's disease from 2004 to 2012
  2. Nursing a person with Addison's disease.
    1. Nursing the Addison PatientNotes for Nurses from the Addison's Self Help Group in England
    2. Stickers alerting others of patient's need for steriod cover
    3. Timing is everything: the patient’s perspective on steroid therapy this presentation tells how the patient feels when in hospital.
  3. Special Medication Considerations
    1. Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy This NIH publication explains the links between cortisol and the human circadian cycle. It is very important since the time when the steroid is administered determines sleep patterns, how the person feels, and how quickly they recover.

      In the case of most illnesses or diseases, medicine is administered to keep a constant titer (concentration level) in the body such as one pill every 6 hours. Since the adrenal gland releases hormones to prepare for anticipated stresses, it releases the highest level of hormones early in the morning to prepare for starting the day. As the day progresses, hormone levels decrease so the body can go to sleep without difficulty. This is called a Circadian cycle Circadian cycle. Generally the patient take a large dose in the morning with decreasing does throughout the day and none after 6 hour before sleep. If the patient is experiencing surgery or large stress then the dosage is adjusted. A good example is shown for Normal stress and for major surgery or dental work.
  4. How does it affect Patient's life?
    1. Addison's disease Owner's Manual This is an excellent comprehensive handbook (20+ pages) of easy to read material to help patients adapt to the new life style with Addison's disease.

It is amazing what a difference you can make in an Addisonian's life once you understand and make the small changes necessary to help them keep their lives stabalized. They are not invalids, just an individual that need to learn how to self regulate their bodies by manually taking steroids at the right time to do what your body does automatically thanks to your HPA axis. They may occasionally panic when they feel they are losing the ability to stabilize. With a little reassurance and patience they will re-stabilize and be like others people who do not have to stabilize themselves. They can also get other illnesses such as the flu, colds, or allergies and this may make stabilization more challenging. A wedding or death of a loved one also presents a stabilization challenge. Each new stressful experience requires that they learn how to manually adjust to the new situation.

If you get chased by a bulldog your adrenal gland releases adrenin and cortisol that allows you to escape immediately. The Addisonian has to tell the bulldog to wait until he/she takes her steroid and waits 30 minutes for it to enable their body to respond and then they can escape.