Which of the following clinical feature seen in a client with Addison disease?

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Addison's disease, or primary adrenal insufficiency, results in decreased cortisol production by the adrenal glands.
The pituitary gland compensates by increasing the secretion of Adrenocorticotropic Hormone (ACTH) to stimulate the adrenal glands.
High levels of ACTH also stimulate melanocytes in the skin, leading to increased melanin production and causing hyperpigmentation (darkening of the skin).

Option A: A puffy, rounded face ('moon face') is a classic sign of Cushing's syndrome, which involves excess cortisol, the opposite of Addison's disease.
Option C: A generalized skin rash is not a characteristic symptom of Addison's disease. While associated autoimmune conditions like vitiligo (loss of pigment) can occur, it is not a primary feature.
Option D: Weight gain, particularly central obesity, is a hallmark of Cushing's syndrome. Addison's disease typically causes weight loss, anorexia, and fatigue.

Visual 1: Image: A picture showing hyperpigmentation in the palmar creases of a patient with Addison's disease.
Visual 2: Chart: A side-by-side comparison table of the signs and symptoms of Addison's disease versus Cushing's syndrome.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of Addison's disease to guide bedside assessment, documentation, and the next nursing action.
Nurses must be able to differentiate the signs of adrenal insufficiency (Addison's) from adrenal excess (Cushing's) for accurate assessment and reporting.
Patient education is critical, especially regarding medication adherence and the signs of an impending Addisonian crisis, which is a medical emergency.
What if? If a patient with known Addison's disease presents with fever and vomiting, the nurse's priority is to assess for signs of an Addisonian crisis (severe hypotension, shock) and prepare for emergency IV steroid administration, as illness increases cortisol demand.

How to Approach the Question

First, identify the core concept of the question: the clinical features of Addison's disease.
Recall that Addison's disease is a state of adrenal insufficiency, meaning low cortisol and aldosterone.
Think about the body's compensatory mechanism: the pituitary gland releases more ACTH.
Connect the high ACTH level to its effect on melanocytes, leading to hyperpigmentation.
Evaluate the other options. Recognize that 'puffy face' and 'weight gain' are classic signs of Cushing's syndrome (high cortisol), the opposite condition.
Eliminate the incorrect options based on this contrasting pathophysiology to confirm the correct answer.

Concept Tested & Keywords

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