Adrenal insufficiency (Addison disease): Nursing

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Adrenal insufficiency is an endocrine disorder that happens when the adrenal gland doesn’t produce enough hormones, particularly mineralocorticoids like aldosterone, glucocorticoids like cortisol, and androgens like testosterone. It’s called “primary” when the underlying problem is localized to the adrenal gland itself, which can develop either acutely or chronically, and the chronic form is also known as Addison disease. On the other hand, it’s called “secondary” when the pituitary gland doesn’t stimulate the adrenals enough to ensure adequate cortisol production.

Now, let’s quickly review the anatomy and physiology of the adrenal glands. There are two adrenal glands, one above each kidney, and each one has an inner layer called the medulla and an outer layer called the cortex. Zooming in, the cortex is further subdivided into three more layers, namely the zona glomerulosa, zona fasciculata, and the zona reticularis. And each of their functions can be easily remembered by thinking of the mnemonic Salt, Sugar, and Sex.

So, the outermost layer is the zona glomerulosa, which secretes aldosterone. Aldosterone is part of a hormone system called the renin-angiotensin-aldosterone system. Together, these hormones decrease potassium levels, increase sodium levels, and increase blood volume and blood pressure.

The middle layer is the zona fasciculata, and the cells there make the hormone cortisol as well as other glucocorticoids. The hypothalamus, which is an almond-size structure which sits at the base of the brain, releases corticotropin-releasing hormone, or CRH for short, which acts on the pituitary gland, a pea-sized structure sitting just underneath the hypothalamus. In response, the pituitary gland sends out adrenocorticotropic hormone, or ACTH for short, which stimulates the zona fasciculata to secrete more cortisol.


Adrenal insufficiency, also known as Addison disease, is a condition in which the adrenal glands do not produce enough hormones. Symptoms can include weakness, fatigue, weight loss, low blood pressure, and changes in mood and appetite.

Nursing implications for someone with adrenal insufficiency include monitoring their intake of fluids and sodium to prevent dehydration and low blood pressure; providing emotional support; assisting with activities of daily living; and providing education about the condition.


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