Chart — Endocrine
Adrenal Disorder Comparison Chart
Cushing's syndrome vs Addison's disease vs adrenal crisis vs pheochromocytoma — pathophysiology, BP, symptoms, electrolytes, labs, treatment, and nursing priorities side-by-side.
Educational use only. Adrenal crisis is a life-threatening emergency. Treat first — diagnose second. Always follow institutional protocols and provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
| Feature | Cushing's Syndrome | Addison's Disease | Adrenal Crisis | Pheochromocytoma |
|---|---|---|---|---|
| Pathophysiology | Excess cortisol (glucocorticoid excess). Most common cause: exogenous corticosteroids. Endogenous: ACTH-secreting pituitary adenoma (Cushing's disease), adrenal tumor, or ectopic ACTH. | Cortisol AND aldosterone deficiency (primary = adrenal destruction). Most common: autoimmune adrenalitis. Secondary = pituitary failure (ACTH deficiency — no aldosterone deficiency because aldosterone is RAAS-controlled). | Acute life-threatening glucocorticoid (and often mineralocorticoid) deficiency — precipitated by stress, infection, abrupt steroid discontinuation, or trauma in susceptible patient. | Catecholamine-secreting tumor (epinephrine, norepinephrine) arising from adrenal medulla chromaffin cells; can be sporadic or associated with MEN 2, NF1, VHL syndrome. |
| Blood Pressure | Hypertension — cortisol has weak mineralocorticoid activity; also activates renin-angiotensin system; aldosterone effects from excess ACTH (ACTH-dependent Cushing's) | Hypotension, orthostatic hypotension — aldosterone deficiency causes sodium loss and volume depletion | Severe hypotension unresponsive to IV fluids alone — requires hydrocortisone to restore vascular tone | Episodic or sustained severe hypertension — catecholamine surge. Hypertensive crisis during tumor manipulation (palpation, surgery) if not alpha-blocked first. |
| Key Symptoms | Central obesity (buffalo hump, moon face, supraclavicular fat pads), purple striae, thin skin, easy bruising, proximal muscle weakness, acne, hirsutism; delayed wound healing | Fatigue, weakness (most common), anorexia, weight loss, nausea/vomiting, abdominal pain, salt craving; HYPERPIGMENTATION (primary only — high ACTH stimulates melanocytes) | Severe abdominal pain, vomiting, confusion, profound weakness, fever, hypotension — may mimic acute abdomen. Patient appears critically ill. | Classic triad: Palpitations, Perspiration (profuse diaphoresis), Pallor — episodic, often with throbbing headache. Blood pressure may be labile (very high during paroxysm, normal between episodes). |
| Electrolytes | Hypokalemia (cortisol activates aldosterone receptors), hypernatremia, hyperglycemia (cortisol is counter-regulatory); metabolic alkalosis | Hyponatremia (aldosterone deficiency → Na wasting), hyperkalemia (K retention), hypoglycemia (cortisol deficiency impairs gluconeogenesis); metabolic acidosis | Same as Addison's but more severe: critical hyponatremia, hyperkalemia (may cause dysrhythmias), hypoglycemia | Hyperglycemia (catecholamines stimulate gluconeogenesis, inhibit insulin release); hypokalemia possible with very high epinephrine levels |
| Key Labs | 24h urine free cortisol ↑↑; overnight dexamethasone suppression test: cortisol fails to suppress; elevated AM cortisol; ACTH level helps differentiate cause (high = pituitary/ectopic; low = adrenal tumor) | AM cortisol very low; ACTH very high (primary) — diagnostic; ACTH stimulation test: subnormal cortisol response (< 18–20 mcg/dL); ACTH low in secondary disease | Cannot wait for labs — treat empirically. If drawn: very low cortisol, very high ACTH (if primary), hyponatremia, hyperkalemia, hypoglycemia | Plasma free metanephrines (most sensitive) or 24h urine metanephrines; elevated; confirmed by CT/MRI adrenal glands. Do NOT palpate suspicious adrenal mass. |
| Treatment | Address cause: taper exogenous steroids if possible; surgery for pituitary adenoma (transsphenoidal); adrenalectomy for adrenal tumor; medications (ketoconazole, metyrapone) for inoperable cases | Daily hydrocortisone (usually 15–25 mg/day in divided doses) + fludrocortisone (mineralocorticoid replacement); increase dose during illness/stress (sick-day rules); medical alert bracelet | IV Hydrocortisone 100 mg bolus IMMEDIATELY (do not wait for labs) → IV NS + Dextrose (D5NS) → treat precipitating cause; transition to oral steroids once stable + add fludrocortisone for primary | Alpha-blocker FIRST (phenoxybenzamine) for weeks preoperatively to control BP and allow volume expansion → THEN beta-blocker added → surgical adrenalectomy. NEVER give beta-blocker alone (unopposed alpha → hypertensive crisis). |
| Nursing Priorities | Skin integrity (thin, fragile skin — use gentle tape, monitor for wounds); infection risk (immunosuppression); hyperglycemia monitoring; fall prevention (proximal muscle weakness); protect from bruising | Never miss steroid dose; teach stress dosing (illness, surgery → double or triple dose, then contact provider); medical alert bracelet; monitor for adrenal crisis triggers; avoid abrupt discontinuation | IV hydrocortisone first (do not delay); establish IV access; continuous hemodynamic monitoring; glucose replacement; temperature management; identify and treat precipitating cause | Avoid palpating abdomen; minimize stimulation; alpha-block BEFORE any surgical procedure; monitor BP continuously; postoperative: watch for hypotension (tumor removed, no catecholamines); educate on follow-up testing (10% malignant) |
| NCLEX Memory Aid | Cushing's = Cortisol EXCESS → FULL of everything: full face, full trunk, full blood sugar, full blood pressure, full retention (sodium/water). Electrolytes: low K⁺, high Na⁺, high glucose. | Addison's = ABSENT cortisol → EMPTY: empty energy, empty BP, empty Na⁺ (low), empty glucose. FULL K⁺ (hyperkalemia). BRONZE skin = primary only (ACTH-MSH connection). | HYDROCORTISONE FIRST — never wait for labs. Think: no cortisol = no vascular tone = no life. D5NS replaces volume and glucose simultaneously. | 3 Ps: Palpitations, Perspiration, Pallor + severe Pressure (BP). Alpha BEFORE beta (ABCs of pheo surgery prep). Never palpate adrenal mass — can trigger crisis. |
Cushing's vs Addison's Electrolytes
Cushing's: ↓ K⁺, ↑ Na⁺, ↑ Glucose
Addison's: ↑ K⁺, ↓ Na⁺, ↓ Glucose
Opposite patterns — cortisol (and aldosterone) RETAIN Na, EXCRETE K
Adrenal Crisis Priority Sequence
1. IV Hydrocortisone 100 mg bolus
2. IV NS + Dextrose (D5NS)
3. Identify and treat precipitating cause
4. Continuous hemodynamic monitoring
Do NOT delay treatment for labs
Related Resources
Adrenal Disorders for NursesFull guide — adrenal anatomy, Cushing's, Addison's, adrenal crisis, pheochromocytoma
Open →Adrenal Function Tests ReferenceCortisol, ACTH, ACTH stimulation, dexamethasone suppression, metanephrines
Open →Endocrine Crisis Management ReferenceAdrenal crisis priority interventions and do-not actions
Open →Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American Diabetes Association (ADA) Standards of Care · American Association of Clinical Endocrinology (AACE). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →