Hyperaldosteronism is usually caused by a benign tumor in the adrenal cortex. Clinical manifestations are related to excess sodium. Because sodium and potassium exchange for one another, the resultant hypokalemia will also cause manifestations.

Drug therapy may include the administration of spironolactone (Aldactone) to block the effects of aldosterone.​

Addison’s disease is not enough “sugar, salt, and sex”. Because sodium and potassium exchange for one another, hyperkalemia will be seen. It can be autoimmune or secondary due to failure to gradually withdraw steroids or other select medications.

Complication is adrenal crisis which may be triggered by stress or the sudden withdrawal of steroids. In the crisis state, the ability to hold onto sodium and water is lost leading to hypovolemia and shock which could be fatal. Treatment is the administration of glucocorticoids such as hydrocortisone and prednisone and the mineralocorticoid, fludrocortisone (Florinef) if there is a persistent sodium deficit.

Cushing’s syndrome is too much “sugar, salt, and sex”. It is usually due to excess glucocorticoids for several weeks or failure to taper steroids. Because sodium and potassium exchange for one another, hypokalemia will be seen. Treatment is to taper steroids and give anti-adrenals such as ketoconazole (Nizoral) if needed.  

Clinical Manifestations

• Pheochromocytoma is too much catecholamines.
• Disorders of the Adrenal Cortex are Addison’s and Cushing’s.
• Hyperaldosteronism is too much salt.
• Addison’s is not enough sugar, salt, and sex.
• Cushing’s is too much sugar, salt, and sex.
• Na+ and K+ exchange for each other.​

In preparing for the NCLEX exam, it is important to be aware of the disorders of the adrenal gland, clinical manifestations and lab abnormalities. In pheochromocytoma and hyperaldosteronism, the treatment is surgical resection and cure of the disorder. Addison’s and Cushing’s may lead to an immunocompromised state and increased risk of infection.