NR 507 Week 6: Recorded Disease Process Presentation Peer Review

NR 507 Week 6: Recorded Disease Process Presentation Peer Review

I really enjoyed your presentation and felt like I learned more about Addison’s disease. I was interested in this subject matter due to someone I know having this disease and wanting to understand more about her condition.

  1. Discuss the risk factors and the connection to the etiology of the initial injury to the cell/tissue/organ

One of the things I found most interesting about Addison’s that I did not remember from nursing school was the most common cause of Addison’s being tuberculosis worldwide. Upon further research, I found that this is not common in further developed countries such as the United States, but in those underdeveloped countries (Burton, Cottrell, & Edwards, 2015, p. 488). Most often in established countries the cause is an autoimmune disease as you mentioned. Example of the autoimmune diseases would be type 1 diabetes, or Graves’ disease. Other risk factors include other chronic infections, removal of part of the adrenal gland, or polyendocrine deficiency syndrome. These autoimmune disorders cause breakdown of the adrenal cortex most often causing Addison’s disease.

  1. Provide a brief diagnosis of how the disease is diagnosed

In your presentation you mentioned that diagnosis is made based on laboratory values to determine either primary or secondary adrenal insufficiency with high ACTH being primary and low ACTH being secondary. It is important to understand that the cortisol levels must be drawn in the morning to give a more accurate result. In my research, I found that patients are often misdiagnosed until they progress into Addisonian crisis due to providers focusing on other differential diagnoses based on the patient’s sign and symptoms (Burton, et. al, 2015, p.489). Once patients have become this ill, they usually present to the emergency department and the diagnosis is made based on presentation, laboratory values of hyperkalemia and hyponatremia, and then can be confirmed by morning cortisol levels. The delay in diagnosis was the most interesting.

Burton, C., Cottrell, E., & Edwards, J. (2015). Addison’s disease: identification and management in primary care. The British Jounral of General Practice, 65(638), 488-490. to an external site.

  1. Analyze pathophysiologic mechanism associated with Addison’s Diseas:

    NR 507 Week 6 Recorded Disease Process Presentation Peer Review

    NR 507 Week 6 Recorded Disease Process Presentation Peer Review

Mediated destruction

Sanne van Haren, Hannah, Alex & Gijs (2018) indicated as did you that Addison’s Disease Caused by Tuberculosis.  Just like Aspergillus Pneumonia, Addison’s disease is difficult to diagnose and treat.  Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) stated that Interleukin-2 subunit alpha (soluble receptor) reveals and confirms a direct connect between 21OH=directed reactivity and AAD, and 11.2 SNP.  Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) continued that Addison’s disease (AAD) has a direct connect to T-cell destruction of the adrenal cortex.

So there is lyphocytic infiltration of the adrenal gland, autoantibodies, 21 hydroxylase (21OH).  It is also indicated that he etiology remains obscure but genetic and environmental factors can be significant.  Your PowerPoint presentation was excellent.  I read about genes influencing T-cell fate.  Is this true about transcription factors STAT4, GATA3, interleukin-23 (IL23A:  activates STAT4) and interferon-Gamma production aides in the production of interferon-Gamma by the memory CD4+ cells.

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  1. Relate research findings to the management of patients with complex pathophysiologic dysfunction of the adrenal cortex and how the hormones are all related. I can see the difficulty with the treatment in that rifampicin and steroids is part of the treatment, but low dose of steroids can be a problem with any long disorder, especially those who are immunocompromised. In addition, Aspergillus Pneumonia which is a rare opportunistic fungal infection would have a field day and be invasive to this type of individual.  Any type of compromised disease would contribute to a host of problems later down the line.  As with the disease that I had chosen, systemic considerations should be taken when it comes to signs and symptoms.  For example, similarities exist with both diseases in that weight loss and gastrointestinal symptoms are common signs and symptoms for both.  Clara, Joana, Marina, Fábio, Sara, Alexandre & … Teresa (2018) also agree that it is difficult to diagnose Addison’s disease in that this disease is rare and even gave a case about a teenager having multiple visits to the emergency room to which the teenager was treated with hydro cortisone and fludrocortisone and added that Addison’s disease has unspecific symptomatology.


Clara, P., Joana, C., Marina, P., Fábio, B., Sara, L., Alexandre, F., & … Teresa, B. (2018).

Addison’s disease – the difficulty of diagnosis. Nascer E Crasser , Vol 27, Iss 1, Pp

39-42 (2018), (1), 39.

Fichna, M., Żurawek, M., Bratland, E., Husebye, E. S., Kasperlik-Załuska, A., Czarnocka,

B., & … Nowak, J. (2015). Interleukin-2 and subunit alpha of its soluble receptor in

autoimmune Addison’s disease–an association study and expression analysis.

       Autoimmunity, 48, 2, 100-107. doi:10.3109/08916934.2014.976628

Sanne van Haren, N., Hannah, V., Alex, M., & Gijs, L. (2018). Addison’s Disease

       Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties. European

      Journal of Case Reports In Internal Medicine (2018), doi:10.12890/2018_000911

I thought your presentation was outstanding. Great job! You presented the material in a very clear and concise manner with no distractions. Your slides are easy to read and well organized. I see that you covered all the required information, so it is difficult to disagree or come up with any negative feedback. Therefore, I will ask some questions related to your presentation that I am interested in hearing more about that I did not see in the presentation.


#5 Link changes in tissue, organ, and system functioning to the initial presenting signs and symptoms seen in primary care of the disease.

Regarding this question, if a patient is told they will need dialysis, but they refuse, they have an approximate survival time of six months. What would you do to change the patient’s mind about dialysis?

Shafi, Saleem, Anjum, Abdullar, and Shafi (2018) give the results of a six-month study on patients hospitalized with chronic kidney disease. The study included 125 patients, in Pakistan, who were patients in a hospital within a 6-month’s time-frame.  The mean patient age was 47.9±12.1 years. Of all patients, 72 agreed to dialysis and 53 refused.  The study showed that those in middle to higher income groups agreed more frequently to dialysis than those in lower income groups. Trust in the primary care provider (86%) was the most common reason to accept dialysis.  The most common reasons for refusing were frequency of dialysis during the week (52.8%), permanent nature of dialysis (50.9%), and perception of poor quality of life (35.8%).  In this study the median survival after withholding dialysis was 6 months.


#7 Provide a brief description of the pharmacological and non-pharmacological interventions used to treat and manage the disease.

If a patient does receive a kidney transplant, is there a lifetime medication regimen?

Spivey, Burns, Garrett, Duke (2014) explain how immunosuppressant therapy (IST) plays a very important role in maintaining graft function in kidney transplantation.  In a meta-analysis, 22.6% of low-income and minority groups are vulnerable to an increased risk of non-compliance.  There may be severe consequences to this non-adherence such as, rejection or failure of the transplanted organ.  The complexity of medication regimens can be overwhelming to some recipients as well as the high cost of the multiple medications that are needed to prevent graft rejection.


Any information about these two topics that you could add would be great. Again, GREAT JOB!!




Shafi, S., Saleem, M., Anjum, R., Abdullah, W., & Shafi, T. (2018). Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan. Saudi Journal of Kidney Diseases and Transplantation, 29(2), 401-408.

Spivey, C., Chisholm-Burns, M., Garrett, C., & Duke, K. (2014). Serving underserved transplant recipients: Experience of the medication access program. Patient Preference and Adherence, 8, 613-619.