Adrenal & Parathyroid Disorders — NCLEX Nursing Lesson Anatomy & Physiology · RN Track · Medical-Surgical Body Systems · Endocrine · Adrenal & Parathyroid Disorders Condition Lesson · NCLEX-PN / NCLEX-RN

Two tiny glands control salt, sugar, stress, and calcium. Too little cortisol = shock and bronze skin. Too much cortisol = moon face and fragile bones. Calcium too high = stones and bones and groans. Calcium too low = tingling, tetany, and laryngospasm.

In this lesson

Lesson Objectives
Why This Matters
Disease Overview
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Potential Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Differentiate Addison disease vs Cushing syndrome and hyperparathyroidism vs hypoparathyroidism by cause, signs, and labs — and explain WHY each occurs.
Explain adrenal axis (HPA) and calcium regulation (PTH, vitamin D, calcitonin) and how failure causes fluid, electrolyte, and skeletal changes.
Recognize adrenal crisis and severe hypo/hypercalcemia as emergencies and prioritize ABCs, fluids, steroids, and calcium management.
Interpret key labs: cortisol, ACTH, sodium, potassium, glucose, calcium, phosphorus, PTH, and link trends to treatment.
Apply safe medication use: hydrocortisone, fludrocortisone, ketoconazole/metyrapone, bisphosphonates, calcitonin, calcium and vitamin D, and why tapering steroids matters.
Provide patient teaching for steroid tapering, stress dosing, sick-day rules, and calcium safety.

Why This Disease Matters

Prevalence: Adrenal insufficiency affects about 100-140 per million; autoimmune Addison is most common cause in developed countries. Cushing syndrome incidence is 2-3 per million per year but is often iatrogenic from chronic steroids — extremely common in primary care. Primary hyperparathyroidism affects 1-2% of postmenopausal women and is the most common cause of hypercalcemia outpatient. Hypoparathyroidism is rarer, most often post-thyroid/parathyroid surgery.

Patient safety: Adrenal crisis (Addisonian crisis) mortality is high if missed — hypotension unresponsive to fluids/vasopressors, hypoglycemia, hyponatremia, hyperkalemia → shock, death. Caused by abrupt steroid withdrawal, stress without stress dosing, infection. Cushing causes hypertension, hyperglycemia, infections, osteoporosis, fractures, VTE, and impaired wound healing. Severe hypercalcemia >14 mg/dL → coma, cardiac arrest (short QT, bradycardia). Severe hypocalcemia <7 mg/dL → laryngospasm, seizures, prolonged QT → torsades.

NCLEX importance: The NCLEX loves opposites: Addison (low cortisol/aldosterone → low Na, high K, low glucose, low BP, bronze skin) vs Cushing (high cortisol → high Na, low K, high glucose, high BP, moon face, buffalo hump) and hypercalcemia (high Ca, low Phos, stones, bones, groans, moans, psychic overtones) vs hypocalcemia (low Ca, high Phos, tetany, Trousseau/Chvostek). Also steroid tapering, stress dosing, and post-op parathyroidectomy hypocalcemia monitoring.

Why nurses encounter them constantly: Steroids are prescribed everywhere (asthma, RA, IBD, chemo, transplant). Abrupt stops cause crisis. Thyroid and parathyroid surgery is common — post-op calcium checks are routine. Osteoporosis, kidney stones, and fractures bring hyperparathyroid patients to orthopedics, urology, and ED.

Connecting to prior lessons From A&P: Adrenal cortex makes cortisol (stress/sugar), aldosterone (salt/water/K+), and androgens; medulla makes epi/norepi. HPA axis: hypothalamus CRH → pituitary ACTH → adrenal cortisol; cortisol negative feedback. Aldosterone via RAAS holds Na/water and wastes K+/H+. Parathyroid: PTH raises Ca (bone resorption, kidney Ca reabsorption, Phos excretion, vitamin D activation → gut Ca absorption). Calcitonin lowers Ca. Low Ca triggers PTH; high Ca suppresses it.

Disease Overview

Disorder	What it is	Hormone
Addison Disease (Primary Adrenal Insufficiency)	Autoimmune destruction of adrenal cortex → no cortisol + no aldosterone	Low cortisol + low aldosterone, high ACTH
Adrenal Crisis	Acute life-threatening cortisol and aldosterone failure after stress, infection, or abrupt steroid stop	Acute low cortisol emergency
Cushing Syndrome	Too much cortisol — iatrogenic steroids most common, or pituitary adenoma (Cushing disease = ACTH excess), adrenal tumor, ectopic ACTH (small-cell lung)	High cortisol ± high ACTH depending on cause
Hyperparathyroidism	Too much PTH → high Ca, low Phos — primary = adenoma, secondary = CKD low vitamin D	High PTH → high Ca
Hypoparathyroidism	Too little PTH → low Ca, high Phos — most common post-thyroid/parathyroid surgery	Low PTH → low Ca

Analogy — the security system and the thermostat

Adrenals are your stress security team: Cortisol is the team leader who raises sugar, BP, and alertness during emergencies. Aldosterone is the plumber who keeps salt and water in pipes and dumps potassium. In Addison, the team quits — no leader, pipes leak salt/water, potassium builds, sugar drops, and you bronze because pituitary screams ACTH that also stimulates melanin. In Cushing, the team leader never goes home — over-securitizes everything: holds salt/water, raises sugar/BP, breaks down protein (thin skin, muscle loss) and fat redistribution (moon face, buffalo hump).

Parathyroids are calcium thermostat: PTH raises calcium by mining bones and saving calcium in kidneys. Too much PTH = quarry over-mined → bones hurt, stones form, gut groans, brain moans. Too little PTH = quarry closed → calcium crashes → nerves fire uncontrollably → tingling, tetany, laryngospasm.

Pathophysiology

Normal — Adrenal: Stress → CRH → ACTH → cortisol released. Cortisol increases gluconeogenesis, insulin resistance (↑ glucose), maintains vascular tone/BP, suppresses immune/inflammation, and helps stress response. Aldosterone via RAAS: holds Na and water → ↑ BP, wastes K+ and H+ → K+ ↓, pH ↑ slightly. Androgens contribute to secondary sex traits. Cortisol high → negative feedback → ACTH/CRH ↓. ↓ Addison — What goes wrong: Autoimmune destruction, TB, hemorrhage, adrenalectomy → cortex fails → cortisol low + aldosterone low → Na and water lost in urine (hyponatremia, hypovolemia, hypotension), K+ and H+ retained (hyperkalemia, metabolic acidosis), glucose low (no gluconeogenesis). ACTH high from lack of feedback → ACTH precursor MSH → hyperpigmentation (bronze skin, creases, buccal mucosa). No stress response → adrenal crisis with infection/surgery/trauma. ↓ Adrenal crisis progression: Stressor without cortisol → vascular collapse, hypotension unresponsive to fluids/pressors (WHY: no cortisol to maintain catecholamine sensitivity), hypoglycemia, fever, abdominal pain, vomiting/diarrhea → shock, death without IV hydrocortisone. ↓ Cushing — What goes wrong: Exogenous steroids (most common) or excess endogenous ACTH/cortisol → cortisol high → Na/water retention (↑ BP, hypokalemia, metabolic alkalosis), gluconeogenesis → hyperglycemia, protein catabolism → thin skin, striae purple, poor wound healing, muscle wasting, bone loss (osteoporosis), fat redistribution (moon face, buffalo hump, truncal obesity), immune suppression (infection), mood changes. High androgens if adrenal tumor/ectopic ACTH → hirsutism, acne. ↓ Normal — Calcium: Low Ca → PTH ↑ → bone resorption (Ca released), kidney Ca reabsorption ↑, Phos excretion ↑, calcitriol (active vitamin D) ↑ → gut Ca absorption ↑. High Ca → PTH ↓, calcitonin ↑ → Ca ↓. Calcium critical for muscle contraction, nerve conduction, clotting, bone strength. Phos opposite Ca (except CKD). ↓ Hyperparathyroidism — What goes wrong: Adenoma → PTH high → Ca high >10.5, Phos low. Excess bone resorption → osteoporosis, fractures, bone pain. High Ca → kidney stones, polyuria (Ca impairs ADH effect), constipation, anorexia, pancreatitis, muscle weakness, depression, confusion, cardiac bradycardia/short QT. ↓ Hypoparathyroidism — What goes wrong: Surgery/injury/autoimmune → PTH low → Ca low <8.5, Phos high. Low Ca → increased neuromuscular excitability → perioral tingling, distal paresthesias, muscle cramps, positive Chvostek/Trousseau, tetany, laryngospasm, seizures, prolonged QT → torsades. WHY: low Ca lowers threshold for action potential → nerves fire spontaneously.

Risk Factors

Non-modifiable	Modifiable / Preventable	High-risk
Autoimmune disease (Addison, Hashimoto, Type1 DM cluster), female for Cushing adenoma, postmenopausal women for primary hyperparathyroidism, genetic MEN1/MEN2, age, family history	Chronic exogenous steroids (Cushing iatrogenic), abrupt steroid withdrawal (Addison crisis), neck surgery (thyroidectomy/parathyroidectomy → hypoPara), vitamin D deficiency (secondary hyperPara), lithium, thiazides (raise Ca), CKD (secondary hyperPara), smoking/alcohol	People on long-term steroids (>3 weeks), post-thyroid/parathyroid surgery, head/neck radiation, pituitary adenoma, adrenal tumor, small-cell lung cancer (ectopic ACTH), CKD/dialysis, postmenopausal women, autoimmune polyglandular syndrome

Signs and Symptoms

Category	Addison / Adrenal Crisis — WHY	Cushing — WHY	Hyperparathyroid — WHY	Hypoparathyroid — WHY
Early	Fatigue, weakness, anorexia, weight loss, nausea, salt craving — cortisol low → low glucose/energy, aldosterone low → Na loss. Hyperpigmentation of skin creases, knuckles, gums — high ACTH/MSH.	Weight gain central, moon face, buffalo hump, acne, hirsutism — cortisol fat redistribution + androgen excess.	Fatigue, polyuria, polydipsia, constipation, anorexia — high Ca impairs kidney concentrating and gut motility.	Perioral tingling, distal paresthesias, muscle cramps — low Ca → hyperexcitability early.
Expected	Hypotension, orthostasis, hyponatremia, hyperkalemia, hypoglycemia, amenorrhea, depression, bronze skin.	HTN, hyperglycemia, hypokalemia, metabolic alkalosis, thin skin, purple striae, bruising, poor wound healing, muscle weakness, osteoporosis, infection, mood swings, irregular menses.	Bone pain, osteoporosis, fractures, kidney stones, hematuria, HTN, muscle weakness, depression, confusion, bradycardia, short QT.	Tetany, positive Chvostek (facial tap → twitch) & Trousseau (BP cuff → carpal spasm), laryngospasm, dysphagia, seizures, prolonged QT, anxiety.
Emergency	Adrenal crisis: severe hypotension unresponsive to fluids/pressors, tachycardia, fever, vomiting/diarrhea, abdominal pain, hypoglycemia, hyponatremia, hyperkalemia, confusion → shock/coma. WHY: no cortisol to maintain vascular tone + no aldosterone → volume loss.	Cushing crisis not classic but complications: hypertensive emergency, hyperglycemic crisis, infection/sepsis, VTE/PE, pathologic fracture.	Severe hypercalcemia >14: polyuria → oliguria/AKI, confusion/coma, cardiac arrest. WHY: Ca impairs renal and cardiac conduction.	Severe hypocalcemia <7: laryngospasm/stridor, bronchospasm, seizures, prolonged QT → torsades, tetany. WHY: nerves fire uncontrollably.

Emergency red flags Addison crisis: hypotension + tachycardia + fever + abdominal pain + vomiting/diarrhea + confusion after stressor/steroid stop — give IV hydrocortisone + NS + glucose NOW. Cushing: HTN emergency, infection with fever masked by steroids. HyperCa >14: confusion, polyuria→oliguria, bradycardia. HypoCa <7: tetany, stridor, Trousseau, prolonged QT.

Nursing Assessment

Subjective: steroid use (dose/duration/recent stop), stressors (surgery, infection, trauma), autoimmune disease, neck surgery/radiation, TB, cancer (lung small-cell), kidney disease, diet Ca/vit D, thiazides/lithium use, weight change, salt craving, fatigue, muscle cramps, bone pain, stones, fractures, polyuria/polydipsia, tingling, tetany, mood changes, menstrual changes, infections.

Objective: vitals including orthostatics, weight, BMI, I&O, skin (pigmentation, striae, thinness, bruising, acne, hirsutism), fat distribution (moon face, buffalo hump, truncal obesity), muscle strength (proximal weakness in Cushing), Chvostek/Trousseau, lung sounds, edema, neuro (confusion, depression, anxiety), cardiac rhythm (brady in hyperCa, prolonged QT in hypoCa, tall T in hyperK Addison).

Focused	Why / What
Vitals / Weight / I&O	Addison: hypotension, orthostasis, weight loss, low UOP late if shock. Cushing: HTN, weight gain central. HyperCa: polyuria early → oliguria, weight loss, HTN. HypoCa: normal BP, but tetany if severe.
Head-to-toe	Skin: Addison bronze hyperpigmentation creases/mouth vs Cushing moon face, buffalo hump, purple striae, thin skin, bruising, acne. Hair: hirsutism Cushing. Bones: osteoporosis, fractures hyperPara. Neuro: fatigue vs agitation, Trousseau/Chvostek hypoCa.
Red flags / Notify	Hypotension unresponsive to fluids + fever + vomiting/diarrhea in Addison risk → crisis. HyperCa >14 with confusion/oliguria. HypoCa <7 with tetany/stridor/seizure/prolonged QT. HTN emergency in Cushing.

Diagnostic Tests

Test	Purpose / Findings / Nursing
Morning cortisol + ACTH + ACTH stimulation (cosyntropin) test	Addison: low cortisol, high ACTH (primary), low cortisol fails to rise after cosyntropin. Cushing: high cortisol, ACTH high if pituitary/ectopic, low if adrenal tumor. Prep: morning draw (cortisol diurnal highest 6-8am), hold steroids per order before test (can interfere). Nursing: note stress, time of draw.
24h urinary free cortisol, late-night salivary cortisol, dexamethasone suppression test	Cushing workup: urinary free cortisol high, salivary cortisol high at midnight, fails to suppress with low-dose dexamethasone. Teaching: collect all urine 24h, keep on ice, salivary sample at 11pm-midnight per protocol.
CT/MRI adrenal/pituitary	Finds adrenal tumor/hyperplasia or pituitary adenoma (Cushing disease) or adrenal hemorrhage. Prep: contrast allergy check.
Bone density (DEXA)	Cushing and hyperPara cause osteoporosis. Baseline and monitor. Nursing: no calcium 24h before DEXA per facility.
ECG	Addison hyperK: tall peaked T, widened QRS. HyperCa: short QT, bradycardia. HypoCa: prolonged QT → torsades risk. Continuous monitoring in crisis.

Laboratory Tests

Lab	Purpose / Normal / Abnormal / Trend / Priority
Cortisol (AM 6-8am) 6-23 mcg/dL	Addison low <6, crisis very low. Cushing high >23, loss diurnal rhythm (high at midnight). Trend: should normalize with treatment. Priority: AM draw most accurate.
ACTH 10-60 pg/mL	Primary Addison high (>60) + low cortisol (adrenal fails). Secondary Addison (pituitary failure) low ACTH + low cortisol. Cushing disease high ACTH + high cortisol. Adrenal tumor Cushing low ACTH + high cortisol. Priority: pair with cortisol to determine source.
Basic Metabolic Panel: Na 135-145, K 3.5-5.0, Glucose 70-100, Ca, Phos	Addison: Na low <135 (aldosterone loss), K high >5.0 (aldosterone loss), glucose low <70, metabolic acidosis HCO3 low. Cushing: Na high >145, K low <3.5 (mineralocorticoid effect), glucose high >126, metabolic alkalosis HCO3 high, Ca low from osteoporosis. Trend: Na/K opposite in Addison vs Cushing is classic NCLEX. Priority: monitor K+ and glucose hourly in crisis.
Calcium 8.5-10.5, Phosphorus 2.5-4.5, PTH 10-65 pg/mL	HyperPara: Ca high >10.5, Phos low <2.5, PTH high >65 (primary). HypoPara: Ca low <8.5, Phos high >4.5, PTH low <10. Secondary hyperPara CKD: Ca low, Phos high, PTH high. Trend: Ca and Phos inverse (except CKD). Priority: Ca <7 or >14 emergency, monitor QT, Chvostek/Trousseau, I&O for stones/AKI.
Vitamin D, Magnesium, Creatinine	Vit D low in secondary hyperPara, Mg low can cause refractory hypocalcemia (correct Mg). Creatinine high in hyperCa (AKI from stones/dehydration) and CKD.

Medications

Adrenal — Addison / Adrenal Crisis

Class / Meds	Mechanism / Safety / Teaching
Glucocorticoid: Hydrocortisone (Solu-Cortef) IV/PO — first-line crisis + maintenance, Prednisone, Dexamethasone	Mechanism: replaces cortisol → ↑ glucose, maintains BP/vascular tone, stress response. Indication: Addison maintenance, adrenal crisis emergency. Why hydrocortisone in crisis: has both glucocorticoid + mineralocorticoid activity and fast IV. Side: hyperglycemia, HTN, Na retention, K loss, weight gain, mood changes, infection risk, poor wound healing, osteoporosis long-term. Serious: adrenal suppression if stopped abruptly. Nursing: give IV hydrocortisone 100mg IV bolus per order in crisis immediately (do NOT delay), then continuous infusion or q6h per protocol, with NS boluses and glucose monitoring. Check HR/BP, I&O, Na/K/glucose q1-4h, daily weight. Taper, never stop abruptly. Teaching: take exactly as prescribed, morning dose mimics diurnal, wear medical alert, carry emergency kit, stress dosing (double dose for illness/fever/surgery per provider — teach sick-day rules).
Mineralocorticoid: Fludrocortisone (Florinef)	Mechanism: replaces aldosterone → holds Na/water, wastes K+/H+. Indication: Addison (primary needs both cortisol + aldosterone). Side: HTN, edema, hypokalemia, headache. Nursing: monitor BP, weight, edema, Na/K, teach low K diet not needed, high salt may be needed in Addison (salt craving), but monitor for HTN/edema.

Class / Meds

Mechanism / Safety / Teaching

Glucocorticoid: Hydrocortisone (Solu-Cortef) IV/PO — first-line crisis + maintenance, Prednisone, Dexamethasone

Mechanism: replaces cortisol → ↑ glucose, maintains BP/vascular tone, stress response. Indication: Addison maintenance, adrenal crisis emergency. Why hydrocortisone in crisis: has both glucocorticoid + mineralocorticoid activity and fast IV. Side: hyperglycemia, HTN, Na retention, K loss, weight gain, mood changes, infection risk, poor wound healing, osteoporosis long-term. Serious: adrenal suppression if stopped abruptly. Nursing: give IV hydrocortisone 100mg IV bolus per order in crisis immediately (do NOT delay), then continuous infusion or q6h per protocol, with NS boluses and glucose monitoring. Check HR/BP, I&O, Na/K/glucose q1-4h, daily weight. Taper, never stop abruptly. Teaching: take exactly as prescribed, morning dose mimics diurnal, wear medical alert, carry emergency kit, stress dosing (double dose for illness/fever/surgery per provider — teach sick-day rules).

Mineralocorticoid: Fludrocortisone (Florinef)

Mechanism: replaces aldosterone → holds Na/water, wastes K+/H+. Indication: Addison (primary needs both cortisol + aldosterone). Side: HTN, edema, hypokalemia, headache. Nursing: monitor BP, weight, edema, Na/K, teach low K diet not needed, high salt may be needed in Addison (salt craving), but monitor for HTN/edema.

Adrenal — Cushing Syndrome

Class / Meds	Mechanism / Safety
Adrenal steroid inhibitors: Ketoconazole, Metyrapone, Mitotane, Osilodrostat	Block cortisol synthesis → lowers cortisol. Indicated for endogenous Cushing when surgery not possible. Side: hepatotoxicity (ketoconazole black box liver failure), adrenal insufficiency (need stress dosing), nausea, hypokalemia. Labs: LFTs, cortisol, K+. Nursing: monitor for adrenal insufficiency symptoms (hypotension, weakness) — can cause Addison-like crisis if too low.
Pituitary-directed: Pasireotide (Signifor)	Lowers ACTH in Cushing disease. Side: hyperglycemia, diarrhea, gallstones. Monitor glucose, LFTs.
Other: Mifepristone (Korlym)	Glucocorticoid receptor blocker for hyperglycemia in Cushing. Side: hypokalemia, endometrial thickening. Monitor K+.

Parathyroid — Hyperparathyroidism / Hypercalcemia

Class / Meds	Mechanism / Safety
Bisphosphonates: Alendronate PO, Zoledronic acid IV, Pamidronate IV — first-line hypercalcemia	Inhibits bone resorption → Ca lowers. Indication: hypercalcemia, osteoporosis in hyperPara/Cushing. Side: esophagitis (oral), flu-like, hypocalcemia, jaw osteonecrosis rare. Nursing: give oral with full glass water, upright 30 min, on empty stomach. IV: hydrate first, monitor renal function, Ca, Mg, Phos. Teach dental hygiene, report jaw pain.
Calcitonin (Miacalcin) nasal/IM, Cinacalcet (Sensipar)	Calcitonin lowers Ca quickly but tachyphylaxis. Cinacalcet lowers PTH and Ca in secondary hyperPara/Parathyroid carcinoma — calcimimetic. Side: nausea, hypocalcemia. Monitor Ca.
Glucocorticoids for hyperCa from granuloma/vit D excess, Loop diuretic AFTER volume repleted (furosemide)	Steroids lower Ca in granulomatous disease. Loop diuretic only after NS hydration — why: volume repletion first, then loop wastes Ca. Do NOT give loop if dehydrated — worsens AKI.

Parathyroid — Hypoparathyroidism / Hypocalcemia

Class / Meds	Mechanism / Safety
Calcium: Calcium gluconate IV (less irritating) or Calcium chloride IV (central only), Calcium carbonate PO	Replaces Ca. Indication: severe hypoCa <7 with tetany/stridor/seizure/prolonged QT. Side: bradycardia, hypotension if IV too fast, tissue necrosis if extravasation. Nursing: give IV slowly per order with cardiac monitor, check Ca, Mg, Phos, QT, Chvostek/Trousseau, keep airway equipment, give PO calcium with vitamin D, teach not to take with iron/thyroid meds at same time.
Vitamin D: Calcitriol (Rocaltrol) active form, Cholecalciferol	Increases gut Ca absorption. Indication: hypoPara, secondary hyperPara CKD. Monitor Ca, Phos, PTH, kidney stones. Teaching: take as ordered, monitor for hyperCa signs (polyuria, constipation, confusion).

NCLEX Med Safety Never stop steroids abruptly if >3 weeks use — taper, or adrenal crisis. Hydrocortisone in Addison crisis = life-saving, give IV push per order immediately. Bisphosphonates PO = empty stomach, full glass water, upright 30 min. Calcium IV = slow + cardiac monitor + check for extravasation. Thiazides raise Ca — avoid in hyperCa.

Nursing Interventions — Prioritized

Priority	Intervention & WHY
Airway	HypoCa: keep suction, O2, trach set available — laryngospasm/stridor emergency. Addison crisis: airway may be compromised if shock/coma. Why: low Ca causes laryngeal tetany.
Breathing	Monitor RR, SpO2, lung sounds. HyperCa can cause muscle weakness including respiratory. Cushing has risk for PE from VTE.
Circulation	Addison crisis: large-bore IV x2, NS bolus 1L per order (isotonic restores Na/water), hydrocortisone IV 100mg per order STAT, glucose check (hypoglycemia), cardiac monitor for hyperK (peaked T). Cushing: monitor HTN, daily weight, I&O, edema, K+ (hypokalemia). HyperCa: hydrate with NS 200-300 mL/hr per order if cardiac/renal allows to promote Ca excretion, monitor for overload. HypoCa: cardiac monitor for prolonged QT, check Ca/Mg.
Safety	Addison: orthostatic vitals, fall precautions (hypotension), seizure precautions if severe electrolyte shifts. Cushing: fall precautions (osteoporosis, muscle weakness), infection control (immunosuppressed, poor wound healing), skin care (thin skin, bruising), VTE prophylaxis (SCDs, early ambulation). HyperPara: fall precautions (fractures), kidney stone prevention (hydration 2-3L if not contraindicated, strain urine). HypoPara: seizure precautions, keep calcium gluconate at bedside, Chvostek/Trousseau checks q4h.
Comfort / Nutrition	Addison: high Na, high carb during crisis per order, small frequent meals, salt craving normal. Cushing: low Na, high K, high protein, low carb (hyperglycemia), calcium/vit D for bones, low fat. HyperCa: high fluid, moderate Ca intake per provider, low Na if hyperCa from excess vitamin D, fiber for constipation. HypoCa: high Ca (dairy, leafy greens) + vit D, low Phos (avoid colas, processed meats).
Patient education / Interdisciplinary	Endocrine, nephrology, cardiology, pharmacy, dietitian, PT/OT for Cushing weakness/osteoporosis, surgery for adrenalectomy/parathyroidectomy, case management for steroid taper.

Potential Complications

Complication	Early signs	Nursing response / Emergency
Adrenal crisis	Hypotension unresponsive to fluids, tachycardia, fever, abdominal pain, vomiting/diarrhea, confusion, hyponatremia, hyperkalemia, hypoglycemia	Rapid response/ICU, ABCs, O2, cardiac monitor, large-bore IV NS bolus per order, hydrocortisone 100mg IV per order STAT, glucose check + D10W if low, Na/K/glucose q1-4h, I&O hourly, daily weight, keep warm, treat precipitant (infection), no sedatives.
Hypertensive emergency / Hyperglycemia / Infection / VTE (Cushing)	BP >180/120, glucose >300, fever, tachy, dyspnea (PE), calf swelling	BP control per order, insulin per protocol, infection workup (cultures before antibiotics), VTE prophylaxis, early ambulation, monitor glucose, I&O.
Severe hypercalcemia crisis >14	Polyuria→oliguria, confusion, bradycardia, short QT, constipation, bone pain	Hydrate with NS per order (200-300 mL/hr if cardiac/renal ok), bisphosphonate IV per order after hydration, calcitonin per order, monitor Ca, Phos, Mg, BUN/Cr, I&O hourly, daily weight, lung sounds for overload, mobilize to reduce bone resorption.
Severe hypocalcemia tetany / Laryngospasm / Seizure	Perioral tingling, muscle cramps, Trousseau/Chvostek positive, stridor, prolonged QT	Emergency: airway, O2, cardiac monitor, IV calcium gluconate slowly per order, seizure precautions, check Ca/Mg/Phos/QT, keep airway equipment, no stimulation.
Post-adrenalectomy: Adrenal insufficiency / Bleeding	Hypotension, low glucose, bleeding, adrenal crisis if steroids stopped abruptly	Monitor vitals, glucose, Na/K, I&O, give steroids per order taper, stress dosing teaching, wound care.

Patient Education

Disease process: Addison = adrenals not making cortisol/aldosterone → low BP, low Na, high K, low sugar, bronze skin. Cushing = too much cortisol → high BP, high sugar, weight gain central, thin skin, infection risk. HyperPara = high Ca → stones, bones, groans. HypoPara = low Ca → tingling, tetany.
Lifestyle: Addison: high-salt diet if hypotensive per provider, stay hydrated, avoid dehydration, wear medical alert. Cushing: low-salt, high-K (bananas, oranges if K low), high-protein, low-carb, calcium/vit D, exercise for bones/muscle, no smoking/alcohol.
Med adherence: Take steroids same time daily, AM dose, taper slowly, never stop abruptly if >3 weeks. Carry stress dose instructions: double dose for fever, infection, surgery, trauma per provider. Fludrocortisone same time daily. Calcium/vit D same time, separate from iron/thyroid meds. Bisphosphonates PO: empty stomach, full glass water, upright 30 min.
Home care: Daily weight, BP, glucose logs, I&O if ordered, skin care (Cushing thin skin), oral care, infection prevention (hand hygiene, vaccines per provider).
Follow-up: Endocrine, labs: Na/K/glucose for adrenal, Ca/Phos/PTH for para, A1c for Cushing, DEXA, eye exams, kidney stone screening.
Warning / Emergency: Addison crisis: severe hypotension, fever, vomiting/diarrhea, abdominal pain, confusion, extreme weakness → call 911, give IM hydrocortisone if prescribed emergency kit. Cushing: HTN >180, glucose >300, chest pain, signs infection (fever may be masked), calf pain/swelling (VTE). HyperCa: polyuria→oliguria, confusion, constipation, bone pain. HypoCa: perioral tingling, muscle cramps, tetany, stridor, seizures → emergency.

Clinical Judgment (NCSBN CJMM)

Recognize cues: 34-year-old woman with Addison, had flu 2 days, now vomiting/diarrhea, no steroids taken yesterday because of nausea, HR 112, BP 82/54, Temp 101.2°F, RR 24, confused, dry mucosa, poor turgor, weight loss 2kg, Na 122 low, K 6.2 high, glucose 58 low, cortisol low.
Analyze cues: Addison + infection + missed steroids → adrenal crisis. Low cortisol + low aldosterone → Na loss, K retention, water loss → hypovolemic hypotension, hyperkalemia, hypoglycemia, fever from lack of cortisol. Risk: shock, cardiac arrest from hyperK, hypoglycemia brain injury.
Prioritize hypotheses: #1 Adrenal crisis with fluid volume deficit and hypoglycemia. #2 Hyperkalemia → dysrhythmia risk. #3 Infection precipitant.
Generate solutions: ABCs, O2, cardiac monitor, large-bore IV, NS bolus per order, hydrocortisone 100mg IV STAT per order, glucose check + D10W per order, Na/K/glucose q1-4h, I&O hourly, daily weight, treat infection (cultures, antibiotics per order), no sedatives, keep warm.
Take action: Rapid response/ICU, give NS 1L bolus, hydrocortisone IV STAT, D10W for glucose 58, recheck glucose q1h, monitor K+ and ECG (peaked T), orthostatics, neuro checks, daily weight, teach after crisis about stress dosing and not stopping steroids when ill.
Evaluate outcomes: BP rises to 104/66, HR 88, glucose 88, Na 132, K 4.8, confusion improved, fever decreasing, I&O adequate. Transition to PO hydrocortisone + fludrocortisone with taper plan, stress dose teaching, medical alert bracelet, emergency kit, follow-up endocrine.

Clinical Connections — commonly confused on NCLEX

Feature	Addison (low cortisol + low aldosterone)	Cushing (high cortisol)	Hyperparathyroid (high Ca, low Phos)	Hypoparathyroid (low Ca, high Phos)
Cause	Autoimmune adrenal destruction, abrupt steroid stop	Exogenous steroids most common, pituitary ACTH adenoma, adrenal tumor, ectopic ACTH	Parathyroid adenoma (primary), CKD (secondary)	Post-thyroid/parathyroid surgery, autoimmune
Na / K / Glucose	Na low, K high, glucose low	Na high, K low, glucose high	Ca high, Phos low	Ca low, Phos high
BP / Weight / Skin	Hypotension, weight loss, bronze hyperpigmentation	HTN, weight gain central, moon face, buffalo hump, purple striae, thin skin, acne, hirsutism	Polyuria, constipation, bone pain, stones, HTN, muscle weakness, depression	Tetany, perioral tingling, Chvostek/Trousseau, laryngospasm, seizures, prolonged QT
Lab hallmark	Low cortisol, high ACTH (primary), low Na, high K, low glucose	High cortisol, high/low ACTH depending, low K, high glucose, metabolic alkalosis	High Ca >10.5, low Phos, high PTH, short QT, kidney stones	Low Ca <8.5, high Phos, low PTH, prolonged QT, tetany
Treatment	Hydrocortisone + fludrocortisone, NS fluids, glucose, stress dosing, never stop abruptly	Taper steroids if iatrogenic, surgery for tumor, adrenal inhibitors (ketoconazole), control HTN/glucose/K+, VTE prophylaxis	Hydrate NS, bisphosphonates, calcitonin, cinacalcet, loop diuretic after volume repleted, surgery for adenoma, mobilize	IV calcium gluconate slowly + cardiac monitor, PO calcium + calcitriol, check Mg, seizure/airway precautions

NCLEX High-Yield Review

What the NCLEX Wants You to Know

Addison = low, low, high, low, bronze Low Na, low BP, low glucose, high K, bronze skin, salt craving, weight loss. Crisis = hypotension unresponsive + fever + vomiting/diarrhea + hypoglycemia.
Cushing = high, high, low, high, moon High Na, high BP, high glucose, low K, moon face, buffalo hump, purple striae, thin skin, osteoporosis.
Steroid safety Never stop abruptly >3 weeks, taper, stress dose double for illness/surgery/fever per provider, take AM, monitor glucose/BP/weight/K+, infection risk.
HyperCa = stones, bones, groans, moans, psychic overtones High Ca >10.5, low Phos, high PTH, polyuria, constipation, bone pain, kidney stones, bradycardia, short QT, confusion. Treat: hydrate NS, bisphosphonates, mobilize.
HypoCa = tetany, tingling, Trousseau, Chvostek, prolonged QT Low Ca <8.5, high Phos, low PTH, perioral tingling, muscle cramps, laryngospasm, seizures. Treat: IV calcium gluconate slowly + cardiac monitor, PO calcium + calcitriol, check Mg.
Chvostek/Trousseau = low Ca Tap facial nerve → twitch (Chvostek), BP cuff 3 min → carpal spasm (Trousseau). Keep calcium gluconate at bedside post-thyroidectomy.

Common distractors: Giving K+ supplements to Addison (already high K), giving steroids without checking glucose/K+, giving thiazides in hyperCa (raises Ca), giving loop diuretic before hydrating in hyperCa (worsens AKI), stopping steroids abruptly, confusing Addison vs Cushing Na/K, confusing hyper vs hypoCa treatments.

Expected vs unexpected: Expected Addison: bronze skin, hypotension, salt craving. Expected Cushing: moon face, weight gain central, striae. Expected hyperCa: polyuria, constipation, bone pain. Expected hypoCa: tingling, cramps. Unexpected/emergency: adrenal crisis hypotension unresponsive + hyperK + hypoglycemia, Ca >14 with oliguria/confusion, Ca <7 with stridor/tetany/seizure/prolonged QT, HTN emergency in Cushing.

Delegation: RN assesses, interprets cortisol/ACTH/Ca/PTH, manages crisis, teaches steroid taper/stress dosing, monitors post-op calcium. LPN/VN can check vitals, I&O, daily weight, glucose, give PO/IV calcium per order/protocol, reinforce teaching, report Chvostek/Trousseau. UAP can obtain vitals, weight, I&O, assist hygiene, keep fall precautions — but cannot interpret labs, manage crisis, or teach initial diagnosis.

Memory Aids

Addison = ADD low: A-D-D = Low Na, Low BP, Low Glucose + High K, Bronze skin, Salt craving.
Cushing = CUSHING: Central obesity, Urine glucose high, Striae purple, Hirsutism, Hypertension, Infection risk, Na high/K low, Glucose high.
Steroids: Never Stop Abruptly — Taper, Stress Dose, Take AM, Monitor Sugar/BP/K.
HyperCa = CHIMP: Constipation, Hypercalciuria stones, Irritability/confusion, Muscle weakness, Polyuria/polydipsia.
HypoCa = TENT: Tingling perioral, Tetany, Trousseau/Chvostek, Prolonged QT, ENT laryngospasm.
Calcium and Phos are opposite: High Ca = Low Phos, Low Ca = High Phos (except CKD).
Bisphosphonates PO: Empty stomach, Full glass water, Upright 30 min — EFU.

Case Study — from admission to discharge

Patient: Maria, 52, on prednisone 20mg daily for RA for 6 months, now admitted for pneumonia with fever 101.8°F, HR 102, BP 158/96, glucose 210, K 3.1 low, Na 148 high, moon face, buffalo hump, truncal obesity, thin skin with bruising, purple striae, proximal muscle weakness, 2kg weight gain, cushingoid appearance. Labs: cortisol high, ACTH low (exogenous steroid).

Recognize & Analyze Cues

Cues: chronic steroids → iatrogenic Cushing. High cortisol → Na retention → HTN 158/96 and Na 148 high, K wasting → K 3.1 low, gluconeogenesis → glucose 210 high, fat redistribution → moon face, buffalo hump, truncal obesity, weight gain, protein catabolism → thin skin, bruising, purple striae, muscle weakness, osteoporosis risk, immune suppression → pneumonia, poor wound healing. ACTH low because exogenous steroids suppress HPA. Risk: hypertensive emergency, hyperglycemic crisis, infection, VTE, fracture.

Prioritize & Plan

Priorities: #1 Infection and hyperglycemia/HTN. #2 Hypokalemia → dysrhythmia. #3 Adrenal insufficiency risk if steroids stopped abruptly. Plan: treat pneumonia (cultures, antibiotics), monitor vitals q4h, BP, glucose q4-6h, I&O, daily weight, K+ q4-6h, replace K+ per order, low Na high K diet per order, glucose control per protocol, VTE prophylaxis, fall precautions, skin care, do NOT stop steroids abruptly — taper per provider when stable, discuss stress dosing, bone protection.

Take Action & Evaluate

Actions: NS? Actually restrict Na, give K+ replacement PO, insulin per sliding scale per order, antibiotics for pneumonia, PT for muscle weakness, DEXA referral, teach about steroid taper importance, stress dosing for future illness/surgery, medical alert, infection prevention, diet teaching. Evaluated: after antibiotics, fever resolved, BP 132/84, K 4.0, glucose 128, weight stable, no fracture, no VTE. Discharge: taper prednisone per provider (slow taper over weeks), do not stop abruptly, stress dose double for fever/surgery per provider, monitor glucose/BP/weight, high-protein low-carb calcium/vit D diet, exercise, fall precautions, skin care, when to seek emergency (fever, infection, chest pain, HTN >180, glucose >300, calf swelling), follow-up endocrine and rheumatology.

NCLEX Practice Questions

Answers are fully shuffled — no sequential pattern.

1. A client with Addison disease reports salt craving, weight loss, and bronze skin. Which lab pattern is expected?

High Na, low K, high glucose
Low Na, high K, low glucose, low cortisol, high ACTH
High Ca, low Phos, high PTH
Low Ca, high Phos, low PTH

Rationale

Answer: 2. Addison primary = adrenal cortex fails → low cortisol + low aldosterone → Na low (aldosterone loss wastes Na), K high (retained), glucose low (no cortisol gluconeogenesis), cortisol low, ACTH high (no feedback, ACTH also causes hyperpigmentation bronze). Option 1 is Cushing (high Na, low K, high glucose). Option 3 is hyperparathyroidism. Option 4 is hypoparathyroidism.

2. A client taking prednisone 30mg daily for 2 months asks about stopping abruptly. What is the nurse's best response?

"You can stop abruptly, no problem."
"You must taper slowly per provider to prevent adrenal crisis — never stop abruptly."
"Stop and take extra salt."
"Double the dose then stop."

Rationale

Answer: 2. Chronic steroids >3 weeks suppress HPA axis → adrenal atrophy → if stopped abruptly, no cortisol → adrenal crisis (hypotension unresponsive, hypoglycemia, hyponatremia, hyperkalemia, shock). Must taper slowly per provider, stress dosing for illness/surgery. Option 1,3,4 unsafe.

3. A client post-thyroidectomy 12 hours ago reports perioral tingling and muscle cramps. Chvostek sign positive. Ca 7.2 mg/dL, Phos 5.0 high, PTH low. What is the priority action?

Give IV calcium gluconate slowly per order with cardiac monitoring and prepare airway equipment
Give NS bolus 1L rapidly
Give 3% saline infusion
Encourage high-phosphorus diet

Rationale

Answer: 1. Hypoparathyroidism post-thyroidectomy → low Ca 7.2, high Phos, low PTH → perioral tingling, cramps, Chvostek positive → tetany risk, laryngospasm, prolonged QT. Priority is IV calcium gluconate slowly with cardiac monitor, check Mg, QT, keep airway equipment, seizure precautions. NS bolus (2) does not fix Ca, 3% saline (3) for SIADH/hyponatremia, high-phos diet (4) worsens hypocalcemia — need low-phos diet.

4. A client with hyperparathyroidism has Ca 13.2 mg/dL. Which intervention is appropriate?

Restrict fluids and give thiazide diuretic
Hydrate with NS 200-300 mL/hr per order if cardiac/renal status allows, encourage mobilization, prepare for bisphosphonate IV after hydration
Give calcium carbonate PO
Keep on bed rest

Rationale

Answer: 2. Hypercalcemia 13.2 → risk stones, AKI, confusion, cardiac arrest. Hydrate with isotonic NS to increase Ca excretion (if cardiac/renal ok), mobilize (weight bearing reduces bone resorption), bisphosphonate IV after hydration (zoledronic acid/pamidronate) to lower Ca. Restrict fluids and thiazides (1) worsen hyperCa — thiazides raise Ca. Calcium carbonate (3) would worsen. Bed rest (4) worsens bone resorption.

5. A client in adrenal crisis has BP 78/50, HR 118, Na 120 low, K 6.4 high, glucose 52 low, fever 101.5°F. Which order should the nurse implement first?

Give 3% saline infusion
Give hydrocortisone 100mg IV per order STAT + NS bolus + glucose check/replacement per order
Give furosemide
Give levothyroxine

Rationale

Answer: 2. Adrenal crisis = life-threatening low cortisol + aldosterone → hypotension unresponsive, hyperK, hyponatremia, hypoglycemia, shock. First is hydrocortisone IV STAT per order (replaces cortisol, has mineralocorticoid activity), plus NS bolus for volume/Na, plus glucose replacement for hypoglycemia, cardiac monitor for hyperK. 3% saline (1) not first-line alone — need steroids. Furosemide (3) would worsen volume loss and K. Levothyroxine (4) not for adrenal crisis.

6. SATA. Which findings support Cushing syndrome? Select all that apply.

Moon face, buffalo hump, truncal obesity, purple striae
Hypertension, hyperglycemia, hypokalemia, metabolic alkalosis
Thin skin, bruising, poor wound healing, proximal muscle weakness
Weight loss, hypotension, bronze skin, salt craving
Osteoporosis and infection risk

Rationale

Answers: 1, 2, 3, 5. Cushing high cortisol: moon face, buffalo hump, central obesity, purple striae, thin skin, bruising, poor healing, muscle weakness, HTN, high Na, low K, high glucose, alkalosis, osteoporosis, infection risk, mood changes, hirsutism. Option 4 is Addison: weight loss, hypotension, bronze hyperpigmentation, salt craving, low Na, high K, low glucose.

7. SATA. Which are appropriate for hypocalcemia from hypoparathyroidism? Select all that apply.

Monitor for perioral tingling, muscle cramps, positive Chvostek/Trousseau
Keep calcium gluconate IV at bedside with cardiac monitoring and check prolonged QT
Encourage high-phosphorus foods like colas and processed meats
Give calcium carbonate PO with vitamin D per order, separate from iron and thyroid meds
Seizure and laryngospasm precautions with airway equipment available

Rationale

Answers: 1, 2, 4, 5. HypoCa: monitor tingling, cramps, Chvostek/Trousseau, keep IV calcium gluconate at bedside, cardiac monitor for prolonged QT → torsades, give PO calcium + calcitriol, separate from iron/thyroid meds, seizure/laryngospasm precautions, airway equipment. High-phosphorus foods (3) worsen hypoCa — need low-phos diet.

8. Priority. The nurse has four clients. Who should be seen first?

Client with Cushing syndrome, BP 150/90, glucose 180, K 3.4
Client with hyperparathyroidism, Ca 11.0, reports constipation and polyuria, stable vitals
Client with Addison disease, missed steroids, now BP 82/50, HR 120, Na 118, K 6.6, glucose 50, confused, fever 101.8°F
Client with hypoparathyroidism, Ca 8.0, mild tingling, stable, awaiting PO calcium

Rationale

Answer: 3. Addison crisis with hypotension 82/50 unresponsive risk, hyperK 6.6 (dysrhythmia), hypoglycemia 50, hyponatremia 118, fever, confusion → shock, cardiac arrest. Needs rapid response, NS bolus, hydrocortisone IV STAT, glucose replacement, cardiac monitor. Others are stable chronic or mild abnormalities.

9. Delegation. Which task can the RN delegate to LPN/VN for a stable client with Cushing syndrome on chronic steroids?

Interpret cortisol and ACTH and adjust steroid taper
Assess for adrenal crisis and manage emergency
Teach initial disease process and steroid tapering rationale
Check vital signs, blood glucose, daily weight, I&O, and reinforce low-salt high-protein teaching per plan

Rationale

Answer: 4. LPN/VN can check vitals, glucose, weight, I&O, give meds per order/protocol, reinforce teaching (low-salt, high-protein, calcium/vit D), report changes. Interpreting labs and adjusting taper (1), assessing/managing crisis (2), and initial teaching (3) require RN.

10. NGN Case Study. A 60-year-old post-thyroidectomy day 1 has Ca 7.0 low, Phos 5.2 high, PTH 8 low, reports perioral tingling, muscle cramps, positive Trousseau sign with BP cuff → carpal spasm, HR 88, BP 122/78, QT prolonged on ECG, anxious.

a) What condition and cues support it?
b) What are 3 priority actions and why?
c) What teaching for discharge?

Model answer

a) Hypoparathyroidism with severe hypocalcemia post-thyroidectomy: Post-thyroid surgery → parathyroid injury/removal, Ca 7.0 low <8.5, Phos 5.2 high, PTH 8 low, perioral tingling, muscle cramps, Trousseau positive (carpal spasm), prolonged QT — low Ca lowers threshold for action potential → neuromuscular hyperexcitability, tetany, laryngospasm risk.

b) Priorities: 1) Airway and cardiac safety — keep airway equipment, O2, suction, cardiac monitor for prolonged QT → torsades risk, seizure precautions. 2) IV calcium gluconate slowly per order (less irritating than chloride) with cardiac monitor, check Ca/Mg/Phos, QT, Chvostek/Trousseau q4h, do not give with bicarbonate same line. 3) PO calcium carbonate + calcitriol per order when stable, low-phos diet teaching, check Mg (low Mg makes Ca hard to correct), I&O, daily weight, notify provider STAT for stridor/laryngospasm/seizure.

c) Discharge teaching: Take calcium + calcitriol daily same time, separate from iron, thyroid meds, and high-phos foods (colas, processed meats, dairy excess per provider), high-calcium diet per provider but avoid excess Phos, report perioral tingling, cramps, tetany, stridor, seizures, prolonged QT symptoms (palpitations), need lifelong follow-up Ca/Phos/PTH, DEXA, medical alert bracelet, when to seek emergency (stridor, tetany, seizure). Teach to not stop calcium/vit D abruptly, carry emergency info, follow-up endocrine.

Key Takeaways

Addison = low cortisol + low aldosterone = low Na, high K, low glucose, low BP, weight loss, bronze hyperpigmentation, salt craving; crisis = hypotension unresponsive + fever + vomiting/diarrhea + hypoglycemia + hyperK → give hydrocortisone IV STAT + NS + glucose.
Cushing = high cortisol = high Na, low K, high glucose, HTN, moon face, buffalo hump, purple striae, thin skin, bruising, poor healing, muscle weakness, osteoporosis, infection, VTE risk; treat by tapering steroids, surgery for tumor, adrenal inhibitors, control BP/glucose/K+.
Never stop steroids abruptly >3 weeks — taper, stress dose double for illness/surgery/fever, wear medical alert, carry emergency kit.
Hyperparathyroid = high Ca >10.5 + low Phos + high PTH = stones, bones, groans, moans, psychic overtones, polyuria, constipation, bradycardia, short QT; treat hydrate NS, bisphosphonates after hydration, mobilize, surgery for adenoma.
Hypoparathyroid = low Ca <8.5 + high Phos + low PTH = tingling, tetany, Chvostek/Trousseau, laryngospasm, seizures, prolonged QT; treat IV calcium gluconate slowly + cardiac monitor + airway equipment, then PO calcium + calcitriol, low-phos diet, check Mg.
Ca and Phos inverse, Na/K inverse in Addison vs Cushing — NCLEX loves opposites.

References

Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., … Torpy, D. J. (2016). Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 101(2), 364–389. https://doi.org/10.1210/jc.2015-1710
Nieman, L. K., Biller, B. M. K., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., & Tabarin, A. (2015). Treatment of Cushing's syndrome: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 100(8), 2807–2831. https://doi.org/10.1210/jc.2015-1818
Wilhelm, S. M., Wang, S. G., & Egan, S. E. (2016). American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surgery, 151(10), 959–968. https://doi.org/10.1001/jamasurg.2016.2310
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.
Silvestri, L. A., & Silvestri, A. E. (2023). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier.
Assessment Technologies Institute. (2023). ATI RN adult medical-surgical nursing review module (12th ed.). ATI Nursing Education.

Adrenal & Parathyroid Disorders

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