A client with Addison's disease develops orthostatic hypotension. The nurse attributes this finding to which hormonal change?

A client with Addison's disease develops orthostatic hypotension. The nurse attributes this finding to which hormonal change?

• A. A decrease in cortisol release
• B. A decreased secretion of aldosterone
• C. An increase in epinephrine secretion
• D. Increased levels of androgens

Answer: (B)

Orthostatic hypotension in Addison’s disease mainly comes from a loss of mineralocorticoid activity, which is aldosterone. Aldosterone normally promotes sodium reabsorption in the kidneys, and water follows sodium. When aldosterone is deficient, there’s excessive sodium—and thus water—loss, leading to a decrease in extracellular fluid volume. With less circulating blood volume, standing causes a more pronounced drop in venous return and blood pressure, producing orthostatic hypotension. Cortisol deficiency is part of Addison’s but it’s not the primary driver of orthostatic drops in BP; it affects stress response and vascular tone but doesn’t directly explain the volume loss that causes this symptom. Increased epinephrine would tend to raise blood pressure, not lower it. And adrenal androgens are typically reduced in Addison’s, not increased, so elevated androgens wouldn’t explain the finding.

Orthostatic hypotension in Addison’s disease mainly comes from a loss of mineralocorticoid activity, which is aldosterone. Aldosterone normally promotes sodium reabsorption in the kidneys, and water follows sodium. When aldosterone is deficient, there’s excessive sodium—and thus water—loss, leading to a decrease in extracellular fluid volume. With less circulating blood volume, standing causes a more pronounced drop in venous return and blood pressure, producing orthostatic hypotension.

Cortisol deficiency is part of Addison’s but it’s not the primary driver of orthostatic drops in BP; it affects stress response and vascular tone but doesn’t directly explain the volume loss that causes this symptom. Increased epinephrine would tend to raise blood pressure, not lower it. And adrenal androgens are typically reduced in Addison’s, not increased, so elevated androgens wouldn’t explain the finding.