The nurse cares for a client with Addison's disease who is being treated with hydrocortisone. Which symptoms should the nurse recognize as manifestations of medication overtreatment? Select all that apply.

Management of Addison’s disease involves lifelong glucocorticoid replacement therapy, commonly with medications such as Hydrocortisone. The goal is to mimic normal cortisol levels while avoiding under-replacement or over-replacement. Overtreatment leads to symptoms of excess glucocorticoid activity, resembling Cushingoid features due to sodium and water retention, metabolic effects, and altered glucose regulation. Careful monitoring is required to balance hormone replacement and prevent iatrogenic complications. Rationale: A. Hypotension is a hallmark of under-treatment in Addison’s disease, not overtreatment. Insufficient cortisol leads to decreased vascular responsiveness to catecholamines and reduced sodium retention, resulting in low blood pressure. Therefore, hypotension suggests inadequate dosing rather than excess hydrocortisone therapy. B. Hyperpigmentation is associated with chronic Addison’s disease due to elevated ACTH stimulating melanocyte activity. It reflects primary adrenal insufficiency and occurs when cortisol levels are low. This finding does not indicate overtreatment with hydrocortisone but rather ongoing or unresolved deficiency. C. Fatigue is a common symptom of cortisol deficiency and is more consistent with undertreatment. Low cortisol impairs energy metabolism, leading to weakness and decreased endurance. While nonspecific, it does not indicate excessive glucocorticoid dosing. D. Fluid retention is a key sign of hydrocortisone overtreatment. Excess glucocorticoids have mineralocorticoid-like effects, promoting sodium and water retention, which can lead to weight gain, edema, and hypertension. This reflects supraphysiologic cortisol levels and requires dose adjustment. E. Weakness is more commonly associated with insufficient cortisol replacement. In Addison’s disease, low cortisol impairs glucose metabolism and muscle energy production, resulting in generalized weakness. Although steroid excess can also cause muscle wasting over time, acute weakness is more suggestive of under-replacement rather than overtreatment.