Addison's Disease -- hypoadrenocorticism

[weezyNollie]

Addison's disease is a condition that occurs when the adrenal glands stop producing hormones.We vets often miss this disease because the symptoms are vague...just not feeling well, off and on digestive and intestinal problems, weakness, and so forth. Poor body condition, dehydration, a weak pulse, a slow heart rate, and blood in the stools are other common signs, but that's true of a lot of diseases. And the signs often come and go over a long period of time.
One of the big hints that your pet may have Addison's is that it gets sick fairly often, but everytime the vet gives it fluids and/or steroids, it gets better for a while.
Often, it's not until the patient is critically ill that diagnose the disease. This is yet another example of why performing routine blood work on sick animals is beneficial: we can diagnose these types of problems before they become an emergency.
Blood work may indicate: anemia, electrolyte imbalances (elevated potassium, low sodium, and low chloride), low blood sugar, elevated calcium, acidosis, and elevation of liver and kidney values
Any age dog can get this disease, but it tends to be seen in middle aged female dogs. Especially female dogs that haven't been spayed. About one third of cases are mixed-breed dogs, but there appears to be some breed predilection toward Poodles, Portuguese water dogs, Great Danes, Sheperds, and Rottweilers.

There is no "cure", but with treatment, (lifelong) most pets live a pretty normal life. The drugs most commonly used to treat Addison's disease are some combination of prednisone, Florinef, and DOCP. We need to monitor your dog's blood on a regular basis so we can adjust the doses of these medications as needed. All three of these medications frequently cause mildly troublesome side effects, so we often have to deal with those. We refer to this process as "careful management" . **However, because the prednisone and others are to supplement what isn't being produced, typical negative side effects of long term prednisone are not seen or troublesome**

Approximately 35% of dogs with this disease present in what is known as Addisonian crisis; this is a true emergency and immediate treatment is required to save the dog's life. These animals have the classic signs of shock: mental dullness, pale mucous membranes, weak pulses, and cold extremities. In addition, they have an abnormally slow heart rate due to elevated blood potassium levels.

**With Louise this was a FLUKE we diagnosed so early in the disease, it's said that this disease begins at birth and slowly progresses into the "crisis" but with Weezy we caught it before any of it**
A Little About The Disease:

Mammals, in general, have 2 adrenal glands. Their job is to produce the steroidal hormones that help regulate cellular function. In Addison's disease, the part of the adrenal glands that produce cortical steroids is diseased and not functioning well.
There may be no clinical signs of disease until 90% of the adrenal cortex has ceased to function. The usual cause of the destruction of the adrenal glands is thought to be auto-immune...for reasons we don't understand well, the body's immune system attacks it own cells. This occurs in other organs as well. In fact, many of our diseases are auto-immune type problems.
One of the more interesting causes of Addison's Disease is from steroid therapy. Usually it's associated with long term steroid treatment for something like severe skin allergies, and then for some reason or other, the steroid treatment is stopped. Another medication called Lysodren can cause Addison's disease as a side effect.
DIAGNOSIS
Once we suspect your pet has Addison's Disease, there is no simple, cheap, in-clinic test to prove it, which is a nuisance, but there is a fairly straight forward test called an ACTH Stimulation test that is definitive. ACTH will stimulate a normal adrenal gland to produce alot of cortisol. If very little cortisol is produced, then we know for certain that your pet has Addison's Adrenal Gland Disease. Once a certain diagnosis is made, then life long treatment will be needed if you want to keep your pet.
TREATMENT
Inital treatment of a dog in suspected "Crisis" is lots of IV Fluids and high dose steroid injections. Your vet will do everything he or she can to get the body temperature up to normal and treat the other secondary problems associated with a patient in shock.
At the same time, expect a lot of testing to be done to confirm the suspected diagnosis and to look for other problems. These dogs that are in Addisonian Crisis are rapidly dying and we need to rule out heart failure, toxic shock, poisoning and other causes of weak, cold, slow heart rated emergency patients.

**Once again, not Weezy.. because we caught it so early. However, this is why it is SO important to pre-anesthetic bloodwork, like we were doing. If we had continued to do a dental without any of this bloodwork, she might have gotten into a BAD situation on the table during the dental ending up in a serious emergency. She can now have the dental once the disease is stabilized. But it might have been near fatal without this blood work**

Once the patient is stablized, treatment involves replacing synthetically the hormones a healthy adrenal gland would produce. Since the adrenal gland produces two major types of steroid hormones (cortical or gluco-corticoid and mineral-corticoid) we usually treat this disease successfully by giving prednisone (inexpensive and readily available) and either fludrocortisone (Florinef) orally or a once a month injection of DOCP (Percorten-V) These last two meds are a little expensive and your vet may not keep them on hand. It's not quite as easy as I make it sound, like diabetes, it takes repeat testing, trial and error, and frequent adjustments in the medication to get everything just right so that your dog can lead a long and comfortable life.


If you have any questions, feel free to ask. I've learned a lot myself, in addition to the brief knowledge I had before. But this disease, although often tested for, is rarely diagnosed.

[pung-yo]

That was a real good educational post wheezy. You hit the nail on the head. Very nice of you to post this, it might come in handy for a member someday.

[mara]

Interesting info, thanks for posting.
So Wheezy has Addisons for sure?
What does DOPC stand for?
I hope you get Wheezy stabaized and feeling well soon.

[weezyNollie]

Sorry i never checked back in on this thread. DOCP is also known as Percorten-V. It is an EXPENSIVE injectable steroid. Usually it's given every 25-28 days. It's drug name is: desoxycorticosterone pivalate. It's another corticosteroid supplement, made specifically for Addisonian patients.

yes, she has Addison's for sure. Her test came back VERY clear that she has Addisons. Her pre and post ACTH stim were both less than 0.2mcg. Meaning.. ADDISONS.

[tigersmom]

Dear Weezys mom,
I use the DOCP my vet gets it for me about 70 dollers a bottle and I do my own injections (I started after about 3 months after he started treatment) we have bloodwork done every 6 months just to check levels. Since Tiger vcannot take oral steriods this is the way we have to go and so far he has thrived on this treatment.
Tigersmom

[mara]

Just curious, what part of a routine blood panel done preoperatively would show Addison's Disease? The article suggests routine blood work on sick animals but most dogs undergoing surgery for example spay/neutering are not "sick". I wouldn't think electrolyte imbalances or Urea/Creatinine rises would be seen except in dogs already showing signs of illness?

[weezyNollie]

Addison's mocks lots of other types of disease/malfunctions.

Louise's blood work looked like liver failure. We were just doing pre-anesthetic blood work for her for a dental. She was not showing any signs either.

Her blood work was VERY low albumin, low total protein, high cholesterol, low total bilirubin. Her CBC came back indicative of anemia. We also did electrolytes. Although they seemed somewhat normal, the potassium/sodium ratio is what clues you in on Addison's.

Addison's is VERY tricky to diagnose. However, it's the easiest answer so worst case almost every vet tests for it.. usually negative, but they still try.

[mara]

Thanks!!