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Addison's Disease (Hypoadrenocorticism)
Addison's Disease is another endocrine disorder, but at the opposite end of the spectrum from Cushing's. In this disease, there is insufficient production of the hormones cortisol (gludcocorticoids) or aldosterone (mineralocorticoids) or both. Aldosterone is necessary for the regulation of blood sodium and potassium levels . Cortisol is essential for regulation of blood sugar, the breakdown of fats and protein and also acts as an anti-inflammatory agent. Hypoadrenocorticism is a disease of primarily young to middle aged female dogs4. Dr. Addison was a 19th century physicion who first described the illness in people.
Types:
  • Primary Addison's -- due to disease (i.e., granulomatous disease, metastatic tumor, immune-mediated disease) or injury (mitotane overdose) to the adrenal gland which causes reduced production of cortisol and aldosterone.
  • Secondary Addison's -- caused by the withdrawal of glucocorticosteroids after long-term usage or disease of the pituitary gland (i.e., tumor) that causes decreased production of adrenocorticotropic hormone (ACTH) and therefore decreased cortisol production. Aldosterone production is unaffected.
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Signs and Symptoms
A hallmark of the disease is the waxing and waning of symptoms as the destruction of the adrenal gland progresses.
  • lethargy
  • weakness
  • anorexia (loss of appetite)
  • vomiting
  • weight loss
  • diarrhea
  • shaking
  • increased water consumption (polydipsia)
  • increased urination (polyuria)
  • dehydration
  • elevated blood potassium (hyperkalemia) and decreased blood sodium (hyponatremia) and chloride (hypochloremia) are classically seen on chemistry profiles
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Testing
Undetectable or low serum cortisol concentrations do not increase after a challenge of ACTH (ACTH Stimulation Test).

 

Treatment of chronic primary Addison's disease
  • Glucocorticoid replacement (i.e., low dose prednisone, prednisolone)
  • Mineralocorticoid replacement with either
  1. Fludrocortisone acetate - Florinef® or
  2. DOCP - Desoxycorticosterone pivalate (Percorten® - V)
    Desoxycorticosterone pivalate [DOCP] sterile suspension
Treatment of secondary Addison's disease
  • Supplement with a glucocorticoid (i.e., low dose prednisone, prednisolone)

For more in depth discussion of treatment options, visit Addison's Disease on the Mar Vista Animal Medical Center web site.

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References:
  1. Tilley, LP, Smith, FWK, The 5 Minute Veterinary Consult, Canine and Feline. 1997, Williams & Wilkins.
  2. Mordecai Siegal (Ed.) The UC Davis Book of Dogs. 1995, HarperCollins Publishers.
  3. Bonagura, JD (ed.) Kirk's Current Veterinary Therapy XIII Small Animal Practice. 2000,W. B Saunders Company.
  4. In a retrospective study of 225 dogs with Addison's disease, 71% were female.   J Am Vet Med Assoc 1996 Jan 1;208(1):85-91.  Pretreatment clinical and laboratory findings in dogs with hypoadrenocorticism: 225 cases (1979-1993).  Peterson ME, Kintzer PP, Kass PH.

 

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Last updated: Saturday, February 06, 2010
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