What Is Addison's Disease

  
(retired)min- ister misty

be calm, dont- worry!
 
 
Barked: Thu Apr 19, '12 1:25am PST 
So Your Dog Has Addison's Disease

The diagnosis is in; it's Addison's Disease.
All of us here at AddisonDogs.com remember hearing those words from our vet.
Sometimes they brought up feelings of sadness or fear, occasionally relief to know what's going on. Then the vet starts talking about mineralo-somethings and prednisone and DOCP and daily this and monthly that and soon your head is swimming.
You just want your dog back.
That's how AddisonDogs.com came to be.


What is Addison's disease anyway?

Let's start with a brief overview of Addison's disease.
It is the common name for hypoadrenocorticism, or adrenal insufficiency.
It is a disease with symptoms that are common in many other ailments, making diagnosis difficult and sometimes a process of elimination.
But once Addison's is correctly diagnosed, a properly treated dog can live a normal active life.


The adrenal, one on each kidney, is made up of two layers, the cortex and the medulla.
The outer area, or cortex, secretes corticosteriod hormones such as cortisol and aldosterone.
The medulla, part of the sympathetic nervous system, secretes epinephrine (adrenaline), which is generally not affected by Addison's.

There are three forms of Addison's disease:

primary, secondary and atypical.

Primary and atypical Addison's are usually the result of immune mediated damage to the glands.

Secondary hypoadrenocorticism is from failure of the pituitary to stimulate the adrenals with adrenocorticotropic hormone (ACTH).

It is important for you to know which type of Addison's disease your dog is being treated for.

I don't have a diagnosis

The symptoms of Addison's disease can be vague.
More importantly, they are similar to the symptoms of many different problems.
Initially, the dog may be listless, or seem depressed.
Many dogs are described as just seeming off, or losing the normal sparkle in their eye.
Lack of appetite is a good indicator.

Dog Feeling Sick

SYMPTOMS:

Vomiting
Diarrhea
Lethargy
Lack of appetite
Tremors or shaking
Muscle weakness
Pain in hind quarters

Other symptoms include gastrointestinal problems like vomiting and diarrhea.
Pain in the hind quarters, or generalized muscle weakeness such as a dog that can't jump onto a bed or couch as he has done in the past is not uncommon. Shivering or muscle tremors may also be present.
The most important thing to remember is that you know your dog better than anyone.
If something seems amiss, have it checked out.

These symptoms may wax and wane over months or years making diagnosis difficult.
If the adrenals continue to deteriorating, ultimately the dog will have an acute episode called an Addisonian crisis.
Potassium levels elevate and disrupt normal functions of the heart.
Arrhythmia can result and blood pressure drops to dangerously low levels.
BUN and creatinine levels, generally indicators of kidney function, are often elevated.
At this point many animals are diagnosed with renal failure, as the kidneys are unable to function properly.
Typically animals are given IV solutions for rehydration, which may produce an almost miraculous recovery.
This too, is a great indication that failure of the adrenals rather than of the kidneys is creating the symptoms.


How can you be sure it's Addison's?

One of the first things to look at when Addison's disease is suspected are the electrolyte levels.
The two that are of greatest concern are the sodium (Na) and potassium (K).
In addition to looking at these values, it is important to look at the ratio between the two.

Electrolyte levels are important,
but not a definitive test for Addison's.

Primary Addison's involves changes
in electrolytes while Atypical and
Secondary do not.

An ACTH stim test is the only
definitive test for diagnosing Addison's.

This number is derived by dividing K into Na and should be between 27 and 40.
For example, a dog with a Na level of 145 and a K level of 4.5 would have a ratio of 32.
A dog in an Addisonian crisis will typically have a low Na level, elevated K and low ratio.

While electrolyte levels are important indicators, they are not the definitive test to determine Addison's disease.
In fact, with secondary and atypical hypoadrenocorticism, electrolyte levels may not be affected.
For definitive diagnosis the dog is given a the ACTH stimulation or response test.
This tests the ability of the adrenal glands to produce the corticosteroid hormone cortisol.

To perform the ACTH stimulation test, an initial blood sample is drawn and the cortisol level is measured. The dog is injected with a form of pituitary hormone ACTH that tells the adrenals to produce cortisol. After an hour, blood is drawn again, and the cortisol level measured.
Resting cortisol should range from 1-4 ug/dl in the average dog, and should be significantly higher, in the range of 6-20 ug/dl, post-stimulation.
(These numbers may vary depending on the lab.) If resting cortisol is low and the dog has no or a low response to the stimulation, the diagnosis is Addison's disease.
Be aware that some glucocorticoids, such as predinsone, can affect the results of the ACTH test, while dexamtheasone does not.

Keeping on top of it.

There are several medications used to treat Addison’s. The first type acts as a mineralocorticoid and replaces the aldosterone – the hormone responsible for maintaining electrolyte levels.
It is replaced with either an oral medication called Florinef ™ (fludrocortisone acetate) or the injectable Percorten-V™ (desoxycorticosterone pivalate or DOCP).


Primary Addison' requires the
replacement medications of
mineral corticoids.

Atypical and Secondary require
the replacement of glucocorticoids only.

Atypical Addison's can become Primary
and requires careful monitoring of
your dog.

Addison's dogs may require additional
glucocorticoids during periods of stress, injury or surgery.

For dogs that have atypical or secondary Addison’s neither of these medications are used because the production of aldosterone isn’t effected and electrolytes remain in balance.

In addition to replacing the aldosterone, the cortisol, or glucocorticoids, normally secreted by the adrenals must also be replaced.
This is typically done with an oral form of prednisone or hydrocortisone.
With atypical and secondary Addison’s the glucocorticoid is the only medication given.
Bottom Line

While your dog with Addison’s disease will need medications and monitoring for the rest of his life, most dogs with Addison’s can return to their favorite activities.
You will learn to read your dog, understand what his stress triggers are and follow your instincts in his care.
Together, you will overcome ADversity and learn from this experience.
You will help your dog lead a normal, active and fun-filled life.
(retired)min- ister misty

be calm, dont- worry!
 
 
Barked: Thu Apr 19, '12 1:31am PST 
Treatment and Medications

There are several medications used to treat Addison’s disease.
The first type acts as a mineralocorticoid and replaces aldosterone – the hormone responsible for maintaining electrolyte levels.
It is replaced with either the injectable Percorten-V™ (desoxycorticosterone pivalate or DOCP) or an oral medication called Florinef ™ (fludrocortisone acetate).
For dogs that have atypical or Adrenal shown on dog.
secondary Addison’s neither of these medications are used because the production of aldosterone isn’t

In addition to aldosterone, the cortisol, or glucocorticoids, normally secreted by the adrenals must also be replaced.
This is typically done with an oral form of prednisone or hydrocortisone. During a crisis, the dog may receive an injection of dexamethasone, a potent and fast-acting glucocorticoid.
The dog may be started initially on high doses of prednisone to facilitate a return to health.
On an on-going basis, the glucocorticoid dose can be reduced and in some cases eliminated except on an as-needed basis.
With atypical and secondary Addison’s the glucocorticoid is the only medication given.


Mineralocorticoids:

Primary Addison's disease is treated by replacing the mineralocorticoid, Aldosterone, with either injectable Percorten-V or oral doses of Florinef. These medications help maintain the balance of the electrolytes Sodium (Na) and Potassium (K)

Percorten-V™ also known as
desoxycorticosterone pivalate or DOCP is the injectable form of medication used to treat primary Addisons.

Percorten-V is the brand name for desoxycorticosterone pivalate.
It is an injectable medication with only mineralocorticoid activity.
It does not have any glucocorticoid activity.
The dose recommended by Novartis, the manufacturer, is 0.75 – 1.0 mgs per one lbs. of bodyweight, given every 21 – 30 days.
There are 25 mgs in each ml (or cc) of the medication.

A 50-pound dog would receive between 37.5 – 50 mgs or 1.5 – 2.0 mls.
Some dogs are adequately maintained on lower doses, while some dogs require lower doses to minimize rare side effects.
Percorten-V is available only through a licensed veterinarian, although some veterinary pharmacies may carry the medication.

Florinef ™ or fludrocortisone acetate
is the pill form of medication used to treat primary Addisons.
It can also be purchased in compounded form.

Florinef is the brand name for fludrocortisone acetate.
This medication is also available in its generic form, fludrocortisone acetate, from compounding pharmacists.
It is primarily a mineralocorticoid, but also has some glucocorticoid activity.
The starting dose recommended by the Merck Veterinary Manual is 0.05 – 0.1 mgs per 10 lbs of bodyweight.
Some dogs require significantly higher doses to maintain normal electrolytes.

The dose may be divided and given twice per day or given all at once, usually in the morning.
A 50-pound dog would take between 0.25 and 0.5 mgs to start.
The brand name Florinef tablets may be purchased directly from your vet or from a pharmacy.
Some people find it more cost effective and efficient to have the proper dose of the medication prepared by a compounding pharmacist in capsule, liquid, or chewable form.


Glucocorticoids:

The adrenal glands produce cortisol, a glucocorticoid.
It is the hormone measured by the ACTH Stimulation test used to diagnose Addison’s disease.

All dogs with Addison’s require the supplementation of glucocorticoids in times of stress. Many need glucocorticoids on a more regular basis, particularly those on DOCP.
Dogs with atypical or secondary Addison’s only take glucocorticoids.

The most common glucocorticoids are prednisone, hydrocortisone and dexamethasone.
There are additional glucocorticoids such as prednisolone and methylprednisolone.
The Merck Veterinary manual recommends a prednisone dose of 0.1 – 0.2 mgs/lb. per day.
This is equivalent to 0.4 – 0.8 mgs/lb.
per day of hydrocortisone.

Glucocorticoids, such as prednisone, should be given to an Addison's dog in times of stress and in some on a more regular basis.

However, some dogs show symptoms of excess glucocorticoids on these doses. These problems may include excessive drinking and urination, increased appetite, recurring infections, elevated liver enzymes, panting, restlessness and even behavioral changes.
Because these dogs will be on medications for the rest of their lives, it is important to fine-tune the dosages to maximize benefits, while minimizing unwanted side effects.
If you are working to reduce your dogs dose of glucocorticoids, be sure to work with your vet and lower the amount slowly.

Determining what constitutes stress for your dog, when additional glucocorticoids are necessary, is very individual.
Like people, dogs find different situations stressful.
Stress can be in many forms, both good and bad, from physical to emotional. For some dogs a trip to the vet requires extra medication, while for others it could be houseguests or extra active playtime.
Knowing your dog’s triggers is crucial.
It is essential to monitor the dog closely and be prepared to give extra medication when the need arises.


Laboratory Results: Blood Test

Addison’s disease is diagnosed through a blood test called the ACTH Stimulation or Response test.
This test is typically only done once to diagnose the condition.
To perform the ACTH stimulation test, an initial blood sample is drawn and the cortisol level is measured.
The dog is injected with a synthetic form of the pituitary hormone ACTH that tells the adrenals to produce cortisol.
After an hour, blood is drawn again, and the cortisol level measured.
Resting cortisol should range from 1-4 μg/dl in the average dog, and should be significantly higher, in the range of 6-20 μg/dl, post-stimulation.
If resting cortisol is low and the dog has no or a low response to the stimulation, the diagnosis is Addison’s disease.
Be aware that some glucocorticoids, such as prednisone, can affect the results of the ACTH test, while dexamethasone does not.


Electrolyte ratio is determined by dividing the "NA" number by the
"K" number
145÷4.5 = 32

At diagnosis, your dog will probably have what’s referred to as a Super Chem or Chem Panel and CBC (Complete Blood Count) to look at other important blood values.
The results from these blood tests help to determine if organs such as the kidneys, liver and pancreas are functioning properly, as well as if any signs of infection are present.
A complete blood test should be completed every 6 months to one year for a dog with Addison’s disease.

There are two blood test results that are of particularly interest in Addison’s disease. They are Sodium (Na) and Potassium (K).
The hormone Aldosterone regulates these electrolytes.
In primary Addison’s disease, the adrenal glands don’t produce (enough) Aldosterone, so it must be replaced with Florinef or DOCP. This is information that you and your vet will use to monitor the effectiveness of the mineralocorticoid (DOCP or fludrocortisone).
The electrolytes are checked frequently at the beginning to determine correct medication levels.

Normal ranges for these values may vary based on the lab and equipment used. Typically, the normal level for Sodium is between 139 to 154 mEq/L and Potassium should be between 3.6 to 5.5 mEq/L.
In addition to looking at these values, it can be helpful to look at the ratio between the two.
This number is derived by dividing K into Na and should be between 27 and 40. For example, a dog with a Na level of 145 and a K level of 4.5 would have a ratio of 32.
A dog in an Addisonian crisis will typically have a low Na level, elevated K and low ratio.
It is important to learn at what levels your dog feels his best.
(retired)min- ister misty

be calm, dont- worry!
 
 
Barked: Thu Apr 19, '12 1:32am PST 
Complementary Therapy

Using complementary and alternative forms of care can help your dog feel better and may even reduce his/her dependence on some medication.
There are a number of modalities that can benefit the dog with Addison’s disease. The key to success with alternative care is to look at the whole animal.
It is very important to not simply substitute an herb for a pharmaceutical.
For most people it is easiest to undertake this effort under the guidance of a holistic vet.
A number of list members have both conventional and holistic vets participating in the care of their dog.



http://www.addisondogs.com/addisons/comptherapy/

Edited by author Thu Apr 19, '12 1:33am PST


(retired)min- ister misty

be calm, dont- worry!
 
 
Barked: Thu Apr 19, '12 1:34am PST 
source:

http://www.addisondogs.com/addisons/