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sam dr green > hypoadrenocorticotism addison > Flashcards

hypoadrenocorticotism addison Flashcards

1
Q

how difficult is it to dx addison (hypo)

A

easy to dx and tx

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2
Q

primary vs secondary hypoadrenocotism

A
  • Primary hypoadrenocorticism
    • More than 95% of cases
    • Plasma ACTH high
    • Mineralocorticoid & glucocorticoid-dependent (most common)
    • Glucocorticoid-dependent (less common)
  • Secondary hypoadrenocorticism
    • Glucocorticoid deficiency only
    • Less than 5% of cases
    • Plasma ACTH low
    • Exogenous steroid administration (more common)
    • Hypopituitarism (less common)
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3
Q

discuss primary hypoadrenocortoctism

A
  • Mineralocorticoid and glucocorticoid dependent
    • More common
    • Idiopathic destruction
    • Mitotane or trilostane treatment
    • Bilateral adrenalectomy
  • Glucocorticoid dependent (“atypical”)
    • Less common (5-25% of cases)
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4
Q

how is atypical hypoadrenocorticotism different

A
  • Similar to “classical” but serum electrolytes are normal
  • May remain glucocorticoid-dependent for months to years or progress to mineralocorticoid-dependence
  • Difficult to diagnose because signs are vague
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5
Q

signalment for hypocortticotism

A
  • Approximately 75% are < 7 years at diagnosis (75%)
    • Average age -4 years
  • Approximately 70% are females
  • Any breed or mixed breed
    • but tends to be a large breed dog dz
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6
Q

history for addison dog

A
  • Illness for a few days to several months
  • Chronic disorder that waxes and wanes (25-40%)
  • Acute collapse (10%)
  • History of previous tx and favorable response to fluids and/or glucocorticoids (25-35%)
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7
Q

what do u see on PE for addison dog

A
  • IT MAY BE NORMAL
  • Lethargy (85%)
  • Thin body condition (80%)
  • Weakness (65-75%)
  • Dehydration (40-45%)
  • Signs of shock (25-35%)
  • Bradycardia (20%)
    • Related to hyperkalemia
    • Especially in a dog in shock -helpful clue!
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8
Q

LESS COMMON FINDINGD FOR ADDISON DOG

A
  • Hypothermia (15-35%)
  • GI ulceration and melena (15%)
    • Glucocorticoids needed for maintenance of normal GI mucosa
    • Lack of glucocorticoids / poor tissue perfusion
  • Abdominal tenderness (7-10%)
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9
Q

CBC FINDINGS FOR ADDISON DOG

A
  • Anemia (25-35%)
    • Typically non-regenerative
    • Anemia of chronic disease
    • GI blood loss (may be semi-regenerative)
    • May be masked by dehydration
  • Leukogram
    • Absolute eosinophilia (10-20%)
    • Absolute lymphocytosis (10-15%)
    • Normal numbers of eosinophils and lymphocytes in sick dog RED FLAG!
    • Glucocorticoids: eosinopenia and lymphopenia (stress leukogram)
  • Plasma proteins may be increased due to dehydration
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10
Q

CHEMISTRY PROFILE FOR ADDISON DOG

  1. K AND NA RATIOS
  2. BUN
  3. P
  4. ACID BASE STATUS
A
  • Sodium and potassium abnormalities
    • Hyperkalemia (90-95%)
    • Hyponatremia (80-85%)
    • Na:K ratio < 27:1 (90-95%)
  • Hypochloremia (40%)
  • Azotemia
    • Increased BUN (90%), increased creatinine (60-65%)
      • IF U GIVE FLUIDS THEY GET PRERENAL AZOTEMIA
  • Hyperphosphatemia (65%)
  • Metabolic acidosis (40-45%)
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11
Q

MOST IMPORTANT CHEMISTRY FINDINGS FOR ADDISONS

A
  • Hypoglycemia (15-20%) *
  • Hypocholesterolemia (15%)*
  • Hypoalbuminemia
    • *Possibly more common in “atypical” hypoadrenocorticism
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12
Q

WHAT DO U FIND IN URINALYSIS ON DOGS WITH ADDISON

A
  • Low urine specific gravity (60% have USG < 1.030)
  • Renal medullary washout of solute
  • May cause confusion with acute renal failure
  • Renal function returns to normal after rehydration and re-establishment of normal renal medullary solute concentration
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13
Q

WHAT DO WE SEE ON RADS FOR ADDISON

A
  • NT ALWAYS INDICATED
  • Microcardia (hypovolemia)
  • Megaesophagus (< 1%)
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14
Q

THE VALUE OF DOING RESTING CORTISOL IN DX ADDISON

A
  • Resting plasma cortisol may be useful to rule out dz
    • Sensitivity 100% and specificity 98% if ≤ 1.0 μg/dL
    • Sensitivity 100% and specificity 78% if ≤ 2.0 μg/dL
  • NEVER use resting plasma cortisol to try and rule it in
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15
Q

WHICH TEST SHOULD BE USED TO CONFIRM DX FOR ADDISON

A
  • ACTH STIMULATION TEST
  • Should be used confirm diagnosis
  • Plasma cortisol determined before and 1 hour after ACTH administration
  • Best to perform before administering glucocorticoids that may interfere with test results
    • Dexamethasone does not cross react with cortisol on RIA and can be given if necessary
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16
Q

ACTH Stimulation Test Interpretation FOR CLASSICAL ADDISON

A

Both pre-and post-ACTH cortisols < 2.0 μg/dl in nearly 100% of cases (most < 1.0 μg/dl )

17
Q

ACTH Stimulation Test Interpretation FOR ATYPICAL ADDISON

A

Low resting cortisol (≤ 2.0 μg/dl) with little response to ACTH (≤ 4.0 μg/dl)

18
Q

ACTH Stimulation Test Interpretation FOR Secondary hypoadrenocorticism (hypopituitarism)

A

Low resting cortisol (≤ 2.0 μg/dl) with little or no response to ACTH (≤ 3.0 μg/dl)

19
Q

EMERGENCY TX FOR ADDISON

A
  • Correct hypovolemia and restore tissue perfusion
  • Correct electrolyte and acid base disturbances
  • Replace missing mineralocorticoids
  • Replace missing glucocorticoids
20
Q

FOR ADDISON TX, Fluids and parenteral medications continued until:

A
  • BUN and serum creatinine return to normal
  • Serum electrolytes and acid base balance return to normal
  • Animal begins to eat and drink without vomiting
21
Q

drugs for long term maintainance for addisonians

A
  • Desoxycorticosterone pivalate (DOCP)
    • no glucocorticoids . therefore give with steroids
  • Fludrocortisone (Florinef®)
22
Q

AVDAVANTAGES OF Fludrocortisone (Florinef®) AS A SUBSITUTE FOR ADDISON TX

A

IT HAS BOTH mineralocorticoid and glucocorticoid effects

23
Q

DISAD. FOR Fludrocortisone

A
  • Some dogs respond poorly (poor GI absorption?)
  • Some dogs develop adverse effects due to excessive glucocorticoid activity at dosages required to control serum electrolyte concentrations (e.g. PU, PD, polyphagia, weight gain, hair loss)
  • In some dogs, glucocorticoid effect avoids need for supplemental prednisone
24
Q

TX FOR ATYPICAL ADDISON

A
  • Dogs with secondary hypoadrenocorticism or “atypical” (glucocorticoid dependent) primary hypoadrenocorticism
    • Require only glucocorticoid supplementation
  • Dogs with “atypical” (glucocorticoid dependent) primary hypoadrenocorticism may go on to also become mineralocorticoid-dependent (vigilance is warranted)
25
Q

PX FOR ADDISON

A
  • Excellent (> 80% respond very well to treatment)
  • Median survival is 4-5 years
  • If properly treated many dogs lead long lives and die of another disease
  • LONG term therapy required!!!!!!
26
Q

ADDISON IN DOGS

A
  • Rare
  • Requires very high index of suspicion
  • Clinical and laboratory findings similar to dogs with hypoadrenocorticism
  • Response to treatment may be slower than observed in dogs

sam dr green (10 decks)

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