Emmett's Legacy: Canine Addison's Disease

Every Spring your dog should get a wellness check-up which includes testing for Heartworm, etc. While you are having the blood panels done, please include testing for blood glucose levels, potassium and sodium. If there are any abnormalities (i.e. they are not within the proper range), please do further testing.  Save your dog's life!

HELP SAVE LIVES!!!

WHAT IS ADDISON’S DISEASE?

Addison’s Disease affects both humans and canines. This particular pamphlet focuses on Canine Addison’s Disease.

Addison’s Disease is also called Hypoadrenocorticism.

It is caused by an insufficient production of the hormones secreted by the adrenal glands.  The adrenal glands are two small glands that sit next to the kidneys and essential for life.

There are two types of Addison’s Disease: 1) Primary (Typical) and 2) Secondary (Atypical).

The cause of Primary Addison’s Disease is basically the body’s immune system destroying the adrenal tissues. The cause of Atypical Addison’s Disease is generally due to problems with the pituitary gland.

A number of hormones are produced by the adrenal glands, however the two that are affected in Addison’s Disease are: Mineralocorticoids (Aldosterone) and Glucocorticoids (Cortisol). Aldosterone controls the body’s ability to maintain electrolyte and water balance in the body. Cortisol affects almost every tissue in the body: 1) Promotes general well-being, 2) Appetite, 3) Controls blood glucose levels, 3) Helps the kidneys control water and calcium levels in the blood and 4) Helps control the red and white blood cell numbers.

Without medication to control the levels of Aldosterone and Cortisol, Canine Addison’s Disease is fatal. When a dog has undiagnosed Addison’s Disease, it is fatal within 24 hours of the onset of an Addisonian Crisis.

However, if the dog has been diagnosed with Addison’s Disease, when (s)he goes into an Addisonian Crisis, the vet can stop the crisis with intravenous hydrocortisone and intravenous fluids.

 

ARE ALL BREEDS AFFECTED?

As more research is being done across the world, more breeds are being diagnosed with Primary Addison’s Disease.  Generally speaking, the breeds currently known to be more susceptible to this disease are:

  • Standard Poodle
  • Great Dane
  • Labrador Retriever
  • Nova Scotia Duck Trolling Retriever
  • Portuguese Water Dog
  • Rottweiler
  • Soft-Coated Wheaten Terrier
  • West Highland White Terrier

Addison’s Disease is non-discriminate, it can affect any breed of dog.

There is a belief that Primary Addison’s Disease (AD) could quite possibly be genetic and many studies are currently being conducted with DNA research collected from all breeds of all dogs including: 1) Diagnosed Primary AD, 2) AD relatives of Diagnosed Primary AD, 3) non-AD relatives of Diagnosed Primary AD and 4) non-AD, non-related dogs. 

Please bear in mind that many dogs are cross-bred which brings the occurrence of Primary AD to a broader canine population. Atypical AD can affect any breed of dog as it is a secondary development of a different condition.

If you are a breeder, please keep records of all your litters to see if Addison’s Disease is present in any of the dogs. Keep in touch with adopting families and ask them to let you know if one of the dogs from your litters is diagnosed with AD.

 

WHAT ARE THE PHYSICAL SYMPTOMS OF AD?

  • Weakness
  • Depression
  • Lethargy
  • Anorexia or Poor Appetite
  • Weigh Loss
  • Vomiting
  • Diarrhea
  • Excess Drinking or Urinating
  • Slow Heart Rate
  • Abdominal Pain
  • Hypothermia
  • Changes in Pigmentation of the Skin
  • Seizures due to hypoglycemia
  • Dry, Itchy Skin

Please note that your dog may not present with all of these symptoms. Addison’s Disease is called the Great Mimic, as these symptoms are present in many other illnesses.

An Addisonian Crisis can mimic other illnesses such as: gastrointestinal disorders (diarrhea), acute renal failure (kidney disease), liver disease, insulinoma (too much insulin), hypothyroidism (underactive thyroid) or hypoglycemia (low blood sugar).

Situations such as illness or excessive stress can cause an Addisonian Crisis.

If your dog presents with any of these symptoms, please consider asking your vet to do a full laboratory panel to confirm or eliminate AD.

 

LABORATORY TESTS TO CONFIRM DIAGNOSIS

Primary Addison’s Disease can be diagnosed sometimes as early as 6 months of age. It is the author’s experience, discussing with other families of Addisonian dogs, that many were diagnosed between 6 months and 2 years of age. If your dog presents with any abnormalities in the blood panel between 6 months and a year, it is a possibility that (s)he has AD and comparison blood work will confirm a diagnosis.

If however, at any time during your dog’s life (s)he displays any of the above symptoms, it is never too late to do the blood work and if a positive diagnosis is confirmed, begin the regimen of medication. The alternative is not a choice!

Your vet can test for Addison’s Disease using a blood panel that includes the following:

  • Increased Lymphocyte (a type of white blood cell) numbers
  • Anemia
  • Increase Serum Potassium
  • Decreased Serum Sodium
  • Altered Sodium/Potassium ratio (Na:K): <27
  • Increased Serum Phosphorus
  • Increased Serum Calcium
  • Decreased Blood Glucose
  • Increased BUN & Creatinine (indicators of kidney function)
  • Acidosis (upset in body's acids/base balance)
  • Low Blood Cortisol Levels

Additionally, an ACTH (Adrenocorticotropic Hormone) stimulation test must be performed in order to confirm a suspected diagnosis based on the results of the original blood panel. A normally working pituitary gland releases adrenocorticotropic hormone (ACTH) to signal the adrenal glands to produce cortisol.  The ACTH stimulation test stimulates the pituitary gland to release the hormone. If the adrenal glands are working normally, the cortisol levels should rise.

 

THE ACTH STIMULATION TEST

  • A blood test is taken to determine the baseline cortisol levels
  • An injection of ACTH is given
  • An hour or two later, another blood test is taken and the cortisol levels are measured.

Normally, the dog will produce cortisol in response to the ACTH injection, an AD dog will not. The ACTH is the only test that will give your vet a confirmed diagnosis of Addison’s Disease.

An X-Ray will also show if the heart is smaller than normal due to the volume of circulating fluid in the body being reduced by Addison’s Disease.

 

TREATMENT FOR ADDISON’S DISESASE

If your dog is diagnosed prior to an Addisonian crisis, (s)he will begin maintenance therapy which supplements the missing hormones.  Your dog will be on medication every day for the rest of his/her life, however, closely monitored, the dog can live a full life.

 

DURING AN ADDISONIAN CRISIS

A dog in the midst of an Addisonian Crisis will generally be extremely weak, unable to walk or only just a few feet with assistance, disoriented, abnormal heart rate, diarrhea, vomiting and loss of bladder, depending on the stage of the Crisis.

During an Addisonian Crisis, the dog must be cared for immediately by a vet as AD is fatal without proper medication.  Even if your dog is on medication, there is a possibility (s)he may go into an Addisonian Crisis and will require emergency veterinary care. Generally speaking, the following four medications are used during the emergency care of an Addisonian Crisis, although it may vary with your dog and (s)he may not require all of these medications:

  • IV Saline Solution to help replace lost electrolytes and other minerals.  This can also help to dilute high levels of potassium in the blood
  • IV Prednisolone  Sodium Succinate or Dexamathasone Sodium Phosphate to replace glucocorticoids
  • Percorten-V or Florinef to replace missing mineralcorticoids
  • IV Calcium Gluconate to treat life-threatening heart arrhythmias

 

MAINTENANCE TREATMENT FOR PRIMARY AD

A dog with Primary Addison’s Disease will require cortisol and aldosterone replacements everyday of his/her life. There are two drug options: 1) Fludrocortisone (marketed under the name Florinef) and 2) DOCP (Percorten-V) and Predisone.

Fludrocortisone replaces both cortisol and aldosterone and may provide all that your dog needs.  It comes in pill form and is given each day, however, this drug is costly and could cost several hundreds of dollars each month for a large dog.

The other option is to use Percorten-V which replaces aldosterone and is given monthly by injection. Some vets teach you to give the dog the injection yourself, while others insist that it only be done at the vet’s office. If your vet is willing to show you how to do the injection, it can save you a lot of money, as you can order the medication online. If you choose to use the Percorten-V, your dog will also require a daily dose of Prednisone to replace cortisol, which is given in pill form.

 

LEARNING TO WORK WITH THE MEDICATIONS

As with all medications, there are side effects to each of the above medications that could present in your dog.  Often this may just mean that the vet will need to adjust the dosage of the medication. Often the side effects may mimic symptoms of AD, so it is very important to have regular blood panels to make sure the medication dosages are correct.  Do not change any dosages without first consulting your vet.

 

MAINTENANCE TREATMENT FOR ATYPICAL AD

A dog with Atypical Addison’s Disease only requires Cortisol replacement.  Generally, Prednisone, Hydrocortisone, Dexamethasone or a similar replacement medication is prescribed. The dosage may need to be changed, so again, it is important to have regular blood panel to know that the dosage is accurate.

 

STRESS MANAGEMENT

An Addisonian dog cannot produce stress hormones, so it is best to be prepared prior to a potentially stressful situation to administer extra prednisone to keep his/her levels even. Stress can include illness, hospitalization, issues of trauma, travelling, unfamiliar experiences (such as large family gatherings), thunderstorms, fireworks, etc.

Always make sure you are prepared for any situation.  If you are away from home, make sure you know where the nearest emergency veterinary care programs are during your travels. Always keep extra medication with you in a thermal cooler as well as lots of extra water. If you are flying with your dog, make sure that the crate has a clear label on it, listing that the dog has Addison’s Disease. Include the medications (s)he is taking, your home address, your home vet contact information, your place of destination and the nearest vet clinic at your place of destination.  Carry a letter from your vet with detailed explanations of AD, the medication the dog is taking as well as clearly defined instructions on what to do in the event of an emergency.  Carry the extra medication with you in a thermal cooler, make sure your dog has adequate water for the trip and ask that your dog stay with you until you board the plane (or other mode of transportation where your dog and you will be separated).  Immediately upon reuniting with your dog at your destination, take time to make sure (s)he is doing alright and make sure (s)he drinks a lot of water to balance out the system.  Most likely, (s)he will need to rest when you arrive at your destination so plan ahead to have a little bit of down-time before you begin your travel business.

 

LIVING WITH CANINE ADDISON’S DISEASE

It is not easy to live with Canine Addison’s Disease, both emotionally and financially. It is ideal to keep a small binder that includes copies of all the blood panel results as well as a detailed chart of the dosage of medication given each day.  This will help you keep on top of your dog’s condition as well as provide all the information you need should you require an emergency visit to a vet other than your own.

There are a number of websites with information about Addison’s Disease. Even the websites for AD humans will provide you a lot of information that is useful to you when dealing with Canine Addison’s Disease. You can also find online support groups for Canine AD families and make use of the search engines such as Google and Yahoo to comparison shop for medications online.  Some may require a fax of the prescription from your vet which no doubt is easy enough to do.  Also, I have heard that there are regular pharmacies now who will fill a vet prescription for Prednisone and other medications. Look around and ask questions, the best way to provide you with peace of mind and financial sustainability is to keep reading more information about Canine Addison’s Disease and talking with other families.

Contact Information

Please feel free to contact me via email at emmetts.legacy@gmail.com or via Twitter @kfleming73