Addisons

Addison's disease (Hypoadrenocorticism)

Addison's disease is also known as hypoadrenocorticism. It is an insufficient production of adrenal hormones by
the adrenal gland. Since these hormones are essential for life, this is an extremely serious disease and it must be
treated as such.

Adrenal insufficiency can be primary or secondary. Primary adrenocorticism affects salt/potassium balance in the
body and glucorticoid as well. Secondary adrenocorticism usually only affects the glucocorticoids. It is not
known why primary adrenocorticism occurs but it may be an immune mediated process. Secondary
adrenocorticism probably occurs most often when prednisone or other cortisone being administered for medical
reasons are suddenly withdrawn. It can occur as a result of pituitary cancer or some other process that interferes
with production of hormones that stimulate the adrenal glands.

Most dogs with Addison's disease initially have gastrointestinal disturbances like vomiting. Lethargy it also a
common early sign. Poor appetite can occur as well. These are pretty vague signs and it is extremely easy to miss
this disease. More severe signs occur when a dog with hypoadrenocorticism is stressed or when potassium
levels get high enough to interfere with heart function. Dogs with this problem will sometimes suffer severe
shock symptoms when stressed, which can lead to a rapid death. When potassium levels get high heart
arrythmias occur or even heart stoppage which also is fatal. In some cases, especially secondary Addison's
disease, there are no detectable electrolyte changes.

This disease can be picked up by changes in the ratio between sodium or potassium by accident at times. When
this happens it is still extremely important to treat for it. It is confirmed by an ACTH response test --
administration of this hormone should stimulate production of adrenal hormones. If this does not occur then
hypoadrenocorticism is present. In cases in which the electrolyte levels are normal this is the only test for the
problem and it will be missed unless it is looked for specifically. At times this disease can be hard to differentiate
from renal failure because the symptoms and even the bloodwork can be similar ---- so the ACTH reponse test
may be necessary to differentiate them.

Treatment for this disease is usually done by oral administration of fludrocortisone acetate (Flurinaf), salting the
food, and administration of corticosteroids like prednisone. In a crisis situation this disorder must be treated more
aggressively with intravenous fluids, IV glucocorticoids and correction of acid/base balances.

You have to pay close attention to a dog with this problem. Don't ignore any changes in appetite, GI
disturbances or anything else that makes you think your dog is ill. If you work with your vet and are careful
about following his or her directions this disease has a good prognosis when it is discovered before a crisis
occurs.

Mike Richards, DVM

Our Experience with Addison's disease in our older Malamute

By: Carol Januszewski

November 2000

Nika owned us for 13 1/2 years. She became a member of our household on March 4th 1985. She was born on
December 25th 1984.

My husband was in the Air Force so Nika was a very well traveled Malamute. She and her cat, Tasha, spent a lot of
time in hotels and in their crates moving all over the country and over seas. In the fall of 1992 we left the Air Force life
and became "civilians" in West Michigan. My husband would soon take a job as a long haul truck driver, and I would
once again be home alone with the "kids".

In early January 1993 Nika began refusing her dinners from time to time. She had recently turned 9 years old so I
thought perhaps this was just a sign of aging. She would still eat her favorite treat of cheese, so I was not too
concerned. In early February my husband had come home from a long road trip and mentioned that he thought Nika
had lost some weight. With her heavy coat it was not so visible to me but he noticed right away since he hadn't seen
her in so long. I decided to make an appointment to get her a check-up at the vet, but since it was the weekend I would
need to wait until Monday. That particular weekend was Valentine's weekend, and my husband had to head out on
the road once again. Nika became very depressed and had no interest in anything. I was getting concerned. On
Monday I asked my neighbor to let Nika out in the early evening since I had to work late that night. I made a vet
appointment for her for later in the week. When I got home that evening my neighbor had mentioned she found bird
feathers in Nika's mouth. Nika was not a "hunter" so I figured she just found a couple that had fallen off of a bird. Boy
was I wrong, because she vomited up parts of a bird later that evening. Turns out what I had seen on the lawn earlier
that morning was a dead bird, and not a clump of leaves.

The next morning Nika could not even stand up on her own. I was in a state of panic, and called her vet to tell them
she's having an emergency of some type and please be ready for us. When I got her there she was able to walk in on
her own but then she lay down on the floor and didn't move or woo woo like usual. I was afraid the bird she had eaten
had been poisoned. Nika was put on IV fluids and had blood drawn for extensive testing. I had to leave her there and
go to work. When I called the clinic that afternoon, I was told she was no better, but that her vet had a strong
suspicion of what was going on but that Nika's blood had to go to Michigan State University for confirmation and it
would be at least 2 days for the results. I was a basket case and I had no way to get in touch with my husband.

Friday the test results came back and confirmed our vet's diagnosis, Nika had Addison's disease and she was very
near death. She was in Addison's shock and I didn't even know it. Her sodium and potassium levels were way off the
board and her kidneys nearly failed. Fortunately her vet was already treating several other dogs with this disease and
she was his 5th new case. This disease is very rare in dogs, but for some reason several dogs in our area turned up
with it within the past year. Nika was finally stabilized with Prednisone, then was started on in injection regimen of a
steroid type hormone called DCOP (Desoxycorticosterone Pivilate) it was a very expensive injection, but the results
were astounding. Within 2 days Nika was back to herself 100%! She had lost a considerable amount of weight during
this ordeal (went from 75 lbs to 58 lbs). By the time she was stable, I finally got a call from my husband and I told him
what had happened. He would have been devastated if he had come home and found out Nika had died. Fortunately I
got to tell him the worst was over but we had a long road to go.

The dosage of this drug is based on the weight of the dog and how the body metabolizes it over a period of time.
Normally the shots are given between 20 and 30 days apart, but Nika began to gain back her weight, so it took a few
months to get everything stabilized. Her shot cycle leveled out at every 28 days.

Nika was a high-strung Malamute to begin with (we found out a couple of years after we bought her from a pet shop,
that she came from a puppy mill. Hard lesson learned there.), and this disease and her advancing age made her more
so. She became deathly afraid of thunderstorms and lightening (this is the dog raised on a military base with B-52s
flying overhead day and night). She also developed a severe allergy to flea bites and wound up with a hot spot that
turned into a yeast infection and she lost all the hair on her back end. This set off an Addison's event that had to be
brought under control with a short series of Prednisone. After that mess, we decided to shave her coat down for the
summer, and keep it about 2" long in the winter. I was able to keep her skin in top condition, and she looked pretty
cute too. As long as I had Prednisone on hand and she got her shots on time, she had an excellent quality of life.
Eventually my husband found a job that got him home every day, so he was able to help out with the care regimen we
had developed. I never left Nika alone for more than a half day since she could possibly have an Addison's event and
getting Predisone in her quickly was very important. Nika was our "child" so all of this extra care and expense was
definitely worth the time and money. She lived until 4 months shy of her 14th birthday, and it was simple old age that
sent her to the Rainbow Bridge. Addison's Disease did not seem to shorten her life as long as she was being treated.

A lot more is known about Addison's disease in dogs now than when Nika was first diagnosed. It is not a death
sentence when caught early, and it is 100% treatable. Listed below are some symptoms to watch for, that I should
have paid more attention to, following that is a short list of things I would do differently given what I know now about
the disease. Just a note, Cushing's disease has many of the same symptoms, but the treatment is very different.

Symptoms to watch for:

1. Sudden loss of appetite

2. Acting lethargic or depressed

3. Unexplained weight loss

4. Dull coat, hair breakage

5. Unexplained vomiting of liquid matter or phlegm

Things I wish I had done differently:

1. Paid closer attention to the weight loss

2. Paid closer attention to her personality change. Not everything can be "old age"

3. Gotten her in to the vet sooner, prior to the bird eating incident

4. Not assuming she would just "bounce back" like she had when younger