Addison’s Disease

Addison’s disease is the common name for hypoadrenocortisism. The most simple (and sort of accurate) definition of Addison’s disease is “the opposite of Cushing’s disease.”

Addison’s disease is the common name for hypoadrenocortisism.  The most simple (and sort of accurate) definition of Addison’s disease is “the opposite of Cushing’s disease.” Cushing’s disease (hyperadrenocortisism) is characterized by an excess of cortisol, and Addison’s disease is characterized by a deficiency of cortisol and aldosterone.

Last week we discussed what happens when adrenal glands, for a myriad of different reasons, become overactive.  What happens when the adrenal glands are underactive?  And why would they slack off when they are known for being so hard-working?  Would cortisol and aldosterone be missed if they were no longer being produced by the adrenal glands? Would you ever ask these questions if I were not making you wonder?  I am sure you have if you have a dog with Addison’s disease!

Big Stupid Medical Words

(Note:  I LOVE big stupid medical words.  I am hoping that if you do not yet, you will soon.  No other languages lend themselves better to highly specific and obnoxiously compounded words than Greek and Latin.  Awesome.)

Adrenal glands – These are two little triangle shaped organs, one near each kidney.  The adrenal glands produce stress hormones, help balance electrolyes, oversee the production of sex hormones and manage the body’s “fight or flight” response.

ACTH – adrenocorticotropic hormone – This is a hormone produced and secreted by the pituitary gland that signals the adrenal glands to produce cortisol.

Cortisol – This is the body’s main steroid hormone.  It is produced and secreted by the cortex (outer layer) or the adrenal gland.  It supports life and helps manage the body’s stresses.

Aldosterone – This is another steroid hormone (more specifically a mineralocorticoid, mineral = salt,  See?  Aren’t medical words awesome??)  It is also produced and secreted by the cortex of the adrenal gland.  It signals the kidneys to retain appropriate amounts of sodium and chloride and water and release excess potassium as waste.

Electrolytes – “salts,” or, more specifically, ions that are electrically charged (positive or negative) in solution.

Today’s Electrolytes of Interest – sodium (Na+), chloride (Cl-) and potassium (K+).

Which Dogs?

Addison’s disease is uncommon in dogs and rare in cats.  Addison’s disease seems a bit more “random” in which dogs are affected than Cushing’s disease.  It affects dogs of all ages.  It affects all breeds and mixes, but has been reported more often in Great Danes, Rottweilers, Portuguese Water Dogs, Standard Poodles, West Highland White Terriers and Wheatens (1), and also Bearded Collies and Leonbergers, though the more rare a disease (and a breed!) is, the more difficult it can be to determine patterns.

(1)  Kinzter PP. Hypoadrenocorticism. In: Tilly LP, Smith FW, eds. The 5 Minute Veterinary Consult. Ames: Blackwell, 2007:656.

Peanut is an eighteen (18!) year old mixed breed dog belonging to my friend Tammy Hall.  Peanut was diagnosed with Addison’s disease ten years ago, and is doing wonderfully on medication and periodic wellness exams and blood work.  She is otherwise healthy.  (As Dave Barry so often says, “I am not making this up!”)  Every time I see Peanut, I am encouraged.

Living well with Addison’s disease is possible.

Causes of Addison’s Disease

Most cases of Addison’s disease are thought to be caused by dysfunctions of the immune system that destroy part of the adrenal cortices, causing insufficient cortisol and aldosterone production.

Less commonly, something malfunctions in the pituitary gland causing decreased ACTH production and thus decreased cortisol production by the adrenal glands (secondary Addison’s disease).  Other causes, such as certain cancers, are rare.

A dog can develop iatrogenic Addison’s disease (iatrogenic – “i” caused it!) if long term steroid use is abruptly discontinued or if medication for Cushing’s disease is given at a high enough dose to destroy more of the adrenal glands than what was intended.

A Lack of Cortisol

Cortisol is needed for many of the body’s day to day functions and to manage both normal and excessive stress.  A lack of cortisol may be characterized by vomiting and diarrhea and decreased appetite.

A Lack of Aldosterone – You Never Appreciate Electrolytes Until They Are Unbalanced

Aldosterone signals the kidneys to retain appropriate amounts of sodium and chloride and water and release excess potassium as waste.  Without it, too much salt (sodium and chloride) will be lost, too much water will be lost and too much potassium will be retained.  All of these need to be intricately balanced on a cellular level.  When they are not, bad things happen to every body system, though some are hit harder than others.

High potassium can cause heart rhythm disturbances.  Loss of salt can cause vomiting and diarrhea.  Dehydration causes lethargy.  Dehydration, salt loss and excess potassium together will cause low blood pressure, weakness and PU/PD (polyuria – excess urination, polydipsia – excess thirst) as the dog’s body tries to bring everything back into balance.

Diagnosing Addison’s Disease

It used to be that nonspecific ailments in the veterinary world were often treated with steroids and supportive care.  As frustrating as that can be for veterinarians today (I would never yell at my hero James Herriot, but sometimes I have yelled at his cure-all treatments while reading his books…) many a life has been saved by this “fix all” including many pre-diagnosis Addison’s disease sufferers.

Today, we try to diagnose the specific cause of clinical signs as often as possible, and have better tools with which to accomplish that than in days past.  So, often we will suspect Addison’s disease if a pet is showing signs, non-specific as they are, and do bloodwork.

If liver and kidney values are elevated, and especially if electrolytes are unbalanced – high potassium and low sodium and low chloride – we really become suspicious.

A diagnosis is made by checking cortisol levels before and after giving ACTH by injection.  If cortisol starts and remains low despite the ACTH injection, we have a diagnosis of Addison’s disease.

Even though we can “pin down” Addison’s disease much more effectively than we used to be able to, it still can be a nebulous diagnosis, refusing to read the text books and refusing to present with classic signs and lab work.  With atypical and secondary Addison’s disease, electrolytes (one of the big markers we look for) may not even be out of whack.

Treating Addison’s Disease

An “Addisonian crisis” – an event in which a pet with Addison’s disease becomes critically ill –  is treated with intensive care, steroids and intravenous fluids plus specific treatment as needed for clinical signs, such as low blood pressure, vomiting and diarrhea.  An Addisonian crisis often precedes the diagnosis of Addison’s disease.

Addison’s disease is treatable, but if unchecked can be fatal.  Once the patient is stabilized, diagnosed and on the correct dose of medication, crises are much less common, though they can still happen.  Medication doses may need to be adjusted periodically for a dog with Addison’s disease, more often at the beginning of the course of the disease than later.

Stable Addison’s disease is treated by artificially replacing the aldosterone and cortisol the body’s adrenal glands are not making. This is done with oral fludrocortisone acetate (Florinef) or injectable desoxycorticosterone pivalate (DOCP, Percorten-V) and, if needed, “physiologic” doses (low doses to match what the body should be producing) of prednisone.

Higher doses of prednisone are given to an addisonian pet when he or she is expected to be under more stress than normal, such as when boarding or undergoing anesthesia or when ill.  Pet parents also become skilled at knowing when pets are already stressed and may need “boosts” of prednisone.  Two of the biggest “tells” are decreased appetite and lethargy.  Wellness examinations and blood work are repeated routinely once the pet is stable.  Addison’s disease, though a high maintenance and lifelong condition, generally has a good prognosis.

See full size image

Have you had or known a dog or other pet with Addison’s disease?  What have been your experiences with diagnosis, treatment, and prognosis?  Have your pets with Addison’s disease done well?  I sure hope so.

I will repeat what I said last week when we talked about Cushing’s disease, because though they are on opposite ends of the adrenal disease spectrum, I believe the “blessing” is appropriate for Addison’s disease as well…

I hope that your only experience with this complex and intriguing disease is  this post, and that all of your pets (even, and perhaps especially, your Addisonian friends) have a long and healthy life filled with intricately and perfectly balanced levels of stress hormones and electrolytes!

Resources:

Facebook Support Group

Yahoo Support Group

A Great Website for Pet Parents:

AddisonDogs

See full size image

34 thoughts on “Addison’s Disease

  1. We had a Old English Sheepdog when I was younger who passed away from Addison’s Disease. It sure isn’t something I hear a lot about! Thanks for the informative article!

  2. Thank you for this! My Great Dane has Addison’s. He is now 10 years old and was diagnosed at 11 months!

      1. My 7 yr. old Pyr suffered with this all her life. She was finally diagnosed and treated for atypical addisons. Two weeks later she died from Megaesophagus. I was told the two were not related but I find that hard to believe. Any light you can shed on this would be much appreciated.

        1. Hi Pete, I am sorry to hear about your dog. The two conditions sure could have been related. It is rare, but sometimes megaesophagus follows Addison’s – the cortisol deficiency can make all the muscles weaker, and sometimes that includes the muscle of the esophagus, manifesting as megaesophagus.

          1. I have a 2 year old male Standard Poodle that was diagnosed with Addison’s recently after suffering an acute Addison’s crisis. He is doing great now after a slow comeback. He is on the 2 drugs mentioned in the article. He was severely underweight and we were told to pack on the groceries (special Dog food). He is always hungry! Even though we feed him canned 2X daily and always dry available. He eats the Purina vet diet “EN” canned and also the dry “EN”dry mixed with Royal Canin dry Hydrolyzed Protein. He has the most unbearable gas and it is frequent. He gets very little people food. Only the occasional bite of pizza crust or baked chicken. Sometimes he outsmarts us and get the remains of the wet cat food!! Anyway, we have become somewhat worried about the intense gas bombs. He also burps loudly and drinks tons of water and sometimes even wets the bed. (he sleeps really hard) If he is hungry or thirsty and his respective bowl is empty he starts flipping it all around the kitchen until we respond. Often times he will wake us with an urgent bark to go out and pee forget more water. Does all of this sound normal for an Addison’s patient?? Oliver never acted like this beforehis diagnosis!

            Julie

  3. Thank You. Piper my 4 year old Rottweiler, was diagnosed with addisons two years ago. They suspect is was brought on by her two ACL surgeries. We maintain with florinef. But am interested in reading what others ask or have to say. Again Thanks!

  4. We have a seven year old pug who has Addison’s. She was diagnosed at 10 months and doing wonderful on DOCP injections and prednisone. Having a vet who understands this disease is key. If anyone lives in Cincinnati, Ohio and would like my vets name let me know.

    1. Hi Becky,

      I am 4 hours north of Cincinnati…but would LOVE to get your vet’s information since the vets around me seem to be having difficulties figuring my pup’s issues with Addison’s out.
      Thanks!
      Sue

    2. Hi Becky,

      Just came across this while researching addisons. Our dog was diagnosed almost 2 years ago & has been doing great up until recently. I would like to take her to a vet that really understands this disease & is willing to explore her symptoms. We live in Cincy & currently take her to Oakley Animal Hosp. She has had problems with involuntary urination for 3 months now & they always prescribe antibiotics. I think it’s a sodium issue. I would appreciate your vet contact. Thank you!

  5. Roscoe was diagnosed with Addisons after he went into an Addisonian crisis and we almost lost him! He is doing great now with regular percortan injections.

  6. I have a 5 yr old dane with AD who is managed beautifully on percorten and a very tiny daily dose of prednisone 🙂

    1. Thank you Leslie!! And thank you everyone for your pups’ stories and your nice comments! Sometimes knowing you are not the only family out there struggling through a difficult thing with your pet helps, I think.

  7. Interesting to read about the disease. My black lab mix Maxwell had Cushing’s disease for two years before having to be put down a year ago at the age of 13 yrs. Extra medical care and physical assistance but he maintained his sweet nature to the end. Still miss the guy.

  8. We have a 1.5 year old Great Dane who was diagnosed a little over a month ago and has done very well with the Percorten and Prednisone. 🙂 Great article! I’m still learning what to do and when thanks for the advice.

  9. Living with an Addisonian Rott/Shep mix for 9 years! A rescue at 3 months, at 3 years of age, Mystic was initially diagnosed with Renal Failure (common faux pas, I’m told). While awaiting laboratory tests, she went into Addisonian Crisis… was saved by timely Veterinary intervention.

    She started on DOCP injections every 28 days with a daily supplement of prednilisone. Intensive research on my part came up with an Australian Vet who specialized in LARGE BREEDS with Addisons. DOCP is a HUGELY expensive drug and as a disabled person with very limited resources, I was amazed/relieved to find it IS possible to stretch the intervals without harm to the animal. The dosage (and therefor the cost) is dependent on the weight of the animal. At nearly 100 lbs, I needed to discuss my “findings” with my own Vet. He was amenable to the experiment. So each time Mys got her injection, we’d add another day to the interval. I am extremely happy to tell you that she’s been on a 39-day-interval for nearly 5 years now. (at $170 a pop, that’s a LOT of money). I did have to decrease the interval for several months after my husband (her Master) died unexpectedly and the stress of her grief wreaked havoc with the disease. And though it took nearly 2 years to “comfortably” stretch it back out, she’s currently back to the 39-day dosing schedule. Now ancient (nearly 12 years old), I’m sure I’m going to have to begin to shorten that schedule again….. but a Large-Breed Addisonian to even MAKE 12 years old is a miracle in and of itself. Though she’s cost a fortune over her lifetime, I’d do it all over again because this IS a manageable disease and her quality of life has been unaffected by the Addison’s itself.

    Please understand that I’m NOT advocating messing with your dog’s medication. My Vet and I discussed every conceivable consequence of this experimentation. He agreed that I know my dog best and KNOWS that I’m hyper-vigilant when it comes to their health and well-being. I’m just tossing out a success story for other Big Addisonian owners that a scheduling adjustment could be the difference between treating your dog LONGER than being forced to make the toughest financial decision we as pet owners face.

    1. Hi mel just wondering who the vet was in aus that specialises in addisons, I’m also in aus and finding it hard to find someone to help out with getting my boys meds right, as the vet I’m at now is saying that his reaching his maximum florinef intake (12 a day) I think he could be on more his a 45kg rotty so I just want to talk to someone who knows what there talking about, thanks!!

  10. My 12 yr old Lab was put on prednisone 3months ago, for an attack of arthritis, but now I’m giving him glucosamine and chondroitine as well as other supplements’ which seem to help him lots. I’ve got him down to 5mg one day and 3mg the next, for his 40kg. Could you give me an idea of how long the severage should take, if it will beat all possible. He’s a bit les active the 3mg days, and eats normally, instead of trying to eat for two. His weight’s important because of the arthritis. Thanks for your article, if I’d read it 3 months ago we wouldn’t be in this state.

  11. My chocolate lab was diagnosed 3 years ago with Addison’s disease. He has been receiving percortin shots monthly and takes 5 mg prednisone a day.
    He was one week late for his shot last month and I new it was off when he started acting wierd. He becomes whiney and wants more attention than usual.
    He has terrible gas and wants to eat all the time. He will actually run away for a period of time to seek food and will eat anything he finds edible. He has small very loose stools and has a difficult time passing them. He drinks more water than usual. All if these symptoms have always disappeared within a few days of the percortin dose but this month the gas is much worse and symptoms are worse. It has been over a week since the last shot.
    I have had another expensive blood test a couple of times this year and they are reported as normal.
    I am wondering if the stomach/gas problems are specifically related to the Addison’s or is he taking too much prednisone or if he is going to have a crisis again.

    1. My borer collie is the same way with gas that lessens after his Percorten injection each month. I had his blood retested and all is fine. Two weeks ago I decided to see if he’d improve if I put him on a bland diet of white rice, a dollop of whole milk cottage cheese and canned Blue Buffalo food I had around. Just 1/3 of the can. So low protein, high simple carb. It worked. I am now trying to figure out if it’s too high protein, too high fiber, or the vitamins in the Blue Buffalo Wilderness weight control food he’s been on. My first variable to try is the fiber. My son and I noticed he feels much better and no gas since I’ve been doing this for his evening meal. He has more volume of food. He has held his weight, too. He no longer seems ravenous all the time. So, I’m into food elimination diet. I hope this gives you some ideas. Btw he didn’t have gas problems until Addison’s disease made him sick.

  12. My dog is a Bichon that I rescued knowing that he had Addison’s. His first family gave him up because they could not afford his treatments. When I got him he was taking a quarter of a pill a day and getting his shot every 28 days. I fully understand needing to keep costs low. This is why I worked with my vet and I give the shots at home myself and he gives me his meds at almost cost. We also worked to see if his pill was necessary or not. He was displaying over eating and over drinking. This stopped as we backed down the pill. Now he only gets the pill if we are traveling or in a stressful situation. I agree that finding a vet that knows what they are doing and is willing to work with you to share their knowledge and teach you how to “listen” to your pet. Mine tells me when he needs his shot I keep track of the days, but by watching his actions I have learned if he needs it earlier or later. So to sum up this long post find a good vet and learn to listen to your pet it makes all the difference. And let’s you share a happy and easy life with your pet that happens to have Addison’s.

  13. My 5 yr old Great Dane “Starr” stopped eating two weeks ago, very unusual for her as she is a real “foodie”, I took her to the SPCA vet and they could not find anything but low proteins in blood work which they contributed to her stomach upset that we reported as she was throwing up and first and then lost her appetite. I thought she may have drank some water from the bottom dish of a plant outside that I had just put some B1 and super thrive fertilizer to help the dying plant. They gave her Cernia and worming pills. I brought a urine sample and stool sample in they turned the urine in for lab work but did not take the stool sample. I was a little discouraged as she came home and was doing no better. I brought her with me when I picked up the worming meds but they didn’t want to see her until the next day. I took her to the emergency vet a day later and they did more blood work, EKG, as her heart beat was over 200bpm and an arrhythmia. After two nights and 3 days at the emergency vet she came home with the diagnosis of Gastroenteritis after xrays/EKGs/cardio consult and ultrasound and a scare of possible bloat and emergency surgery considered, her appetite returned and was on a bland diet with Metronidozole, Cernia and Omeprazole. She ate cooked chicken (only) for 3 days then stopped eating again. She is back in the Emergency vet on IV support and due to the low protein that showed up in all her blood work they are now testing her for Addisons. Thank you for your article on Addisons. It gives me hope that that will be the diagnosis and that she will be okay. We have her sister and a EBSPCA rescue Dane/Pointer mix. I will look into pet Insurance as we are on fixed income and this has been very expensive but our dogs are our children and we would do what ever it takes to help them. I miss her terribly but am so thankful for the aggressive looking into what could be wrong with Starr that I know she is at the best place and getting the best treatment and car possible. She totally hates going there and her heart rate races to 170-200 white coat syndrome but I think she knows they are helping her as well. Can’t wait to get her home again. Thank you for your article about Addisons. 🙂

  14. My 12 year 1 1/2 month old Terv had full blood panel, ultra sound, urine/fecal done June 4, 2014. Everything came back incredibly excellent except his liver enzymes were slightly elevated (same as showed up the year before). He also had a few vomiting episodes before I brought him in. So vet said to give him 1 Pepcid AC per day. The vomiting and grass eating increased and he became more picky at meals, so I took him in again on July 12. A couple of days before that I started him on Tylosin 1 pill 2X per day as vet said I should if vomiting increased. Diagnosed as acid reflux/GERD. On the 12, vet said to continue Tylosin but give 1 Pepcid AC 2X a day. From July 12 to 16, appetite decreased to no food, diarrhea, periodic extreme leg weakness, sleeping more, drinking more water. July 17, I rushed him in to the vet around 10:30 am when vet arrived, with dog in shock, dehydrated, listless, couldn’t cock his leg to urinate nor jump in car. Addisonian crisis…never before diagnosed with Addison’s Disease. Vet put him on IV fluids and dexamethezone until 8:00 pm at night when it was determined to put him down because his eye whites, lips, gums were still snow white and he was very unstable standing. The fluids and Dex did not improve him. I am in “shock” as I can not understand what happened. His test results were so good and he was still active until the last day or two. Why did it not work? Can you tell me anything that would help me to stop going over and over it, trying to figure it out, even though I know it is too late now? I know he had an active life: Obedience & Rally titles, tracking, herding, fly ball, scent hurdle racing, natural raw diet, walks every day, tons of love…but it still hurts dreadfully to lose him this sudden, rapid deterioration, unexpected way with no time to fight for him. Thanks so much for any insight you are able to give me. Margaret

  15. my baby Mickey was diagnosed with Addison’s last August. He is 6 years old. I was told he w3ould get better with medications but has gained so much weight he has no life. four months ago he went totally blind. I was told it had nothing to do with his disease, I don’t believe it, plus he is losing his hearing. what do you think. it’s killing me watching him. I am grasping for straws for help. my heart is broke for him, and now I am suffering depression. I would rather die than to put him down.

  16. can Addison=s cause blindness. and if the steroids are suppose to help, how long will it be before I see some change

  17. Our dog passed away recently with Addisons desease. We are missing her a lot.
    I do have 234 tablets of Fludrocortison (florinef) 0.1mg I would like to sell resonaible for your dog $55 Please contact me @ [email protected]

Leave a Reply

Your email address will not be published.