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Tierarztl Prax Ausg K Kleintiere Heimtiere 2018; 46(02): 90-96
DOI: 10.15654/TPK-170668
Originalartikel – Original Articles
Schattauer GmbH

Prednisolone dosages in Addisonian dogs after integration of ACTH measurement into treatment surveillance

Article in several languages: English | deutsch
Florian K. Zeugswetter
1   Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
,
Tanja Haninger
1   Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 25 October 2017

Accepted after revision: 14 February 2018

Publication Date:
04 May 2018 (online)

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Summary

Objective: To examine the prednisolone and fludrocortisone dosages in dogs with primary hypoadrenocorticism after integrating endogenous ACTH (eACTH) determination into the surveillance regimen.

Materials and methods: The local electronic medical records database was searched for dogs with primary hypoadrenocorticism and a complete follow-up including routine eACTH measurements until stabilisation. Dogs were considered stable if they showed no signs of glucocorticoid deficiency or excess, sodium and potassium were within the laboratory reference limits and no change of prednisolone and/or fludrocortisone dosage was recommended by the clinician. To avoid subclinical glucocorticoid overreplacement prednisolone was routinely reduced in case of eACTH concentrations below the detection limit of the assay.

Results: Thirteen client-owned dogs were eligible for inclusion in the study. Stabilisation was achieved after a median (range) of 14 (1–36) months and 4 (2–9) visits. After exclusion of two patients that did not need additional glucocorticoids, the prednisolone dosage was 0.06 (0.02–0.26) mg/kg/day and 9.1 times lower than the starting dose. No correlation was identified between prednisolone dosage in mg/kg/day and bodyweight (rSP = –0.369, p = 0.215). The final fludrocortisone dose was 0.022 (0.013–0.036) mg/kg/day. The median (range) survival time of the dogs that had died during the study period (n = 6) and all dogs was 74.5 (62–98) months and 71 (18–104) months, respectively.

Conclusion and clinical relevance: The integration of eACTH measurement into treatment surveillance helps to optimise glucocorticoid replacement therapy. It supports treatment recommendations and is a particular aid in dogs with ambiguous clinical signs. The results suggest that most dogs on fludrocortisone substitution therapy benefit from additional very low dose prednisolone.

Keywords

Adrenocorticotropic hormone - hypoadrenocorticism - glucocorticoids - monitoring
 

  • References

  • 1 Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003; 361: 1881-1893.
    CrossrefPubMedSearch in Google Scholar
  • 2 Bleicken B, Hahner S, Loeffler M, Ventz M, Allolio B, Quinkler M. Impaired subjective health status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens. Eur J Endocrinol 2008; 159: 811-817.
    CrossrefPubMedSearch in Google Scholar
  • 3 Boretti FS, Meyer F, Burkhardt WA, Riond B, Hofmann-Lehmann R, Reusch CE, Sieber-Ruckstuhl NS. Evaluation of the cortisol-to-ACTH ratio in dogs with hypoadrenocorticism, dogs mimicking hypoadrenocorticism and in healthy dogs. J Vet Int Med 2015; 29: 1335-1341.
    CrossrefPubMedSearch in Google Scholar
  • 4 Church DB. Canine hypoadrenocorticism. In: BSAVA Manual of Canine and Feline Endocrinology. 4th edn.. Mooney CT, Peterson ME. eds. Gloucester: BSAVA; 2012: 156-166.
    Search in Google Scholar
  • 5 Ekman B, Bachram-Lindström M, Lindström T, Wahlberg J, Blomgren J, Arnquist HJ. A randomized, double-blind, crossover study comparing twoand four-dose hydrocortisone regimen with regard to quality of life, cortisol, and ACTH profiles in patients with primary adrenal insufficiency. Clin Endocrinol 2012; 77: 18-25.
    CrossrefPubMedSearch in Google Scholar
  • 6 Feldman EC, Nelson RW. Hypoadrenocorticism (Addison’s disease). In: Canine and Feline Endocrinology and Reproduction. 3rd edn,. Feldman EC, Nelson RW. eds. Philadelphia: Saunders; 2004: 394-439.
    Search in Google Scholar
  • 7 Feldman EC, Peterson ME. Hypoadrenocorticism. Vet Clin North Am: Small Anim Pract 1984; 14: 751-766.
    CrossrefPubMedSearch in Google Scholar
  • 8 Galac S, Reusch CE, Kooistra HS, Rijnberk A. Adrenals. In: Clinical Endocrinology of Dogs and Cats. 2nd edn.. Rijnberk A, Kooistra HS. eds. Hannover: Schlütersche; 2010: 93-186.
    Search in Google Scholar
  • 9 Garcia-Borreguero D, Wehr TA, Larrosa O, Granizo JJ, Hardwick D, Chrousos GP, Friedman TC. Glucocorticoid replacement is permissive for rapid eye movement sleep and sleep consolidation in patients with adrenal insufficiency. J Clin Endocrinol Metab 2000; 85: 4201-4206.
    PubMedSearch in Google Scholar
  • 10 Gunn E, Shiel SE, Mooney CT. Hydrocortisone in the management of acute hypoadrenocorticism in dogs: a retrospective series of 30 cases. J Small Anim Pract 2016; 57: 227-233.
    CrossrefPubMedSearch in Google Scholar
  • 11 Hanson JT, Bonnett B, Hedhammer A. Survival analysis of dogs with adrenocortical insufficiency. J Vet Int Med 2015; 29 ESVE-O-11, 423-483.
    CrossrefPubMedSearch in Google Scholar
  • 12 Hanson JT, Tengvall K, Bonnett B, Hedhammer A. Naturally occurring adrenocortical insufficiency – an epidemiological study based on a swedishinsured dog population of 525,028 dogs. J Vet Int Med 2016; 30: 76-84.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hegstad RL, Johnston SD, Pasternal DM. Effects of sample handling on adrenocorticotropin concentration measured in canine plasma, using a commercially available radioimmunoassay kit. Am J Vet Res 1990; 51: 1941-1947.
    PubMedSearch in Google Scholar
  • 14 Jaffey JA, Nurre P, Cannon AB, DeClue AE. Desoxycorticosterone pivalate duration of action and individualized dosing intervals in dogs with primary hypoadrenocorticism. J Vet Int Med. 2017 DOI:10.1111/jvim.14828..
    PubMedSearch in Google Scholar
  • 15 Kelch WJ, Smith CA, Lynn RC, New JC. Canine hypoadrenocorticism (Canine Addison’s disease). Comp Cont Educ Pract Vet 1998; 20: 921-935.
    PubMedSearch in Google Scholar
  • 16 Kintzer PP. Hypoadrenocorticism (Addison’s disease). In: The 5 Minute Veterinary Consult. Tilley LP, Smith FWK. eds. Baltimore: Williams & Wilkins; 1997: 716-717.
    Search in Google Scholar
  • 17 Kintzer PP, Peterson ME. Treatment and long-term follow-up of 205 dogs with hypoadrenocorticism. J Vet Int Med 1997; 11: 43-49.
    CrossrefPubMedSearch in Google Scholar
  • 18 Klein SC, Peterson ME. Canine hypoadrenocorticism: Part 2. Can Vet J 2010; 51: 179-184.
    PubMedSearch in Google Scholar
  • 19 Lathan P. Hypoadrenocorticism in dogs. In: Clinical Endocrinology of Companion Animals. Rand J. ed. Ames: Wiley-Blackwell; 2013: 1-21.
    Search in Google Scholar
  • 20 Lathan P, Scott-Moncrief JC, Wills RW. Use of the cortisol-to-ACTH ratio for diagnosis of primary hypoadrenocorticism in dogs. J Vet Int Med 2014; 28: 1564-1550.
    PubMedSearch in Google Scholar
  • 21 Lovas K, Husebye ES. Continuous subcutaneous hydrocortisone infusion in Addison’s disease. Europ J Endocrinol 2007; 157: 109-112.
    CrossrefPubMedSearch in Google Scholar
  • 22 Melian C, Peterson E. Diagnosis and treatment of naturally occurring hypoadrenocorticism in 42 dogs. J Small Anim Pract 1996; 37: 268-275.
    CrossrefPubMedSearch in Google Scholar
  • 23 Mooney CT. Addison’s disease (Hypoadrenocorticism) in dogs. Europ J Comp Anim Pract 2007; 17: 167-172.
    PubMedSearch in Google Scholar
  • 24 Oksnes M, Björnsdottir S, Isaksson M, Methlie P, Carlsen AL, Bensing S, Eystein S, Husebye ES, Lovas K. Continuous subcutaneous hydrocortisone infusion versus oral hydrocortisone replacement for treatment of Addison’s disease: a randomized clinical trial. J Clin Endocrinol Metab 2014; 99: 1665-1674.
    CrossrefPubMedSearch in Google Scholar
  • 25 Peterson ME, Kintzer PP. Pretreatment clinical and laboratory findings in dogs with hypoadrenocorticism: 225 cases (1979–1993). J Am Vet Med Assoc 1996; 208: 85-91.
    CrossrefPubMedSearch in Google Scholar
  • 26 Ramsey I. Diagnosis and treatment of canine hypoadrenocorticism. In Pract 2003; 25: 18-25.
    CrossrefPubMedSearch in Google Scholar
  • 27 Reusch C. Hypoadrenocorticism. In: Textbook of Veterinary Internal Medicine. 5th edn.. Ettinger SJ, Feldman EC. eds. Philadelphia: Saunders; 2000: 1488-1499.
    Search in Google Scholar
  • 28 Robben JH, Kooistra HS. Primary hypoadrenocorticism. In: Clinical Endocrinology of Dogs and Cats. 2nd ed.. Rijnberk A, Kooistra HS. eds. Hannover: Schlütersche; 2010: 316.
    Search in Google Scholar
  • 29 Roberts E, Boden LA, Ramsey I. Factors that affect stabilisation times of canine spontaneous hypoadrenocorticism. Vet Rec. 2016 DOI: 10.1136/vr. 103663.
    PubMedSearch in Google Scholar
  • 30 Russel NJ, Foster S, Clark P, Robertson ID, Lewis D, Irwin PJ. Comparison of radioimmunoassay and chemiluminometric assay methods to estimate canine blood cortisol concentration. Aust Vet J 2007; 85: 487-494.
    CrossrefPubMedSearch in Google Scholar
  • 31 Scott-Moncrieff JC. Hypoadrenocorticism. In: Textbook of Veterinary Internal Medicine. 7th edn,. Ettinger SJ, Feldman EC. eds. St. Louis: Saunders; 2010: 1847-1857.
    Search in Google Scholar
  • 32 Scott-Moncrieff JC, Koshko MA, Brown JA, Hill K, Refsal KR. Validation of a chemiluminescent enzyme immunometric assay for plasma adrenocorticotropic hormone in the dog. Vet Clin Pathol 2003; 32: 180-187.
    CrossrefPubMedSearch in Google Scholar
  • 33 Spence S, Fowlie S, Roberts E, Ramsey I. A comparison of the ACTH concentrations in dogs with stable hypoadrenocorticism being treated with either fludrocortisone or desoxycortone pivalate and prednisolone. 27th ECVIM-CA-Congress Proceedings. 2017: 167 http://www.vin.com/doc/?id=8172817..
    PubMedSearch in Google Scholar
  • 34 Vinson GP. The mislabelling of deoxycorticosterone: making sense of corticosteroid structure and function. J Endocrinol 2011; 211: 3-16.
    CrossrefPubMedSearch in Google Scholar
  • 35 Zeugswetter F, Hoyer MT, Pagitz M, Benesch T, Hittmair KM, Thalhammer JG. The desmopressin stimulation test in dogs with Cushing’s syndrome. Dom Anim Endocrinol 2008; 34: 254-260.
    CrossrefPubMedSearch in Google Scholar
  • 36 Zeugswetter FK, Schwendenwein I. Diagnostic efficacy of the leukogram and the chemiluminometric ACTH measurement to diagnose canine hypoadrenocorticism. Tierärztl Prax 2014; 42 (K): 223-230.
    PubMedSearch in Google Scholar
  • 37 Zeugswetter F, Willmann W, Teinfalt M, Benesch T. Physical exercise in dogs with primary adrenocortical insufficiency. Vet Med Aust 2006; 93: 29-31.
    PubMedSearch in Google Scholar