My Vet Says My Dog Has Hypoadrenocorticism: What Do I Do Now?
If your vet says your dog has hypoadrenocorticism, you might panic, especially if you have no idea what a scary-sounding name like hypoadrenocorticism means. Dr. Cathy Alinovi demystifies this health problem, also known as adrenal insufficiency, and talks about causes, symptoms and treatments.
Question 1: What is hypoadrenocorticism?
Dr. Cathy: Think about the definitions: hypo (low) adreno (adrenal gland) corticism (endocrine function). Also called Addison's disease, the hypoadrenocortical patient has an under functioning adrenal gland. Adrenal insufficiency is another name for the disease.
Q 2: How did my dog get Addison's disease?
Dr. Cathy: Conventional teaching says Addison's is most commonly an autoimmune disease where the body's immune system attacks itself, in this case, in the adrenal gland.
Less common causes would be infection or tumor or tissue death due to lack of blood supply. Alternatively, an increasing body of evidence talks about depletion as a cause for Addison's. Depletion due to a lifetime of stress = burnout.
One other cause of Addison's is man-made such as suddenly stopping steroid treatment in a dog that has been on steroids for long-term therapy.
Q3: What's the frequency of occurrence in dogs?
Dr. Cathy: It is quite uncommon (1 in 10,000), which is another reason it is hard to diagnose.
Dogs At Risk For Addison's
Portuguese Water Dogs
West Highland Terriers
Q4: What breeds are at highest risk for Addison's disease?
Dr. Cathy: The highest risk factors are for female dogs between the ages of four and seven years old.
Please refer to the table for a list of dogs with high risk factors for Addison's.
However, Addison's disease might affect any breed.
Q5: What is the difference between Addison's disease and Cushing's disease?
Dr. Cathy: Both diseases affect the adrenal gland. In Cushing's, the glands make too much hormone, but in Addison's they make too little. In Cushing's, it's really only over secretion of cortisol and it is usually a brain (pituitary) driven problem. In Addison's, it is not only underproduction of cortisol, but also the hormones that regulate salt balance in the body; the problem is usually at the adrenal glands.
Q6: What are the symptoms?
Dr. Cathy: Addison's disease is actually pretty hard to diagnose. However, that is not because the tests are difficult to administer, but because the symptoms are very vague. Moreover, it will depend on which hormones are lowest.
If the salts get out of balance and cortisol is low, it presents as a dog with general malaise, that blah feeling. These dogs will be dehydrated and have some vomiting and diarrhea.
A day or two in the hospital with IV fluids usually corrects these patients, but this is a temporary fix until the disease is diagnosed. The IV fluids work because they restore the salt and electrolyte balance in the body.
Again, this is temporary, as daily life will use up the salts, and use them up faster if the dog is stressed. Addison's can also present just as a dog with low cortisol. These dogs become fat, have reduced energy, and are quite difficult to diagnose.
As just mentioned, the symptoms are very vague. Addison's can be as mild as vomiting and diarrhea corrected by a night of IV fluids. It can be as major as a full system collapse or anywhere in between.
Because Addison's is the "great pretender," it looks like many other conditions such as dietary indiscretion, pancreatitis, anemia, sugar imbalance, salt (electrolyte) imbalance. Additionally, it can be misdiagnosed or not properly diagnosed at first. Because Addison's is much less common than any of the just mentioned illnesses, it is not commonly tested for.
Q8: How does a vet diagnose AD?
Dr. Cathy: The definitive test is to give ACTH, which is a hormone that normally stimulates the adrenal gland to produce cortisol. If the blood cortisol level does not change, the patient has Addison's. ACTH stands for adrenocorticotropic hormone, which is a long word that means the hormone that stimulates the adrenal gland.
Q7: How many types of AD are there?
Dr. Cathy: There are three types of Addison's:
Primary is when the whole gland under produces hormones due to something occurring at the adrenal gland like overwhelming stress, autoimmune disease, or trauma.
Secondary is when the brain, through the pituitary or hypothalamus, does not make the hormone signals to the adrenal glands.
Atypical is where only part of the adrenal stops working, so only the stress hormone stops being produced. These dogs do not respond to stress well.
Q9: What is the short-term treatment for AD?
Dr. Cathy: Fluid therapy and perhaps a dose of steroids will turn the average Addison's patient around in a matter of hours.
Q10: What are the long-term treatments for AD?
Dr. Cathy: There are pills and/or injections to replace the missing hormones. What form of Addison's disease your dog has then determines which drug or combination is used. The foundation of treatment really lies in a life that does not build stress. High quality, real food, minimal vaccines and medication, and a happy home keep from overtaxing the adrenal glands.
Q11: How does my vet decide which treatment is right for my pet?
Dr. Cathy: There is a little trial and error in balancing the Addisonian dog based on response to treatment. Once the patient is stabilized, medication starts. Initially, monthly blood work will evaluate the salt balance in the body. Small adjustments to the medication will be made if the salts (electrolytes) are out of balance.
A well-rounded approach to treating the Addison's patient will include diet changes, consistent exercise, and can include herbs or nutraceuticals. Exercise stimulates the body to release beta-endorphins, which are natural pain relievers that inhibit stress and the need for cortisol.
Changing the diet to remove grains and carbohydrates reduces stress on the body significantly. This means skipping dry kibble as it takes a minimum of 30% carbohydrates to form a crunchy bite of kibble. Alternatives would be a high quality canned food, a raw diet, or a balanced home-prepared diet.
Nutraceuticals would aim to decrease stressors (dysbiosis) and support the adrenal gland with its precursors. Herbal therapy addresses the root of the cause, which is an easily stressed patient with weakened reserves. (Kidney Jing deficiency in Traditional Chinese Veterinary Medicine).
Q12: What is the prognosis for dogs with AD?
Dr. Cathy: Once diagnosed, the prognosis can be fair to good depending on how well the owner manages the things that stress the adrenal glands (see next question). If the owner makes no changes, the crises may worsen in frequency and severity, and it can become life threatening.
Q13: How will I manage my dog's AD?
Dr. Cathy: Most likely, there will be daily medication to replace missing hormones. There may also be supplemental medications to address underlying issues. However, building a healthier lifestyle is your best management technique. The steps to a healthier lifestyle including feeding your dog the same food you would eat and maintaining a consistent exercise program with your dog.
Consistent exercise doesn't necessarily mean jogging for miles each day, but it does mean getting moving for 10-20 minutes five days a week. If your dog is small, chasing a toy in the house can be enough. For a bigger dog, a vigorous walk around the block is perfect.
Q14: What quality of life does an Addison's disease dog have?
Dr. Cathy: The Addisionian dog can have a great life if it is well regulated, on a low carb diet, and getting consistent exercise. Stress and poor diet make it harder for the dog with Addison's to have extended good quality as relapses will occur.
Q15: What suggestions do you have for pet parents?
Dr. Cathy: Prevention is ideal. By the time a dog is diagnosed with Addison's a lot of time has passed. Real food and consistent exercise in a low stress home heads off many issues.
Consider waiting to spay your dog to allow her hormones to bring her to full development first. Of course, there are advantages and disadvantages to waiting to spay your dog. The key is to start the conversation early with your vet.
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