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Addison’s Disease

Addison’s Disease. Accession 80173, 80174 Erica Fields, DVM. Joey Akers. 8 yo MC Standard Poodle Weight loss, 2 week history of inappetance, 2 day history of anorexia Severe lethargy No diarrhea, but vomited once, 2 days ago. Radiographic Findings. Microcardia

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Addison’s Disease

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  1. Addison’s Disease Accession 80173, 80174 Erica Fields, DVM

  2. Joey Akers • 8 yo MC Standard Poodle • Weight loss, 2 week history of inappetance, 2 day history of anorexia • Severe lethargy • No diarrhea, but vomited once, 2 days ago

  3. Radiographic Findings • Microcardia • Small pulmonary lobar vessels • Cachexia

  4. Ultrasound Findings • Small adrenal glands • Cystic calculus

  5. Addison’s Disease—Cause(es) • Iatrogenic—adrenocortical atrophy due to mitotane, bilateral adrenalectomy, rarely neoplastic/granulomatous dz or amyloidosis • Primary Hypoadrenocorticism • Progressive destruction of adrenal cortices • Must lose more than 90% to see clinical signs • Rare in dogs, even more so in cats • Usually immune-mediated destruction • Secondary Hypoadrenocorticism • Deficient ACTH production (or suppression) • Mineralocorticoids typically minimally affected (ACTH only minor effects) Hertage, 2004

  6. Addison’s Disease—Signalment and History • Young to middle-aged (median 4-6 yrs) • 70% of naturally occurring cases are in females • Intact > spayed • Bearded collies and Std poodles – no female sex predilection (very heritable in these) • No sex predisposition in cats Hertage, 2004

  7. Common Clinical Signs • Acute (Addisonian crisis) • Hypovolemic shock • Bradycardia (clearly inappropriate in shock) • Abdominal pain, vomiting, diarrhea • Hypothermia • Chronic • Vague, resolve with nonspecific tx • Often chronic/intermittent GI signs, weight loss • Pu/pd • Others—often associated with other immune-mediated endocrine disorders (esp. hypothyroidism) Hertage, 2004

  8. Addison’s Disease—Typical Imaging Findings • 81.8% have one or more of the following (thorax rads): • Small cardiac silhouette (45.5%) • Small cranial lobar arteries (36.4%) • Small caudal vena cava (54.5%) • Small liver (36.4%) Less commonly—megaesophagus! (unsure of mech) • Ultrasound (or CT/MRI) • Small adrenals (difficult to define) Melian, 1999 and Hoerauf, 1999

  9. Ultrasound-measured thickness is most correlated to necropsy findings Thickness is the dimension most affected by adrenal pathology in humans Right adrenal more likely to be V-shaped, making measurement more challenging Grooters, 1995

  10. References • Grooters AM, Biller DS, and J Merryman. Ultrasonographic parameters of normal canine adrenal glands: comparison to necropsy findings. Veterinary Radiology & Ultrasound. 1995.Vol. 36 (2) : 126-130. • Hertage ME. Hypoadrenocorticism, In Textbook of Veterinary Internal Medicine, 6th ed. 2004. WB Saunders. pp 1612-1622. • Melian C, J Stefanacci, ME Peterson, and PP Kintzer Radiographic findings in dogs with naturally-occurring primary hypoadrenocorticism. Journal of the Veterinary Medical Association. 1999. Vol. 35: 208-212. • Rendano VT and JE Alexander. Heart size changes in experimentally-induced adrenal insufficiency in the dog: a radiographic study. Veterinary Radiology and Ultrasound. 1976. Vol 17 (2) : 57-66.

  11. Questions?

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