Ulcerative colitis , crohn's disease and inflammatory bowel disease
Addison’s Disease
18
Addison’s Disease Addison’s Disease Accession 80173, 80174 Accession 80173, 80174 Erica Fields, DVM Erica Fields, DVM
description
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 - PowerPoint PPT Presentation
Transcript of Addison’s Disease
Addison’s DiseaseAddison’s Disease
Accession 80173, 80174Accession 80173, 80174
Erica Fields, DVMErica Fields, DVM
Joey AkersJoey Akers
8 yo MC Standard Poodle8 yo MC Standard Poodle Weight loss, 2 week history of Weight loss, 2 week history of
inappetance, 2 day history of anorexiainappetance, 2 day history of anorexia Severe lethargySevere lethargy No diarrhea, but vomited once, 2 days No diarrhea, but vomited once, 2 days
agoago
Radiographic FindingsRadiographic Findings
MicrocardiaMicrocardia Small pulmonary lobar vesselsSmall pulmonary lobar vessels CachexiaCachexia
Ultrasound FindingsUltrasound Findings
Small adrenal glandsSmall adrenal glands Cystic calculusCystic calculus
Hertage, 2004Hertage, 2004
Addison’s Disease—Addison’s Disease—Cause(es)Cause(es)
Iatrogenic—adrenocortical atrophy due to mitotane, Iatrogenic—adrenocortical atrophy due to mitotane, bilateral adrenalectomy, rarely bilateral adrenalectomy, rarely neoplastic/granulomatous dz or amyloidosisneoplastic/granulomatous dz or amyloidosis
Primary HypoadrenocorticismPrimary Hypoadrenocorticism Progressive destruction of adrenal corticesProgressive destruction of adrenal cortices Must lose more than 90% to see clinical signsMust lose more than 90% to see clinical signs Rare in dogs, even more so in catsRare in dogs, even more so in cats Usually immune-mediated destructionUsually immune-mediated destruction
Secondary HypoadrenocorticismSecondary Hypoadrenocorticism Deficient ACTH production (or suppression)Deficient ACTH production (or suppression) Mineralocorticoids typically minimally affected (ACTH only Mineralocorticoids typically minimally affected (ACTH only
minor effects)minor effects)
Hertage, 2004Hertage, 2004
Addison’s Disease—Addison’s Disease—Signalment and HistorySignalment and History
Young to middle-aged (median 4-6 yrs)Young to middle-aged (median 4-6 yrs) 70% of naturally occurring cases are in 70% of naturally occurring cases are in
females females Intact > spayedIntact > spayed Bearded collies and Std poodles – no female Bearded collies and Std poodles – no female
sex predilection (very heritable in these)sex predilection (very heritable in these)
No sex predisposition in catsNo sex predisposition in cats
Hertage, 2004Hertage, 2004
Common Clinical SignsCommon Clinical Signs
Acute (Addisonian crisis)Acute (Addisonian crisis) Hypovolemic shockHypovolemic shock Bradycardia (clearly inappropriate in shock)Bradycardia (clearly inappropriate in shock) Abdominal pain, vomiting, diarrheaAbdominal pain, vomiting, diarrhea HypothermiaHypothermia
Chronic Chronic Vague, resolve with nonspecific txVague, resolve with nonspecific tx Often chronic/intermittent GI signs, weight lossOften chronic/intermittent GI signs, weight loss Pu/pdPu/pd
Others—often associated with other immune-mediated Others—often associated with other immune-mediated endocrine disorders (esp. hypothyroidism)endocrine disorders (esp. hypothyroidism)
Melian, 1999 and Hoerauf, 1999Melian, 1999 and Hoerauf, 1999
Addison’s Disease—Addison’s Disease—Typical Imaging FindingsTypical Imaging Findings
81.8% have one or more of the following 81.8% have one or more of the following (thorax rads):(thorax rads): Small cardiac silhouette (45.5%)Small cardiac silhouette (45.5%) Small cranial lobar arteries (36.4%)Small cranial lobar arteries (36.4%) Small caudal vena cava (54.5%)Small caudal vena cava (54.5%) Small liver (36.4%)Small liver (36.4%)
Less commonly—megaesophagus! (unsure of mech)Less commonly—megaesophagus! (unsure of mech)
Ultrasound (or CT/MRI)Ultrasound (or CT/MRI) Small adrenals (difficult to define)Small adrenals (difficult to define)
Grooters, 1995Grooters, 1995
Ultrasound-measured thickness is most Ultrasound-measured thickness is most correlated to necropsy findingscorrelated to necropsy findings
Thickness is the dimension most affected Thickness is the dimension most affected by adrenal pathology in humansby adrenal pathology in humans
Right adrenal more likely to be V-shaped, Right adrenal more likely to be V-shaped, making measurement more challengingmaking measurement more challenging
ReferencesReferences Grooters AM, Biller DS, and J Merryman. 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 Hertage ME. Hypoadrenocorticism, In Textbook of Textbook of Veterinary Internal MedicineVeterinary Internal Medicine, 6, 6thth ed. 2004. WB Saunders. ed. 2004. WB Saunders. pp 1612-1622. pp 1612-1622.
Melian C, J Stefanacci, ME Peterson, and PP Kintzer Melian C, J Stefanacci, ME Peterson, and PP Kintzer Radiographic findings in dogs with naturally-occurring Radiographic findings in dogs with naturally-occurring primary hypoadrenocorticism. primary hypoadrenocorticism. Journal of the Veterinary Journal of the Veterinary Medical Association.Medical Association. 1999. Vol. 35: 208-212. 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.
Questions?Questions?
