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Animal Disease > Hypoadrenocorticism (Addison's Dz) > Flashcards

Hypoadrenocorticism (Addison's Dz) Flashcards

1
Q

What is Addison’s Dz?

A

the diminished secretion of one or more adrenocortical hormones

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2
Q

What is the underlying pathophysiology of primary Addison’s Dz?

A
  • the problem is the adrenal gland itself

- suspected immune-mediated destruction of part of the adrenal gland

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3
Q

What do scientists think the immune-mediated destruction caused by?

A

infiltration of adrenal cortex with lymphocytes & plasmas cells that results in chronic inflammation and leads to tissue fibrosis and eventual destruction of adrenocortical cells

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4
Q

List two types of Addison’s

A

Typical

Atypical

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5
Q

What zona(s) are destroyed in typical Addison’s? What does that result in?

A

Glomerulosa (mineralocorticoid deficiency) &

Fasciculata (glucocorticoid deficiency)

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6
Q

What does Aldosterone deficiency look like

A

loss: sodium, chloride, water
retention: potassium

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7
Q

How does an aldosterone deficiency show up on bloodwork?

A 
hyponatremia (low Na)
Hypochloremia (low Cl)
Hyperkalemia (high K)
Dehydration as azotemia (increased BUN & CRE)
Decreased SG
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8
Q

What zona(s) are destroyed in atypical Addison’s? What does that result in?

A

zona fasciculata only

result = decreased secretion of glucocorticoids

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9
Q

How does a glucocorticoid deficiency affect the body?

A
  • decreased formation of new glucose molecules
  • increased update of glucose by body’s cells
  • inability of body to respond adequately to stress
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10
Q

How can you tell if a patient has typical vs atypical Addison’s?

A

Look at bloodwork; if low Na & Cl but high K, you’re looking at typical Addison’s which is deficient in 2 hormones

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11
Q

List the clinical signs of Addison’s

A
  • Shock & dehydration
  • Bradycardia
  • Shivering, shaking, lethargy, weakness
  • Polyuria
  • V/D/Anorexia
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12
Q

Pathophysiology in Addison’s for: Shock & dehydration

A

result of aldosterone deficiency

  • body can’t maintain proper sodium, potassium, and water concentrations
  • water and sodium loss decrease blood volume and BP

result of glucocorticoid deficiency
-body can’t respond to decreased blood volume and BP

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13
Q

Pathophysiology in Addison’s for: bradycardia

A

secondary to presence of hyperkalemia

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14
Q

Pathophysiology in Addison’s for: shivering, shaking, lethargy, weakness

A

secondary to hyponatremia

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15
Q

Pathophysiology in Addison’s for: polyuria

A

excessive sodium loss into the urine alters concentration gradient within the kidneys and makes it difficult for kidneys to concentrate urine

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16
Q

Pathophysiology in Addison’s for: V/D/anorexia

A

secondary to glucocorticoid deficiency b/c glucocorticoids are necessary to maintain proper mucosal integrity of the intestines

17
Q

Presentation of Addison’s animal in acute crisis

A

shock w/ evidence of dehydration, bradycardia, weak femoral pulse

18
Q

Presentation of Addison’s animal with chronic intermittent illness

A

waxing and waning of shivering, shaking, lethargy, weakness, polyuria, V/D, anorexia

19
Q

Presentation of Typical Addison’s

A

collapse, bradycardia, polyuria, polydipsia, GI signs, shivering or shaking, lethargy or depression

20
Q

Presentation of Atypical Addison’s

A

vague signs of glucocorticoid deficiency, intermittent V/D +/- anorexia episodes; may be described as having a sensitive stomach; may have Hx of unexplained GI upset

21
Q

What test is the gold standard for Addison’s?

A

ACTH Stimulation Test

22
Q

What does ACTH stim test evaluate?

A

the ability of the adrenal glands to produce cortisol

23
Q

How is the ACTH Stim. test done?

A

2 blood samples:
Sample 1 = baseline cortisol level for that patient
Sample 2 = drawn a specific time after injection of ACTH hormone

24
Q

What will the results of an ACTH Stim test be for an Addison’s patient?

A
  • low baseline cortisol lvl

- minimal to no response post ACTH administration

25
Q

What are 2 considerations that are important to remember for ACTH stim testing?

A
  • best to do at 8am because cortisol levels are most stable at that time
  • reduce stress during testing procedure b/c cortisol lvls increase if pet is stressed
26
Q

3 Meds that can be used for Addison’s patients

A

Fludrocortisone
Desoxycorticosterone
Pred/Prednisolone

27
Q

Fludrocortisone

  • type
  • pros
  • cons
A
  • mineralocorticoid w/ some glucocorticoid activity; daily oral tablet
  • Pro: easy to adjust dose, typically don’t need to add glucocorticoid
  • Con: side effects of polyuria, polydipsia, incontinence
28
Q

Desoxycorticosterone

  • type
  • pros
  • cons
A
  • mineralocorticoid IM/SQ injection q25-30 days
  • Pros: excellent efficacy, easy to give, lack of side effects
  • glucocorticoid therapy will need to be given
29
Q

Pred/Prednisolone

  • type
  • reason to keep around
A
  • glucocorticoid tablet

- keep extra stash in case of stressful event

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