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Hypoadrenocorticism, Bilateral atrophy/destruction of all 3 layers, THE…
Hypoadrenocorticism
🧪
BG (Hypoglycemia)
BUN, urea & creatinine
Pre-renal azotemia (poor prefusion)
:chart_with_upwards_trend: urea/BUN (NOT creatinine)
PCV/TS
Hemoconcentration (urine loss)
:-1::skin-tone-4: = GI blood loss
Venous Blood gas
Acidemia
Electrolytes :zap:
High :banana:
Low 🧂
NA:K <27
USG (<
1.030
)
Hyposthenuria
Isosthenuria
ECG
6.5mEq/L :banana:
Peaked T-Wave
Heart block
Bradycardia
Atrial standstill
Widened QRS
Reduced R wave
Serum ionized :glass_of_milk:
Hypercalcemia (dehydration)
Hypocalcemia (corticosteroid-mediated metabolism)
Radiographs
narrowed vena cava
Hypoperfused (black) lungs
Microcardia
Megaesophagus (rare)
Tests
:tv:
Basal serum cortisol (
>55
nmol/L = RO)
:dart:
ACTH stim
Pre: plasma cortisol <30nmol/L
1hr post: <30nmol/L
Cross reactivity (24 withold)
Dex (safe) :check:
(Hydro)Cortisone
Prednisone(lone)
Etiology:scroll:
Signalment
Young-middle aged
Female
Cause
Dysfunction of adrenal cortex
Zona Fasciculata
Glucocorticoids
Cortisone/cortisol
Zona Glomerulosa
Aldosterone (🧂/:banana:/Water)
Mineralcorticoids
Zona Reticularis
Sex (Androgens/Estrogens)
Breeds :dog2:
Perdispoed
Poodle
Great Dane
West Highland White Terrier
Familial predispositions
leonberger
NS Duck trolling retriever
Bearded collie
nova soctia
Portuguese water dog
Clinical Signs :sneezing_face:
Waxing & waning
diarrhea
weakness
vomitting
PU/PD
anorexia/weight loss
Hair loss
Lethargy/depression
Previous response to tharpy
DDX
Hyperkalemia
Acute kidney injury
Gastrointestinal disorders
Tissue trauma
3rd space loses
Hemorrhagic gastroenteritis
Parvo-viral enteritis
GI FB
Pancreatitis
Ethylene glycol
Acute Crisis
GI hemorrhage
Bradycardia
Weak pulse/Hypotension
Painful abd
Injected/Pale MM
Slow CRT
Hypothermia
:hospital:
Acute Crisis
:four:correct acid-base (pH <7.2)
Bicarbonate
:five: supp. glucocorticoid
Dexmethasone sodium phosphate (0.1mg.kg IV)
:three:correct K/Na abnormalities
:two: correct hypoglycemia
50% dextrose 0.5-1ml/kg bolous
Maintenance: 2.5-5% dextrose CRI
:six: Supp w/ mineralocorticoid
Begin when stable (oral meds0
:one: correct hypovolemia
(shock rate)
q10-15min
90mls/kg
60-80ml/kg/hr (1st 1-2hr)
Fluids
LRS/PLA
K+ 4-5mEq/L
Alkalinizing solution
0.9% NaCl
K+ free
Acidying solution
Effects: Dilute K, improve perfusion
Lifelong :older_woman::skin-tone-4:
Mineralocorticoid
DOCP
No glucocorticoid effects
1-1.8mg/kg SQ q 28-30d
Dogs <3yrs need higher doses
Monthly injections
Fludrocortisone acetate
Daily, oral
Glucocorticoid effects
Dosing
Initial: 10.20ug/kg/day BID
Stable: adjust doses 0.05-0.1mg (1.2-1 tablet)
Monthly eval (3-6m) then 3-6m evals
Glucocorticoids
Physiologic dose: 0.2mg/kg/day
May not be required & may be tapered
Stress: inc dose 0.5-1.0mg/kg
Types
Primary (Adrenals)
Atypical
Effect: Z. fasciculata & Reticularas destroyed
No electrolyte disturbances/mineralcorticoids spared
Iatrogenic
2nd to mitotane/trilostnae
drugs that produce adrenocortical lysis
Typical:fire:
Infiltrative dz
Amyloidosis
Hemorrhagic dz
Fungal infection/neoplasia
Immune-mediated destrcution:fire:
Secondary (Pituitary/ACTH)
Uncomoon
Iatrogenic
Drugs induced hypoadrenocorticism
drugs that inhibit glucocorticoid production or adrenocortical lysis
Bilateral atrophy/destruction of all 3 layers
THE GREAT PRETENDER :clown_face: