How to recognize and treat this serious disease
Over the past few decades, there has been an alarming increase of dogs affected by a variety of diseases of the endocrine (hormonal) system in dogs, including adrenal gland problems.
If your dog's breed is genetically predisposed to this life-threatening disease or if your dog has already been diagnosed with Addison’s disease, this article is for you.
Superheroes in your dog's body
The adrenal glands are hidden right by the kidneys and are truly the superheroes of the canine body. They help the body fight stress, viruses and bacteria and ensure the electrolytes such as potassium and sodium are in perfect balance.
Most people don't realize without properly functioning adrenals, the heart would stop!
Two sides of the adrenal disease “coin"
Adrenal glands suffer from two opposing pathologies, hyper-function (Cushing’s disease) and hypo-function (Addison’s disease). Dr. Thomas Addison, an extremely talented and dedicated physician, discovered hypoadrenocorticism while working in central London Guy’s Hospital. In addition to discovering that hypo-function of adrenal glands can lead to serious and life-threatening diseases, he was also the person behind the discovery that vitamin B12 deficiency can lead to pernicious anemia.
Who is at fault? The general, the captain, or the soldier?
The adrenal glands can be thought of as the body’s two soldiers who report to the captain - the pituitary gland in the center of the brain. The pituitary gland is like a 'hormonal thermostat' that continuously monitors glands and their hormone levels, including in the adrenal glands. If the levels are low, the pituitary gland (the thermostat) signals the adrenal gland to produce more adrenal hormones.
However, the hierarchy doesn’t end there. The hypothalamus, located in the center of the brain, is the endocrine system’s 'general' that governs the pituitary gland and how much hormone is produced.
That means dysfunction of 'the general' (the hypothalamus), 'the captain' (the pituitary gland), or the 'soldier' (the adrenal gland) can cause Addison's disease. If any of these elements don't do their jobs, there will be a lack of adrenal gland hormone.
If you are like most people, reading any medical book makes you feel like you may have every disease out there. The diagnosis of Addison’s disease is often very challenging. The symptoms are usually non-specific and unclear, which earned Addison’s disease the title of a “great pretender.” This is why it is often missed.
Two key symptoms always make me think of Addison’s disease:
- A fluctuating cyclic pattern of diarrhea that often happens after a period of increased stress.
- Periods of listlessness and lethargy.
In the early stages of the disease, a dog may not seem sick at first, and the blood chemistry may appear normal. Later on, potassium and sodium levels creep away from each other, with potassium being too high and sodium in the low normal range.
Diagnostic labs around the world use different units; therefore, I will not mention the actual levels here. The reference ranges are usually listed in your dog’s results. Just remember that high potassium and low-normal or low sodium may mean your dog has Addison’s disease.
The adrenal glands regulate electrolyte levels in the bloodstream. The primary role of potassium and sodium is to regulate hydration and water balance between the intracellular and extracellular space. Heart and other muscle contractility is also dependent on very precise potassium and sodium levels in the bloodstream, and the heart can simply stop if Addison’s is severe enough.
Most common causes
People often wonder why Addison’s disease happened to their dog and if it could've been prevented. It would be nice to have a trivial explanation, but most diseases, including adrenal disorders are caused by a multitude of factors. To prevent disease, one has to look at as many contributing factors as possible. I also suggest that you take my Health and Longevity Course for dogs to better understand the connections.
Are your dog’s genes responsible?
Some people still believe certain genetic tendencies will express themselves no matter what, but many of these predispositions will never cause a disease if we address other predisposing factors. Here are some that play a significant role in the development of Addison's disease:
- Processed food that causes nutritional imbalances, excessive toxin build-up and immune system stimulation, such as wheat gluten, starches, preservatives, fungi and molds in food.
- Excessive vaccination overwhelms the immune system, which causes dysfunction and the body starts creating antibodies against its own tissue, including adrenal glands. Click here for a holistic approach to vaccination.
- Essential nutrient deficit - minerals, amino acids, omega oils, vitamins, and probiotics have a crucial role in the proper function of cells, organs, and glands.
- Injury or congestion of the spinal energy flow, especially in the region of the third lumbar vertebra can compromise the adrenal glands. This section of the spine supplies energy to the kidneys and adrenal glands.
- Excessive stress or physical or emotional trauma, such as abandonment or abuse may predispose dogs to adrenal dysfunction.
Breed predilection also plays a role in Poodles and Leonbergers, and Nova Scotia duck tolling retrievers are the most predisposed to Addison’s disease. American pit bull terriers, American Staffordshire terriers, Chihuahuas, cocker spaniels, golden retrievers, Lhasa Apsos, Schnauzers, and Yorkshire terriers are the least predisposed.
The up and down roller coaster ride
Often, Addison’s disease is missed as the cause of lethargy, muscle weakness, exercise intolerance, low appetite, and digestive problems.
A dog with adrenal insufficiency (Addison’s) usually has repetitive patterns of being unwell, and then doing fine. The symptoms range from mild to very severe. When the adrenal glands lose the ability to produce adrenal hormones completely, this stage is called an Addison’s crisis and is life threatening.
The most significant change in dogs’ adrenal insufficiency is the shift in the levels of potassium and sodium. For an easier explanation, it is as if potassium and sodium are two repelling magnets. Their values move apart: Sodium is low, and potassium high. While some other blood chemistry parameters can go up and down by tens or even hundreds of units, potassium and sodium values that shift just by a few tenths of a unit can have serious, life-threatening consequences. Their precise concentration is essential to good health and life. That is why early and accurate diagnosis is so important.
Diagnosis - step by step
- Blood work consisting of chemistry, complete blood count and thyroid values.
- Urine examination.
- An ultrasound to assess the adrenal gland size can be very helpful. Some practitioners reach immediately for the ACTH stimulation test. I like to do an ultrasound first because dogs with adrenal insufficiency usually have a small adrenal gland. Doing an ultrasound also helps to rule out other potential problems, such as tumors, pancreatitis, gall bladder issues or intestinal foreign bodies. I suggest having the ultrasound done under the guidance of a specialist. Some general practitioners have ultrasound machines; however, it takes time to acquire the proper skills to interpret the findings, and mistakes can easily be made.
- The ACTH stimulation test usually confirms the diagnosis of Addison’s disease. It consists of measuring the cortisol levels in two blood samples. One sample is taken before and one after an injection of ACTH (adreno-cortico-trophin-hormone). ACTH is a pituitary gland hormone that stimulates the adrenal glands to produce cortisol. If the cortisol in the second blood sample is low, it means that the adrenals are insufficient and the patient has Addison’s disease. A single blood cortisol level test without running an ACTH test may be helpful, but a stimulation test is usually needed to confirm the diagnosis.
Holistic support for dogs with Addison's Disease
STEP A - HEALTHY DOGS THAT ARE PREDISPOSED TO ADDISON’S
If your dog is healthy but belongs to one of the genetically predisposed breeds, or has a relative who was diagnosed with a disease, prevention is the key.
Here are the preventive steps I suggest:
STEP B - DOGS WITH NO CLINICAL SYMPTOMS BUT MARGINAL ADRENAL FUNCTION
If your dog has marginal adrenal gland function but is asymptomatic, it is reasonable to apply steps 1-4 above first before you reach for pharmaceutical drugs. It is possible to boost the adrenal gland function especially if the lumbar spine has been injured and the energy and blood flow to adrenals are diminished.
Please note: This situation is relatively rare because Addison’s is usually diagnosed when a dog already has clear symptoms.
(For further information, read chapter 7 of the Health and Longevity Course for dogs.)
STEP C - DOGS WITH CLINICAL SYMPTOMS AND ADDISON’S DISEASE DIAGNOSIS
When it comes to the treatment of any hormonal condition, a very precise and well-organized approach to treatment and good client-practitioner communication is the key to success. Regular blood test re-checks and fine-tuning are usually required.
Despite my strong preference for holistic medicine, in the case of moderate to advanced cases of Addison’s, it is important to use conventional medication, in addition to the following protocol.
Conventional hormonal therapy details
To treat Addison’s, we need to supplement two groups of hormones: Mineralocorticoids and glucocorticoids.
These are the hormones that regulate electrolyte levels, such as Aldosterone and its precursor Deoxycorticosterone (DOC). These two hormones stimulate the kidneys to let go of potassium. If they are missing, as in the case of Addison’s disease, hyperkalemia (high potassium state) occurs.
Mineralocorticoids can be artificially supplemented in two forms:
• Fludrocortisone acetate (brand name Florinef)
• Desoxycorticosterone pivalate (brand name Percorten-V)
While Florinef is less costly than Percorten-V, I prefer the latter, as it appears to deliver better results. Several patients who came to me for a second opinion did so because they did poorly on Florinef, but did very well as soon as I switched them to Percorten. Knowing this, I always suggest my clients use Percorten-V.
The name, glucocorticoid, is derived from the words (glucose + cortex + steroid) suggesting that these hormones’ function is to regulate glucose, which is true to a point. However, these hormones have a wide array of effects on cells. While they may appear helpful in reducing inflammation, they also heavily suppress immune system function if given in higher than necessary amounts.
Supplementing corticosteroids in Addison’s disease may or may not be necessary and your veterinarian should help you establish the accurate dose. Addison’s is the only indication where I prescribe steroids in my practice because the body does not produce them on its own.
I have seen that most dog guardians are able to recognize when a corticosteroid dose is needed. The need is usually higher at times of stress, travel, or increased demands on the body.
I would like to repeat that this is a very rare situation where supplementing steroids is necessary and not contraindicated from the holistic point of view.
A closing note
The goal of any hormonal therapy should be to use minimal doses of medication and attempt to restore the normal production of the natural hormone. This can only happen in a dog that has a mild form of Addison’s disease or has no signs, but is considered predisposed.
As in every other medical condition, the best way is to support the predisposed patient so he or she never reaches the clinical state. I hope this article will help you do exactly that.
© Dr. Peter Dobias, DVM