ISSN 2398-2950      

Hypoadrenocorticism

ffelis
Contributor(s):

Carmel Mooney

Emma Roberts

Synonym(s): Addison's disease


Introduction

  • Rare endocrine disease in cats.
  • Cause: insufficient mineralocorticoid and glucocorticoid production.
  • Diagnosis: ACTH stimulation test ACTH stimulation test.
  • Treatment: hormonal replacement therapy.

Pathogenesis

Etiology

  • Impaired adrenocortical function.
  • Thought to be immune-mediated.
  • Other reported causes:
    • Adrenal infiltration by lymphoma.
    • Trauma-induced.
    • Secondary hypoadrenocorticism caused by lymphocytic panhypophysitis has been reported in one case.
    • Iatrogenic secondary hypoadrenocorticism can occur following cessation of chronic corticosteroid treatment.
    • Atyical hypoadrenocorticism (lack of glucocorticoid production but not mineralocorticoids) reported in one case BUT aldosterone levels were not checked.

Predisposing factors

General

  • Iatrogenic:
    • Bilateral adrenal excision (for treatment of hyperadrenocorticism Hyperadrenocorticism).
    • Withdrawal of high-level, prolonged corticosteroid treatment.

Pathophysiology

Aldosterone deficiency

  • Reduced ability to conserve sodium and chloride and excrete potassium and hydrogen ions.
  • Sodium loss may be further increased by vomiting/diarrhea and intake reduced by anorexia.  
  • Depletion of total body salt stores leads to volume depletion.
  • Reduced renal perfusion  → further increase in hyperkalemia  →  reduced myocardial excitability.

Glucocorticoid deficiency

  • Reduced gluconeogenesis + fat metabolism may  →  hypoglycemia  Hypoglycemia.
  • Reduced cortisol to the CNS may lead to lethargy and depression.
  • Cortisol also required for intestinal integrity and reduction contributes to vomiting, diarrhea and inappetence.
  • Cortisol stimulates appetite and red blood cell production, therefore deficiency can result in inappetence and anemia.
  • In 1° adrenal insufficiency →  increased ACTH secretion from pituitary →  impaired tolerance to stress.

Timecourse

  • Days to months.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Rudinsky A J, Clark E S, Russell D S et al (2015) Adrenal insufficiency secondary to lymphocytic panhypophysitis in a cat. Aus Vet J 93 (9), 327-331 PubMed.
  • Woolcock A D & Ward C (2015) Successful treatment of a cat with primary hypoadrenocorticism and severe hyponatremia with desoxycorticosterone pivalate (DOCP). Can Vet J 56 (11), 1158-1160 PubMed
  • Sicken J & Neiger R (2013) Addisonian crisis and severe acidosis in a cat: a case of feline hypoadrenocorticism. J Fel Med Surg 15 (10), 941-944 PubMed.
  • Hock C E (2011) Atypical hypoadrenocorticism in a Birman cat. Can Vet J 52 (8), 893-896 PubMed.
  • Bell R, Mellor D J, Ramsey I et al (2005) Decreased sodium:potassium ratio in cats: 49 cases. Vet Clin Pathol 34 (2), 110-114 PubMed.
  • Gunn-Moore D (2005) Feline endocrinopathies. Vet Clin North Am Sm Anim Pract 35 (1), 171-210 PubMed.
  • Smith S A, Freeman L C & Bagladi-Swanson M (2002) Hypercalcemia due to iatrogenic secondary hypoadrenocorticism and diabetes mellitus in a cat. JAAHA 38 (1), 41-44 PubMed.
  • Stonehewer J & Tasker S (2001) Hypoadrenocorticism in a cat. JSAP 42 (4), 186-190 PubMed.
  • Parnell N K, Powell L L, Hohenhaus A E et al (1999) Hypoadrenocorticism as the primary manifestation of lymphoma in two cats. JAVMA 214 (8), 1200, 1208-1211 PubMed.
  • Peterson M E, Greco D S, Orth D N (1989) Primary hypoadrenocorticism in ten cats. JVIM (2), 55-58 PubMed.

Other sources of information

  • Scott-Moncrieff J C (2015) Hypoadrenocorticism. In: Canine and Feline Endocrinology. 4th edn. Feldman E C, Nelson R W, Reusch C R & Scott-Moncrieff J C (eds). St Louis, Missouri. Elsevier Saunders. pp 514-516.
  • Scott-Moncrieff J C (2010) Hypoadrenocorticism. In: Textbook of Veterinary Internal Medicine. 7th edn. Ettinger S J & Feldman E C (eds). St Louis, Missouri. Elsevier Saunders. p 1857.

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