juvenile onset Addisons

Re: juvenile onset Addisons

Martin Atkinson — Wed, 12 Sep 2012 16:21:28 GMT

[quote user="Rajat"]Me too! Do keep us posted pls if you find something interesting![/quote] I've just advised dropping the preds to 1mg eod as his skin is under control so will see if the Ca goes up. Last leucogram was interesting though, eosinophils low but lymphocytes up - opposing features for either too much or too little corticosteroids! I don't suspect lymphoma as said for this dog but as he's had so much wrong at such an early age I rule out nothing.

Re: juvenile onset Addisons

David Mills — Wed, 12 Sep 2012 16:19:37 GMT

Certainly wouldn't rule out juvenile - only 12 months old and all GP closure times are based on averages/medians thereby by definition there are loads of dogs either side of these figures - and PTH/etc likely an added unwarranted expense at this stage if dog fine clinically. Spayed? That can extend GP closure time and theoretically increase juvenile hypercalc.

Re: juvenile onset Addisons

Rajat — Wed, 12 Sep 2012 15:48:19 GMT

[quote user="Martin Atkinson"]and when renal function returned to normal that it would correct although it was actually normal when first presented with azotaemia and it had a marked hyperphosphataemia of 4[/quote]

I guess if the Ca-P product is not elevated then it should be fine with mild hypercalcemia though it could also pre dispose to calcium oxalate uroliths, other than age and Addisons which is sub clinically relevant, I can't see why else he should be hypercalcemic (I mean obviously ruling out the usual culprits). Dennis Chew (god of hypercalcemia and calcium, PTH related stuff as far as many are concerned) was saying at last BSAVA that the Ca-P product theory is now not as valid as once thought..fwiw..

The phos again one could attribute to age and young dog but he really should have normalised now

I'd be doing the same as you and checking PTH, PthrP too (might as well if you're doing the former, though a very long shot that!) and an ionised Ca- I don't think the dog is going to be that affected by mildly elevated Ca/P for short-medium term ...but one does wonder that if on steroids he has hi calcium how high it would be when off them..!! Wouldn't worry about treating it specifically (frusemide would be one option) just yet anyways if I was treating him.

[quote user="Martin Atkinson"]

I do love these challenges.

[/quote]

Me too! Do keep us posted pls if you find something interesting!

Re: juvenile onset Addisons

Martin Atkinson — Tue, 11 Sep 2012 14:12:03 GMT

[quote user="Rajat"]

[quote user="Martin Atkinson"] should I still expect juvenile hypercalcaemia in one year old Shih tzu or am I missing a point here (before anyone asks it is not polydypsic and there are no lumpy bits) and as far as I'm aware hypercalcaemia is not a feature of Addisons'.[/quote]

I guess I wouldn't rule out juvenile hypercalcemia but wouldn't expect it to be raised at this age..how's that for sitting on the fence?

Addisonian's frequently have hypercalcemia...there's a bit on Addisons here under Causes of hypercalcemia

Did the calcium go down with steroid use?

[/quote] Thanks Rajat, I had assumed any hypercalcaemia in Addisons would be nephrogenic and when renal function returned to normal that it would correct although it was actually normal when first presented with azotaemia and it had a marked hyperphosphataemia of 4! The Ca is fluctuating on the regular monitoring but at 3.25 it is as high as its been and the dog still on corticosteroids! It has been mildly hyperphosphataemic all along but paradoxically the phosphate is normal this time, although albumin is raised. Given the dog is clinically normal (apart from its skin/food hypersensitivity) should I be concerned with a Ca that fluctuates from 2.95 - 3.25 or am I just trying to treat numbers? I suspect we're all guilty of the latter but I will do ionised Ca and parathyroid hormone eventually if for nothing else out of interest. I do love these challenges.

Re: juvenile onset Addisons

Rajat — Tue, 11 Sep 2012 13:53:20 GMT

I guess I wouldn't rule out juvenile hypercalcemia but wouldn't expect it to be raised at this age..how's that for sitting on the fence?

Addisonian's frequently have hypercalcemia...there's a bit on Addisons here under Causes of hypercalcemia

Did the calcium go down with steroid use?