iatrogenic addisons

RE: iatrogenic addisons

Roland Bulkyn-Rackowe — Wed, 12 Dec 2018 11:42:48 GMT

I have also seen Addisons after trilostane (Modrenal many years ago). The dog stayed addisonian for over 3 months, requiring fludrocortisone treatment, and eventually became cushingoid again.

I have never seen a dog addisonian after withdrawing preds and I'm sure many owners forget to taper the dose.

RE: iatrogenic addisons

Phil Fox-Manning — Mon, 10 Dec 2018 23:22:11 GMT

I actually have a patient with Addisons secondary to Trilostane, so it does happen!!

Re: iatrogenic addisons due to rapid pred withdrawal, I have two thoughts:

1. The animal on long-term preds must still be producing its own mineralocorticoids (because pred has very little mineralocorticoid effect) so i’d have thought you’d be unlikely to get the addisonian crisis that you’re probably concerned about..?

2. Even truly addisonian dogs seem to cope fine for ages without treatment. Many dogs can go 2-3 months between zycortal injections (not that they necessarily should) We had an owner who just stopped coming for injections, and the dog didn’t show any signs til 3+ months later!

So i suspect that the worst you’d see would be signs of atypical addisons (probably just GI signs) and even then, not until weeks (maybe months?) later.

RE: iatrogenic addisons

Andreas Ege — Sat, 08 Dec 2018 23:15:48 GMT

[quote user="Silvia Maldonado"]It would be interesting to have a wider study (more cases, even studying how dogs cope with stress after steroids suppression...) [/quote]

Wouldn't it always? :-D

I'm always surprised on how small a number of studies and/ or test subjects a lot of veterinary recommendations for whole populations are based.

RE: iatrogenic addisons

Silvia Maldonado — Sun, 02 Dec 2018 01:18:19 GMT

[quote user="Andreas Ege"]

Thanks. Fits with personal experiences a colleague has mailed on another list.

Leaves the question what to tell a client in a situation as above. Somehting along the line "There is a theoretical risk, but it has not been observed in practice", I guess.

[/quote]

Risks extrapolated from human experiences? Do dogs behave differently? Would it be related to the extremely likelihood to find an addisonian cat? Do they cope better than humans?

It would be interesting to have a wider study (more cases, even studying how dogs cope with stress after steroids suppression...)

RE: iatrogenic addisons

David Mills — Wed, 28 Nov 2018 00:38:39 GMT

[quote user="Andreas Ege"]think I wouldn't expect it under 48h, though that's just a hunch and I guess it will be dependent on the dose as well as individual.[/quote]

Given when you send a dog for a derm referral they specify no steroids for 2 months, I think you're fine. Mossy long term preds are at miniscule doses, physiologically. Also the steroid feedback loop is pretty sensitive, and upregulation happens quickly. [quote user="Michael Woodhouse"]I personally think this is one of those great myths of veterinary medicine.[/quote]

Pretty much this. File along with trilostane causing Addisons.

RE: iatrogenic addisons

Michael Woodhouse — Wed, 28 Nov 2018 00:09:15 GMT

I personally think this is one of those great myths of veterinary medicine.

I wouldn't worry if it was my dog.

RE: iatrogenic addisons

Andreas Ege — Tue, 27 Nov 2018 23:30:40 GMT

Thanks. Fits with personal experiences a colleague has mailed on another list.

Leaves the question what to tell a client in a situation as above. Somehting along the line "There is a theoretical risk, but it has not been observed in practice", I guess.

RE: iatrogenic addisons

Robert FalconerTaylor — Mon, 26 Nov 2018 06:12:22 GMT

See here http://www.vetfolio.com/internal-medicine/canine-hypoadrenocorticism-pathogenesis-and-clinical-features

2/3 down - "A recent study demonstrated that 28 dogs that received long-term corticosteroid therapy (i.e., 1 to 36 months; mean: 9.4 months) had suppressed or absent adrenal responses to ACTH stimulation but did not show clinical signs of hypoadrenocorticism following abrupt cessation of corticosteroid administration.20 However, this study did not assess these dogs' ability to respond to a stressful situation."

20. HUANG H, YANG H, LIANG S, ET AL: IATROGENIC HYPERADRENOCORTICISM IN 28 DOGS. JAAHA 25:200-207, 1999