Atypical Addisons /Topical ophthalmic steroids

RE: Atypical Addisons /Topical ophthalmic steroids

onecarisma — Tue, 24 Dec 2019 21:48:59 GMT

I knew about Osurnia that can influence also the acth test

.because contains small amount of steroids

RE: Atypical Addisons /Topical ophthalmic steroids

Paul Harris — Sun, 08 Dec 2019 09:54:25 GMT

Hi everyone

Just got the results back after 1 month off topical prednisolone eye drops and the ACTH stim test is now normal.

It appears that topical Pred Forte Eye drops can result in suppression of pituitary adrenal axis at least in this dog.

Thanks for everyone's input

Paul

RE: Atypical Addisons /Topical ophthalmic steroids

Sarah Keir — Mon, 04 Nov 2019 09:38:08 GMT

You cannot tell if this dog has naturally occuring hypoadrenocorticism or iatrogenic until many weeks after the topical steroid has been stopped.

https://academic.oup.com/endo/article/146/7/3163/2500416 OK, ear drops but still topical.

https://www.vetfolio.com/learn/article/comparative-adrenocortical-suppression-in-dogs-with-otitis-externa-following-topical-otic-administration-of-four-different-glucocorticoid-containing-medications

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/adrenal-cortex-atrophy

RE: Atypical Addisons /Topical ophthalmic steroids

Beats — Mon, 04 Nov 2019 07:40:17 GMT

[quote user="Paul Harris"]
Current plan is to withdraw eye drops and repeat ACTH stim in 4-6weeks (Assuming we don't have an adrenal crisis in the mean time) [/quote]

That sounds a reasonable plan to me.

I think you've just picked up this poodle's Addison's quite early though, and starting on some low-dose oral pred or equivalent and checking electrolytes in a month, then perhaps 3-monthly for a year would also be a reasonable plan. Should be obvious response to therapy - if not I'd reconsider the diagnosis.

RE: Atypical Addisons /Topical ophthalmic steroids

Paul Harris — Mon, 04 Nov 2019 06:31:42 GMT

Initial basal cortisol ran in house but ACTH stim run at external lab.

That my feeling as well but bit reluctant to commit to life long meds if there is any doubt.

Just thinking would there be any point in checking ACTH? Would low support suppression and and high with low cortisol support atypical addisons?

RE: Atypical Addisons /Topical ophthalmic steroids

Michael Woodhouse — Sun, 03 Nov 2019 23:01:19 GMT

I don't believe the pred in the eye drops will lead to significant adrenal suppression. It's thought that the analysers will recognise prednisolone as cortisol in the assay (not dex).

Is this run in house? Do you still have the samples? Maybe send to an external lab for confirmation?