Addison's disease – why does it often go undetected?

This adrenal gland disorder, also known as Addison's disease, was first described in humans in 1855 by Thomas Addison (chief physician at a London hospital), after whom it was named. It causes adrenal insufficiency (also known as hypoadrenocorticism), which is the partial or total failure of hormone production in the adrenal cortex. It is much less common in dogs than adrenal hyperfunction (Cushing's disease), but can lead to life-threatening symptoms. It primarily affects middle-aged female dogs of large breeds.

INHALT
Cause and origin Symptoms Diagnosis Treatment Forecast Prophylaxis
Cause and origin

In dogs, the adrenal glands are located at the front edge of the kidneys. They produce various hormones that perform important functions in the body. Primary adrenal insufficiency is triggered by a disorder of the immune system, which causes the body's own cells to destroy certain areas of the adrenal cortex. However, the cause of this autoimmune disease is unknown.

The more tissue is destroyed, the fewer hormones can be produced. In the case of Addison's disease, there is mainly a deficiency of glucocorticoids and mineralocorticoids. Glucocorticoids include the body's own cortisol, which stimulates appetite and regulates the immune system, among other things. Mineralocorticoids are responsible for the sodium/potassium balance and thus blood pressure. A deficiency of both hormones causes an imbalance in the mineral and water balance.

In very rare cases, NNR can also develop secondarily as a result of tumors, injuries, circulatory disorders, or infections. Metabolic diseases such as diabetes are also suspected of influencing the function of the adrenal cortex.

Diagram of the kidneys and adrenal glands in dogs
1a Left kidney | 1b Right kidney | 2 Adrenal glands | 3 Ureter
Symptoms

The lack of the body's own cortisol (glucocorticoid) and aldosterone (mineralocorticoid) can cause a wide variety of symptoms, some of which are very unspecific, meaning that the disease often remains undetected for years.

Affected dogs suffer from recurrent, sometimes bloody diarrhea, abdominal pain, and vomiting. They often appear very tired or apathetic and have a variable appetite. Weight loss, muscle weakness, muscle tremors, increased thirst, increased urination, and heart problems may also occur.

The symptoms can escalate to what is known as an "Addisonian crisis." The affected dog then suddenly shows signs of total exhaustion, even collapse, a reduced heart rate, bloody diarrhea, severe pain, a drop in blood pressure, hypoglycemia, and symptoms of shock (pale mucous membranes, low body temperature, weakness). This situation is an absolute and life-threatening emergency that requires immediate treatment.

Diagnosis

Since the disease is relatively rare and does not always manifest itself through clear symptoms, it is easily overlooked. In practice, the veterinarian will first perform a general clinical examination. However, the results of this examination, in conjunction with the owner's preliminary report, can usually only provide indications of the disease.

A comprehensive blood test is essential in this case, as it can reveal clear changes indicative of Addison's disease, particularly in the electrolyte levels. A reliable method for confirming Addison's disease when suspected is a special hormone test known as the ACTH stimulation test. By administering a hormone that stimulates the adrenal cortex (ACTH), the adrenal glands are stimulated to produce cortisol. This value is then measured in the blood and will be very high in a healthy dog, but low in an Addison's patient. Further X-ray or ultrasound examinations can be used to diagnose existing changes in the heart or lungs.

Treatment

In the case of a dog with an acute Addison's crisis, your vet will perform intensive emergency and shock treatment to stabilize the dog's electrolyte and hormone balance as quickly as possible. The dog will need to be hospitalized for a few days and will receive special medication and infusions.

In the case of chronic Addison's disease, the missing hormones must be replaced, i.e., added externally in the form of medication. This requires lifelong hormone replacement therapy.

Forecast

Since the adrenal cortex tissue cannot regenerate once it has been destroyed, the disease cannot be cured. However, dogs with primary NNR can regain a significant quality of life and lead a largely normal life with the help of lifelong hormone replacement therapy. Regular veterinary check-ups are important, however. If secondary NNR is present, the prognosis depends on the specific cause and possible treatment.

Prophylaxis

Due to the fact that the causes of the autoimmune reaction are still unknown, there is no effective way to prevent the disease. However, it is recommended that dogs with an increased risk, such as those with diabetes or thyroid problems, be seen by a veterinarian regularly and tested for Addison's disease if gastrointestinal or weakness symptoms occur.