Diagnosis and treatment of canine hypoadrenocorticism

Clinical characteristics, treatment, and outcomes of hypoadrenocorticism in dogs

OBJECTIVES

To determine the long-term survival of dogs with hypoadrenocorticism during the period that desoxycorticosterone pivalate has become widely used. Secondary goals were to compare age at diagnosis, median survival times, and age at death for dogs with hyponatraemic and/or hyperkalaemic hypoadrenocorticism and eunatraemic eukalaemic hypoadrenocorticism, and to determine the frequency of glucocorticoid-related side effects in these dogs.

MATERIALS AND METHODS

Retrospective cohort study with data collected from medical records and from a questionnaire sent to owners of affected dogs.

RESULTS

141 cases were identified; 125 had spontaneous hypoadrenocorticism and 16 had iatrogenic hypoadrenocorticism secondary to treatment of hyperadrenocorticism. Dogs with spontaneous hyponatraemic and/or hyperkalaemic hypoadrenocorticism were significantly younger at the time of diagnosis (median age: 5.1, range: 0.8 to 14.1 years, n = 97) compared to dogs with spontaneous eunatraemic eukalaemic hypoadrenocorticism (median age: 8.3, range: 3.0 to 12.7 years, n = 26). Sixty-six dogs were included in the survival analysis. For dogs with spontaneous hyponatraemic and/or hyperkalaemic hypoadrenocorticism, all of which were managed with desoxycorticosterone pivalate, median survival time was 5.7 years (95% CI: 4.0 to 7.2 years; n = 47) and median age at death was 11.0 years (range: 4.0 to 17.0 years; n = 30). For dogs with spontaneous eunatraemic eukalaemic hypoadrenocorticism, median survival time was 5.6 years (95% CI: 4.1-N/A years; n = 9) and median age at death was 11.8 years (range: 11.0 to 13.0 years; n = 4). The majority of owners that completed the questionnaire reported side effects commonly associated with glucocorticoid therapy.

CLINICAL SIGNIFICANCE

Hypoadrenocorticism carries an excellent prognosis. Desoxycorticosterone pivalate was the most frequently used mineralocorticoid therapy in this group of dogs.

Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.