Comparison of Hydrocortisone Continuous Rate Infusion and Prednisolone or Dexamethasone Administration for Treatment of Acute Hypoadrenocortical (Addisonian) Crisis in Dogs

Comparison of prednisolone and alternative glucocorticoid dosing protocols for canine hypoadrenocorticism: insights from a survey-based study

Objectives

The aim of the study was to analyze glucocorticoid (GC) dosing protocols in dogs with hypoadrenocorticism (HA), and to identify predictors for optimal clinical outcomes during both the acute and chronic phases of the disease, as well as during long-term therapy.

Methods

This observational cross-sectional study utilized a case-based online questionnaire. Practicing veterinarians across Germany were invited to participate. The survey collected data in the disease course and follow-ups. Responses were analyzed using descriptive statistics, single and multiple comparisons, and a multivariable logistic regression model.

Results

For 103 dogs the questionnaire was fully completed and analyzed. Of these, 85 dogs (82.5%) were hospitalized, and they received either prednisolone (52.9%), dexamethasone (31.8%) or hydrocortisone (11.8%). Hydrocortisone therapy was associated with a shorter hospitalization time and faster normalization of electrolytes compared to prednisolone. Follow-up data were available for 85 dogs, with 82.35% (n = 70/85) achieving an optimal or well-adjusted clinical outcome. Multivariable logistic regression analysis indicated that the eukalemic and eunatremic form was significantly less associated with the presence of azotemia and the occurrence of an acute adrenal crisis. Dividing the daily GC dosage was associated with poorer clinical outcomes and a reduced likelihood of achieving optimal medication adjustment.

Conclusion

Our findings provide new, relevant recommendations for the therapeutic management of HA in dogs. Hydrocortisone appears to be a promising treatment for managing HA during hospitalization, highlighting its potential use in clinical practice. Once-daily administration of prednisolone is advisable for long-term therapy. To achieve the best possible outcome, implementing an optimal treatment protocol is essential, which veterinarians should tailor based on the needs of both owners and animals. The main limitations of the study include its retrospective nature and the limited number of participants. Future studies, particularly prospective ones, could further validate the beneficial effects of hydrocortisone and evaluate long-term therapy in comparison to prednisolone.

Clinical findings, treatment, and outcomes in cats with naturally occurring hypoadrenocorticism: 41 cases

BACKGROUND

Hypoadrenocorticism in cats is uncommonly reported. Most reports consist of cats with hyponatremia, hyperkalemia, or both.

HYPOTHESIS/OBJECTIVES

To describe clinical findings, treatment response, and outcome in cats diagnosed with hypoadrenocorticism, including cats with abnormal and normal serum sodium and potassium concentrations.

ANIMALS

Forty-one cats with hypoadrenocorticism; 36 with and 5 without abnormal serum sodium and potassium concentrations.

METHODS

Multicenter retrospective observational study. Data for the entire cohort were assessed using descriptive statistics and differences between cats with and without abnormal serum sodium and potassium concentrations were evaluated.

RESULTS

Median age was 5.7 years (range, 0.2-13.8). Twenty-three (56%) cats were male and 18 (44%) were female. Cats with hyponatremia, hyperkalemia, or both were less likely to have a history of vomiting (P = .01) but more likely to be hypothermic (P = .03), dehydrated (P = .04) or weak (P = .04) on examination, compared with nonhyponatremic and nonhyperkalemic cats. Frequency of hypercalcemia was 31.7%. Exocrine pancreatic insufficiency (EPI) was diagnosed in 4/7 cats tested; all 4 had concurrent cobalamin deficiency. Thirty-five (85.4%) cats survived to discharge. In 2 cats, hypoadrenocorticism occurred secondary to lymphoma. Median survival time (MST) for all-cause mortality was 2035 days (95% confidence interval [CI], 294-4380 days); MST for disease-specific mortality was not reached.

CONCLUSIONS AND CLINICAL IMPORTANCE

Approximately one-third of cats with hypoadrenocorticism had hypercalcemia. In some cases, hyponatremia and hyperkalemia were not observed. Cats with nonneoplastic associated hypoadrenocorticism that survive initial hospitalization can have a favorable long-term prognosis. Testing for EPI may be warranted in cats with hypoadrenocorticism.

A retrospective study of hydrocortisone continuous rate infusion compared with administration of dexamethasone boluses in dogs with adrenal crisis

BACKGROUND

Evidence indicating the optimal treatment protocol for dogs in adrenal crisis is lacking.

OBJECTIVES

Compare outcomes of dogs presented in adrenal crisis treated with either hydrocortisone (HC) continuous rate infusion (CRI) or intermittent dexamethasone (DEX) administration.

ANIMALS

Thirty-nine client-owned dogs.

METHODS

Multi-institutional retrospective observational study (July 2016-May 2022) including dogs diagnosed with adrenal crisis and with available sequential blood work during hospitalization. Dogs were excluded if already on treatment with exogenous corticosteroids. Outcomes assessed included duration of hospitalization, survival, number of repeat measurements of electrolyte concentrations, and time to normalization of electrolyte and acid-base status.

RESULTS

No significant difference was found between the groups for hospitalization time (P = .41; HC median [range] 48 h [19-105 h]; DEX 57 h [17-167 h]) nor case fatality rate 2/28 in the DEX group and 0/11 in the HC group (P = 1), nor in number of measurements of electrolyte concentrations (P = .90; HC 4 [2-10]; DEX 4.5 [2-15]). No significant differences were found between the 2 treatment groups in time to normalization of serum Na (P = .30; HC 33 h [7-66 h]; DEX 16 h [1.5-48 h]), K (P = .92; HC 17 h [4-48 h]; DEX 16 h [1.25-60 h]) or Na/K ratio (P = .08; HC 17 h [8-48 h]; DEX 26 h [1.5-60 h]).

CONCLUSIONS

This study detected no difference in outcomes for dogs in adrenal crisis treated with either DEX boluses or HC CRIs.