Zycortal Symposium Proceedings

Monitoring and treatment of Addisonian patients with normal electrolytes

The monitoring and treatment of patients with normal electrolytes is largely dependent on the aldosterone levels. If truly an atypical case (i.e. normal aldosterone) then only glucocorticoid supplementation is required. It is however recommended that the aldosterone (or at least the electrolyte) levels are monitored as there have been atypical cases reported who subsequently develop aldosterone deficiency. Aldosterone/electrolyte levels should be monitored every 3-6 months, or sooner should the patient seem unwell in any way. As for patients with normal electrolytes and abnormal aldosterone, the majority of specialists agreed that mineralocorticoid supplementation should be administered; as relying on compensatory mechanisms when there is a deficiency in aldosterone increases the chance of the patient presenting in an Addisonian crisis. The starting dose of DOCP used in these cases should however be reduced to around 50% of the licensed starting dose. Other specialists advised that if finances allowed frequent electrolyte monitoring, then they would wait and start DOCP at a routine dose once electrolyte abnormalities have been documented. In stable Addisonian patients, there is no need to avoid elective surgery if it will benefit the patient. The prednisolone dose should however be increased to two to three times the standard dose. A temporary increase in prednisolone dosage for around 2 to 5 days post- surgery, should not affect wound healing. A constant rate infusion, or at least boluses, of hydrocortisone can also be considered to improve anaesthetic stability during anaesthesia and recovery from surgery. There was discussion of entire female Addisonian patients who have not stabilised on treatment with DOCP and prednisolone. It is suspected that this could be due to sex hormones having cross reactivity with other steroid receptors. It was concluded that all entire female dogs should not necessarily be neutered, however neutering should be considered in entire dogs who are difficult to stabilise. It is also advised that pregnancy be avoided in these patients. Should elective surgery be considered in dogs with Addison’s disease?

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