Wednesday, February 17, 2010

Medical Jargon Explained: Hypo- versus Hyperadrenocorticism

Endocrine glands: Adrenal Glands

Adrenal glands are part of your dog's endocrine system. They are located next to the kidneys, and they produce many types of hormones that are essential to normal body function. The hormones we will be focusing on here are produced by the outer part of the adrenals, the cortex. These are called corticosteroids. Sounds familiar? Yes, that's right, that is what corticosteroid medications are—a synthetic form of one of the adrenal gland hormones.

Aldosterone

Aldosterone is a hormone that regulates your dog's electrolyte levels. It helps control both sodium and potassium in order to maintain blood pressure and fluid balance.

Cortisol

Cortisol is released in order to help your dog respond to stress. Cortisol can affect blood pressure and blood sugar levels, fat metabolism, muscle and kidney function and immune response.

Addison's versus Cushing's

Even though you couldn't tell by their names, these two diseases represent deficient and excess conditions of the adrenal gland hormones. Addison's disease is also referred to as hypoadrenocorticism and Cushing's disease is  can go by the name hyperadrenocorticism.

Because hormones produced by the endocrine system have regulatory function in the body, any imbalances in their Production or release can cause serious health problems.

Addison's Disease

Addison’s disease, or hypoadrenocorticism, is a relatively uncommon but serious deficiency condition during which your dog's adrenal glands produce insufficient amounts of the aldosterone and cortisol hormones.

Addison's disease can be caused by autoimmune destruction of the adrenal glands, or as a result of underproduction of the adrenal stimulation hormone. Some medications can also disrupt the adrenal balance.

The good news is, that like in the case of hypothyroidism, hypoadrenocorticism can be successfully managed with hormone supplementation.

Diagnosis of Addison's disease isn't easy, because the symptoms are common in many other conditions.
Some of the signs are
  • vomiting
  • loss of appetite
  • diarrhea
  • weakness
  • dehydration
  • depression
  • low energy levels
  • tremors
  • collapse
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=608
http://www.canadasguidetodogs.com/health/addison.htm
http://www.addisondogs.com/

Cushing's Disease

Cushing’s disease, or hyperadrenocorticism, is an excess condition. Cushing’s is one of the most common hormone imbalance conditions in dogs. It is quite common in older dogs, and the symptoms are often dismissed as signs of aging.

If your dog has Cushing’s Disease, it means that he has excessive levels of cortisol in the body.

It can be caused by some medications, but most commonly it is caused by over-stimulation of the adrenal glands due to a tumor on the pituitary gland or a tumor on the adrenal gland itself.

Because cortisol reduces immune response, dogs with Cushing's disease will often suffer from frequent or recurrent infections.

Some of the signs of Cushings disease are
  • excessive drinking
  • increased urination
  • potty accidents
  • excessive appetite
  • lethargy
  • hair loss
  • panting
  • muscle weakness
  • weight gain or pot-belly appearance
Treatment options will depend on the underlying cause of your dog’s Cushing’s disease and his overall condition. If the imbalance is caused by medication, gradual discontinuation of the drug might be all that is needed.

Pituitary-based Cushing’s disease is usually managed with oral medications, although more aggressive treatment is sometimes needed.  If an adrenal tumor is to blame, surgery to remove the gland may be the best option.

Being forewarned is being forearmed. Be aware of health conditions your dog might face and be sensitive to potential signs of disease. Often, the sooner the problem gets addressed, the better chance your dog will have at living a long and happy life.

Veterinary Partner: Symptoms of Cushing's Syndrome
Veterinary Partner: What Exactly is Cushing's Disease
Veterinary Partner: Laboratory Hints Suggesting Cushing's Disease

Jana

In this series:
Hypothermia vs Hyperthermia
Hypothyroid vs Hyperthyroid
Addison's vs Cushing's
Hypoglycemia vs Hyperglycemia

Did I miss something? Have a question or something do add? Leave a comment.

20 comments

  1. Our Bishon, Finley was diagnosed with Cushing's. He was treated with Medrol and became Addisonian (no adrenal function at all). Now the Vet wants to test for Cushings. What symptoms would I see if Cushing's is a possibility

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  2. Hi! What is referred to as Cushings disease are excessive levels of cortisol hormone in the body.

    Finley is being treated for the Addison's right? Which means cortisol supplementation.

    If I understand correctly what you're saying, it seems to me that Finley is either simply over-medicated for his acquired Addison's, or his adrenals re-gained some function, which together with the supplemented cortisol also results in cortisol levels being too high.

    If my above assumptions are correct, adjustment in medication should solve the problem.

    I am assuming that the chemo was successful.

    Some of the symptoms are described above. Excessive drinking, increased urination/potty accidents, excessive appetite, hair loss, panting, weight gain or pot-belly appearance ...

    Symptoms with these conditions can be quite vague and misleading.

    Testing makes sense if your vet suspects that the cortisol levels are too high. If Finley test positive, your vet will probably first make adjustments in the medication, and he might want to test whether there is something else going on with the adrenal glands.

    Testing hormone levels in any of these conditions make sense, since the levels are being externally manipulated, and it is important to make sure that the correct levels are maintained. Sometimes medication needs to be adjusted.

    Either way, I think testing is a good idea to see what is really going on.

    I hope this helps.

    Jana

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  3. PS: for example our Jasmine is on thyroid hormone, and her levels need to be tested regularly to make sure the levels are where they need to be.

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  4. I do agree with your views that cussing is the outcome of hormone imbalances. But can it a cause of hair loss diseases in women? You have really tried your best to explain the medical jargons in best possible ways. I really appreciate your efforts.

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  5. Dear Julia. I really wouldn't know, my blog is about dogs. But since it does cause hair loss in dogs, it is quite possible that it might do the same in people.

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  6. Our 8 year old dog was diagnosed with Cushing in April as a result of a pituitary tumor. She went through a week of Lysodren treatment and then went into Addison shock two times. She has been on prednisone every since. She recently starting showing signs of Cushings again, so the vet recommended stopping the pred so we could get an accurate ACTH stim test. She lost her appetite since going off the pred, which indicated to me that she was still Addison, so I put her back on the pred but her appetite is not normal. She has symptoms of both diseases, any thoughts?

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  7. Oh wow, poor girl. I think testing is the only way to determine where her levels really are. Because there is a fine balance between too much or too little cortisol, it can be quite a balancing act.

    There also seems to be a new surgery to remove the tumor I was recently reading about
    http://whatwouldadogdo.blogspot.com/2010/10/cedars-sinai-medical-center-offers-help.html

    Perhaps something to look into

    Either way, testing and determining what exactly is going on is the main step.

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  8. I would like to know if my dog is drinking a lot of water and he looking down and he has trouble moving and he sleeping a lot what could be wrong with him. If any one know please tell me i don't want to lose my boy.

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    Replies
    1. Alejandro, only a veterinarian, after examination and testing can tell you what's wrong with your dog. Sounds serious, though, so please do see one as soon as possible.

      Delete
  9. My friend has a pit puppy about 5 months old and since she has had him he drinks so much water and if he can't find water he stresses out looking for some... He constantly urinates in the house and can be let outside and pee but then come right back in and pee on the floor... She is beside herself.. She has taken him to vet and urine was checked and he said it was consentrated like kidney failure, but did blood work and it came back the everything is working normally how do they check for cushings.. Wouldn't the blood work show something or is this just a behavioral issue

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    Replies
    1. The peeing would normally come with all that drinking. What goes it, must come out. It wouldn't really surprise me that the urine would be quite dilute. Was the urine that was analyzed first morning urine (and before he drank anything)? When checking kidney function, first morning urine is the most telling, particularly when there is an excessive drinking issues.

      Urine would show a kidney problem long before blood would (over 75% of kidney function has to be lost for Creatinine in the blood to get elevated)

      Cushing's seems kind of unlikely to me with a dog this young. However, SOMETHING is going awry. If your vet cannot figure it out, get a consultation with a specialist.

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    2. Hi, We have a 1 year old female dog with the same sythoms, drinking tons of water and having accidents in house, even in her sleep. we took her into vet all labs were normal kidney function, liver function. cbc, etc. also urine was fine no infection. we asked about cushings and the vet said one of the labs would be abnormal, so he did not think that was the problem. they did not how ever check for kidney stones or addisons. could this be a homone issue or kidney stones? or could this be stress related? please help?

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    3. The incontinence alone, I'd almost think it could be some anatomical abnormality causing that. BUT, typical incontinence doesn't cause increased drinking.

      I agree with the vet that with Cushing's "regular" labs would show some abnormalities such as elevated liver values. I'd like to believe that Addison's would also show some abnormalities on "regular" labs. I'd also expect other symptoms.

      "The first step in making a diagnosis of Addison’s disease is to perform basic blood tests, which commonly show abnormalities that point to hypoadrenocorticism as the potential problem. For example, a complete blood count (CBC) may reveal the following changes that could indicate Addison’s disease:

      Anemia (low red blood cell count)
      High numbers of lymphocytes, a type of white blood cell
      High numbers of eosinophils, another type of white blood cell

      A serum chemistry profile generally reveals one or more of the following abnormalities in dogs with Addison’s disease:

      High potassium concentration
      Low sodium concentration
      Low sodium/potassium ratio (Na:K less than 27:1)
      High urea nitrogen concentration
      High creatinine concentration
      High phosphorus concentration
      High calcium concentration
      Low glucose concentration"

      http://www.animalendocrine.info/2011/04/how-is-canine-addisons-disease-best.html

      However, SOMETHING is going on and you need to keep digging. ANY infection could lead to increase drinking - any signs of infection on the blood work? Tested for tick-borne disease?

      Your vet needs to keep digging or you need a second opinion or a referral to a specialist.

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    4. Hi i have a 10 yr old frenchy and hes started to drink ridiculous amounts of water and is wettimg himself self throughout the day even though hes weeing throughout the day all day. Ive tried giving him little amounts of water during the course of the day but he just cries for more. Hes a greedy dog but if i put water and food down he hoea straight for the water where as before he would go for the food first. Ive notice his eyes are all blood shot, hes loosing alot of weight and his rib area seems swollen due to his back end being thinner plus his hair has fell out on either side of his ribs and hes vompletely bauldy where its fell out. Could anyone help me please ???

      Delete
    5. Hi i have a 10 yr old frenchy and hes started to drink ridiculous amounts of water and is wettimg himself self throughout the day even though hes weeing throughout the day all day. Ive tried giving him little amounts of water during the course of the day but he just cries for more. Hes a greedy dog but if i put water and food down he goes straight for the water where as before he would go for the food first. Ive notice his eyes are all blood shot, hes loosing alot of weight and his rib area seems swollen due to his back end being thinner plus his hair has fell out on either side of his ribs and hes completely bauldy where its fell out. Could anyone help me please ???

      Delete
    6. Please do not limit water intake because the body needs it. It's trying to flush something out. Please do see a veterinarian and have this diagnosed. Please see a veterinarian asap.

      Delete
  10. I have 10 months old poodle, she had strong urine odor and the vet give to her two injections for urinal infection, two days after this she started shaking and breathing very fast constantly. also she is drinking a lot of water and frequently urinate. Can anyone help??

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    Replies
    1. Please go back to the vet. She's in trouble whatever is going on. What injections did she get?

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  11. Hi,
    Ive got an almost 11 year old maltese shitzu, who is going to be looked at for diabetes and cushing disease. Is it possible that he could potentially have both of these issues? Or would it be more likely that it is one or the other? A blood test was performed with the vet and he informed me the glucose was high (so my dog was given an insulin injection) AND there was also another marker that was high (but can't recall now which one that was) They will be performing an ACTH test. I guess i just want to know how worried I need to be!! He is more than just my dog, he is my family.

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    Replies
    1. Hi high was the glucose? Did they test urine also? Follow up test? Do find out which marker was high for Cushing's. I suppose it is possible to have both but I would think that it's one or the other.

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