Historically, mitotane Lysodren has been the mainstay of treatment. This drug is a chemotherapeutic agent that selectively destroys zona fasciculate and zona reticulosa of the adrenal cortex. This would seem to be an ideal treatment as loss of sex hormones product of zona reticulosa is not usually clinically significant in our patients. This would mean only the excessively functioning layer is affected. However, at increased doses, the zona glomerulosa is affected as well, leading to the production of a dog with Addison's disease and all the physiologic disturbances associated with that disease.
It is therefore vital that daily communication between the veterinary staff and owner regarding the dog's well being occur during induction and the initial stages of treatment with this drug. Once adequate control is achieved, maintenance therapy is instituted. Continued monitoring with ACTH stimulation assays is essential. More recently, the use of trilostane Vetoryl has been introduced to the United States. In contrast to mitotane, the adrenal cortical tissue is spared during treatment with trilostane.
Trilostane inhibits synthesis of cortisol, therefore, while the adrenal tissue is still functional, a "blockade" is formed in the synthesis pathway and functional product is not secreted.
It is more attractive in that it is more difficult to induce an Addisonian state, though it has been reported, and the effects are more rapidly reversed in the event of an overdose. Monitoring of clinical signs and objective criteria are imperative during treatment with both of these options. Specific protocols for treatment as well as monitoring parameters will be discussed during the presentation. The technician is a key component to successful management of Cushing's syndrome in dogs.
By Role. Cushing's and Addison's disease: Testing and management Proceedings. April 1, Julia K. Addison's disease The overwhelming majority of cases of Addison's disease hypoadrenocorticism are due to a primary failure of the adrenals.
Diagnosis After recognizing the possibility of Addison's disease, diagnosis is straightforward. Table 1: ACTH stimulation test protocol. Treatment Replacement of glucocorticoids is the hallmark of the management of Addison's disease. Cushing's syndrome Cushing's syndrome is the opposite of Addison's: it is an excess of cortisol. Low in ACTH-independent. No suppression of cortisol with an ectopic source. With secondary causes, get cortisol response after 24 hrs — adrenal cortex wakes up.
Bilateral adrenalectomy if source cannot be located, or recurrence post surgery. Pituitary radiotherapy in children. Avoid giving late in the day because it can cause insomnia. Any Questions? Case studies Total views 15, On Slideshare 0. From embeds 0. Number of embeds Downloads Shares 0.
Comments 0. Likes You just clipped your first slide! Clipping is a handy way to collect important slides you want to go back to later. Now customize the name of a clipboard to store your clips. Visibility Others can see my Clipboard. Cancel Save. Exclusive 60 day trial to the world's largest digital library. Activate your free 60 day trial. Different types of adrenal insufficiency have different causes. The most common cause of adrenal insufficiency overall is suddenly stopping corticosteroids after taking them for a long time.
As treatment improved over the years, TB became a much less common cause. The most common cause of tertiary adrenal insufficiency is suddenly stopping corticosteroids after taking them for a long time.
Prescription doses of corticosteroids can cause higher levels of cortisol in your blood than your body normally makes. High levels in your blood for a long time cause the hypothalamus to make less CRH. Once you stop taking corticosteriods, your adrenal glands may be slow to start working again.
0コメント