deoxycortone-pivalate and Addison-Disease

Clinicians alter dosing for desoxycorticosterone pivalate (DOCP) to mitigate costs, but this practice has not been critically evaluated in a prospective clinical trial.. The duration of action of DOCP is longer than 30 days in dogs with primary hypoadrenocorticism (PH).. A total of 53 client-owned dogs with PH. Twenty-four dogs with newly diagnosed PH (Group 1) and 29 dogs with treated PH (Group 2).. Prospective, multicenter, clinical trial. For phase I, DOCP was administered and plasma sodium and potassium concentrations were measured until the dog developed hyponatremia or hyperkalemia at a planned evaluation, or displayed clinical signs with plasma electrolyte concentrations outside of the reference interval independent of a planned evaluation, thus defining DOCP duration of action. Plasma electrolyte concentrations then were assessed at the end of the individualized dosing interval (IDI; i.e., DOCP duration of action minus 7 days, phase II and at least 3 months after concluding phase II, phase III).. The duration of action of DOCP in dogs in phase I with naïve PH (n = 24) ranged from 32 to 94 days (median, 62 days; 95% confidence interval [CI], 57, 65) and previously treated PH (n = 29) from 41 to 124 days (median, 67 days; CI, 56, 72). Overall, the final DOCP dosing interval for all dogs that completed phase II (n = 36) ranged from 38 days to 90 days (median, 58 days; CI, 53, 61). No dog that completed phase III (n = 15) required reduction in the IDI. The DOCP duration of action, independent of group, was not significantly associated with several baseline variables. The median drug cost reduction using IDI was approximately 57.5% per year.. The duration of action of DOCP in dogs with PH is >30 days, and plasma sodium and potassium concentrations can be maintained with an IDI >30 days long term.

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Electrolytes; Female; Male; Mineralocorticoids; Potassium; Prospective Studies; Sodium

Primary hypoadrenocorticism (PH) is rare in cats and knowledge about treatment is sparse.. To describe cats with PH with a focus on long-term treatment.. Eleven cats with naturally occurring PH.. Descriptive case series with data on signalment, clinicopathological findings, adrenal width, and doses of desoxycorticosterone pivalate (DOCP) and prednisolone during a follow-up period of >12 months.. Cats ranged from 2 to 10 years (median 6.5); 6 cats were British Shorthair. Most common signs were reduced general condition and lethargy, anorexia, dehydration, obstipation, weakness, weight loss, and hypothermia. Adrenal glands on ultrasonography were judged small in 6. Eight cats could be followed for 14 to 70 months (median: 28). Two were started on DOCP doses ≥2.2 mg/kg (2.2; 2.5) and 6 < 2.2 mg/kg (1.5-2.0 mg/kg, median 1.8) q28 days. Both high-dose cats and 4 low-dose cats needed a dose increase. Desoxycorticosterone pivalate and prednisolone doses at the end of the follow-up period were 1.3 to 3.0 mg/kg (median: 2.3) and 0.08 to 0.5 mg/kg/day (median: 0.3), respectively.. Desoxycorticosterone pivalate and prednisolone requirements in cats were higher than what is currently used in dogs; thus, a DOCP starting dose of 2.2 mg/kg q28 days and a prednisolone maintenance dose of 0.3 mg/kg/day titrated to the individual need seems warranted. Small adrenal glands (width < 2.7 mm) on ultrasonography in a cat suspected of hypoadrenocorticism can be suggestive of the disease. The apparent predilection of British Shorthaired cats for PH should be further evaluated.

Topics: Addison Disease; Adrenal Insufficiency; Animals; Cat Diseases; Cats; Desoxycorticosterone; Dog Diseases; Dogs; Prednisolone

Dogs with primary hypoadrenocorticism were included if the initial starting dose was 1.5 mg/kg DOCP subcutaneously. The first, second and the last known dose of DOCP were documented. Electrolyte concentrations at the time of diagnosis as well as 10-14 days after the first injection, on the day of the second injection as well as at the last known injection were recorded. A dog was considered medically well-regulated when clinically healthy, sodium and potassium concentrations within the reference ranges, and when the responsible veterinarian did not recommended a dose alteration.. All 13 included dogs were clinically healthy after the first or second injection. One dog received 1.6 mg/kg DOCP as last documented dose, all other dogs received ≤ 1.5 mg/kg (median: 1.3, range: 0.4-1.6) DOCP. Eleven dogs were injected once monthly, 2 dogs received injections every 60 days. The dogs were followed at least 7 months (median: 20 months, range: 7-26 months).. We were able to show that a starting dose of 1.5 mg/kg DOCP (Zycortal. Aufnahme in die Studie fanden Hunde mit primärem Hypoadrenokortizismus, die mit einer DOCP-Anfangsdosis von 1,5 mg/kg s. c. therapiert worden waren. Dokumentiert wurden die 1., 2. und letztbekannte DOCP-Dosis sowie die Elektrolytkonzentrationen zum Zeitpunkt der Diagnose, 10–14 Tage nach der ersten DOCP-Injektion, am Tag der 2. und der zuletzt dokumentierten Injektion von DOCP. Ein Hund galt als stabil eingestellt, wenn er ein ungestörtes Allgemeinbefinden hatte, Natrium- und Kaliumkonzentration im Referenzbereich lagen und der behandelnde Tierarzt keine Dosisanpassung empfahl.. Alle 13 in die Studie eingeschlossenen Hunde waren nach der 1. bzw. 2. Injektion stabil eingestellt. Ein Hund benötigte als letzte dokumentierte Dosis 1,6 mg/kg DOCP, alle anderen ≤ 1,5 mg/kg (Median: 1,3 mg/kg, Spanne: 0,4–1,6 mg/kg). Elf Hunde erhielten monatlich eine Injektion, 2 Hunde alle 60 Tage. Der Beobachtungszeitraum betrug mindestens 7 Monate (Median: 20 Monate, Spanne: 7–26 Monate).. Wir konnten zeigen, dass eine Anfangsdosis von 1,5 mg/kg DOCP (Zycortal

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Mineralocorticoids; Potassium; Retrospective Studies; Sodium

Lowering the dose of desoxycorticosterone pivalate (DOCP) for the treatment of dogs with primary hypoadrenocorticism (PH) decreases costs and could lead to increased owner motivation to treat their affected dogs.. To evaluate the efficacy of a low-dose DOCP treatment protocol in dogs with PH.. Prospective study, 17 client-owned dogs with naturally occurring PH (12 newly diagnosed, 5 previously treated with fludrocortisone acetate [FC]).. Dogs with newly diagnosed PH were started on 1.5 mg/kg DOCP SC; dogs previously treated with FC were started on 1.0-1.8 mg/kg DOCP SC. Reevaluations took place at regular intervals for a minimum of 3 months and included clinical examination and determination of serum sodium and potassium concentrations. The DOCP dosage was adjusted to obtain an injection interval of 28-30 days and to keep serum electrolyte concentrations within the reference interval.. Median (range) follow-up was 16.2 months (4.5-32.3 months). The starting dosage was sufficient in all but 2 dogs and had to be significantly decreased after 2-3 months to a median dosage (range) of 1.1 mg/kg (0.7-1.8). Dogs 3 years of age or younger needed significantly higher dosages compared to older dogs. None of them, however, needed the 2.2 mg/kg DOCP dosage, recommended by the manufacturer.. A starting dosage of 1.5 mg/kg DOCP is effective in controlling clinical signs and serum electrolyte concentrations in the majority of dogs with PH. An additional dose reduction often is needed to maintain an injection interval of 28-30 days. Young and growing animals seem to need higher dosages.

Topics: Addison Disease; Age Factors; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Female; Male; Mineralocorticoids; Potassium; Prospective Studies; Sodium

Thyrotropin (TSH) can be increased in humans with primary hypoadrenocorticism (HA) before glucocorticoid treatment. Increase in TSH is a typical finding of primary hypothyroidism and both diseases can occur concurrently (Schmidt's syndrome); therefore, care must be taken in assessing thyroid function in untreated human patients with HA.. Evaluate whether alterations in cTSH can be observed in dogs with HA in absence of primary hypothyroidism.. Thirty dogs with newly diagnosed HA, and 30 dogs in which HA was suspected but excluded based on a normal ACTH stimulation test (controls) were prospectively enrolled.. cTSH and T4 concentrations were determined in all dogs and at selected time points during treatment (prednisolone, fludrocortisone, or DOCP) in dogs with HA.. cTSH concentrations ranged from 0.01 to 2.6 ng/mL (median 0.29) and were increased in 11/30 dogs with HA; values in controls were all within the reference interval (range: 0.01-0.2 ng/dL; median 0.06). There was no difference in T4 between dogs with increased cTSH (T4 range 1.0-2.1; median 1.3 μg/dL) compared to those with normal cTSH (T4 range 0.5-3.4, median 1.4 μg/dL; P=0.69) and controls (T4 range 0.3-3.8, median 1.8 μg/dL; P=0.35). After starting treatment, cTSH normalized after 2-4 weeks in 9 dogs and after 3 and 4 months in 2 without thyroxine supplementation.. Evaluation of thyroid function in untreated dogs with HA can lead to misdiagnosis of hypothyroidism; treatment with glucocorticoids for up to 4 months can be necessary to normalize cTSH.

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Female; Glucocorticoids; Hypothyroidism; Male; Prednisolone; Thyrotropin; Thyroxine

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Drug Therapy, Combination; Evidence-Based Medicine; Fludrocortisone; Glucocorticoids

A 22-yr-old, captive-born, presumed female Hoffmann's two-toed sloth (Choloepus hoffmanni) presented in respiratory distress with severe dehydration and symptoms of hypotension. During treatment, dysphagia was noted and oral examination revealed enlarged palatine tonsils and mucosal plaques. Bloodwork showed a decreased sodium:potassium ratio, a low baseline cortisol, a decreased adrenocorticotropin response test, and a blunted aldosterone stimulation test. All values were compared to a healthy male Hoffmann's two-toed sloth at the same facility. Despite aggressive medical management and treatment for hypoadrenocorticism, the sloth was found deceased. Necropsy revealed abdominal effusion, multifocal plaques throughout the upper gastrointestinal tract, and testes. Histopathology showed marked adrenal cortical atrophy and intranuclear mucosal inclusions in the gastrointestinal tract; advanced molecular techniques did not uncover any viral etiologies. This is the first reported case of hypoadrenocorticism in a sloth.

Topics: Addison Disease; Animals; Desoxycorticosterone; Fatal Outcome; Male; Sloths

Vitiligo is presumed to be an autoimmune disorder in the dog; primary adrenal insufficiency (Addison's disease) is associated with immune-mediated destruction of the adrenal cortex.. In this case report we describe a dog with primary hypoadrenocorticism that developed generalized vitiligo.. A 4-year-old spayed female cross-bred dog developed signs of Addison's disease and this was confirmed by biochemical testing; the dog was treated with fludrocortisone acetate and then desoxycorticosterone pivalate. Three months after the diagnosis, the dog developed depigmentation of the whole hair coat and of several focal areas of the skin. Histopathological findings were consistent with vitiligo.. Dogs with immune-mediated disease may develop other manifestations of immune-mediated disease, including a combination of Addison's disease and vitiligo. The cause in this case was not determined.

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Female; Fludrocortisone; Vitiligo

Topics: Addison Disease; Animals; Desoxycorticosterone; Dog Diseases; Dogs

Topics: Addison Disease; Adrenal Cortex; Adrenal Cortex Diseases; Desoxycorticosterone; Hypertension; Kidney

Topics: Addison Disease; Adrenal Insufficiency; Desoxycorticosterone; Hypoadrenocorticism, Familial

Topics: Addison Disease; Adrenal Insufficiency; Cortisone; Desoxycorticosterone; Humans; Hypoadrenocorticism, Familial