deoxycortone-pivalate and Adrenal-Insufficiency

Desoxycorticosterone pivalate (DOCP) is a commonly used mineralocorticoid replacement for dogs with primary hypoadrenocorticism (HA), but manufacturer-recommended dosing protocols can be cost-prohibitive. Recent reports also have raised concerns that label dose protocols could be excessive.. To investigate the relative efficacy and adverse effects of 2 DOCP dosages in dogs with primary glucocorticoid and mineralocorticoid deficient HA.. Thirty-seven dogs, including 19 test population dogs and 18 controls.. Randomized controlled double-blinded clinical trial. Dogs with newly diagnosed primary HA were assigned to standard (2.2 mg/kg q30d, control population) or low-dose (1.1 mg/kg q30d, test population) DOCP treatment. Clinical and laboratory variables were assessed 10 to 14 days and approximately 30 days after each DOCP treatment for 90 days.. Mean serum sodium to potassium ratios at reevaluations were ≥32 in both populations throughout the study. No dog developed electrolyte abnormalities warranting medical treatment, although hypokalemia occurred on at least 1 occasion in 9 controls and 6 test population dogs. Urine specific gravities (median, interquartile range) were lower in control dogs (1.022, 1.016-1.029) as compared to test population dogs (1.033, 1.023-1.039; P = .006). Plasma renin activity was overly suppressed on 84 of 104 (80.8%) assessments in control dogs whereas increased renin activity occurred on 23 of 112 (20.5%) assessments in test population dogs.. Low-dose DOCP protocols appear to be safe and effective for treatment of HA in most dogs. Standard-dose protocols are more likely to result in biochemical evidence of overtreatment.

Topics: Adrenal Insufficiency; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Mineralocorticoids

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

To determine if urine electrolyte assessments can be used to monitor the adequacy of mineralocorticoid therapy in dogs with hypoadrenocorticism (HA).. 29 dogs with naturally occurring glucocorticoid- and mineralocorticoid-deficient HA.. Urine sodium and potassium concentrations, sodium-to-potassium ratios, sodium-to-creatinine ratios, and potassium-to-creatinine (K:Cr) ratios were evaluated in dogs with newly diagnosed HA that were treated with desoxycorticosterone pivalate (DOCP). Dogs underwent measurements of urine and serum sodium, potassium, and creatinine concentrations and plasma renin activities twice monthly for up to 3 months. Regression analyses and calculation of coefficients of determination (R2) were performed to investigate potential associations between urine and serum variables. Urine variables also were compared between dogs considered to be undertreated or overtreated based on plasma renin activities.. Urine K:Cr ratios were significantly associated with serum potassium concentrations 10 to 14 days (P = .002) and 30 days (P = .027) after the initial DOCP injection, but R2 values were only 0.35 and 0.17, respectively. Urine K:Cr ratios (median [IQR]) also were higher in dogs that were overtreated with DOCP (1.3 [0.7 to 2.3]) as compared to those dogs that were undertreated with DOCP (0.8 [0.5 to 0.9]) at 10 to 14 days after the initial DOCP injection (P = .039) but not at 30 days after the initial injection. Other urine variables were not significantly different between undertreated and overtreated dogs.. Measures of urine electrolytes were not useful for assessing the adequacy of mineralocorticoid therapy in HA dogs that were treated with DOCP.

Topics: Adrenal Insufficiency; Animals; Creatinine; Dog Diseases; Dogs; Electrolytes; Mineralocorticoids; Potassium; Renin; Sodium

A 6-year-old, castrated male Siamese cat was diagnosed with primary hypoadrenocorticism, confirmed by an adrenocorticotopic hormone (ACTH) stimulation test documenting both hypocortisolism and hypoaldosteronism. The cat was successfully treated using a combination of prednisolone and desoxycorticosterone pivalate (DOCP). This case demonstrates that DOCP can be used successfully as mineralocorticoid supplementation in cats with hypoadrenocorticism and may have a longer therapeutic duration than that in dogs.

Topics: Adrenal Insufficiency; Animals; Cat Diseases; Cats; Desoxycorticosterone; Glucocorticoids; Hyponatremia; Male; Mineralocorticoids; Prednisolone

Topics: Adrenal Insufficiency; Animals; Atrioventricular Block; Desoxycorticosterone; Dog Diseases; Dogs; Electrocardiography; Female; Glucocorticoids; Hyperkalemia; Mineralocorticoids; Prednisone

To evaluate the efficacy of initial doses of desoxycorticosterone pivalate (DOCP) that are lower and less expensive than the presently recommended initial dose of 2.2 mg/kg for treating dogs with primary hypoadrenocorticism.. A retrospective study was performed on 49 dogs with primary hypoadrenocorticism, including 36 with initial DOCP doses less than 2.2 mg/kg. Medical records were reviewed for clinical data. All study dogs were followed up with telephone calls to owners or veterinarians to determine the date of death or last follow-up. Data were analysed to investigate relationships between initial DOCP dose and survival and serum Na, K and their ratio.. Regardless of their initial DOCP dose, none of the dogs developed uncontrolled hypoadrenocorticism or severe electrolyte abnormalities or clinical problems that would have made an increase in the DOCP dose necessary. Over time, most dogs had a decrease in their DOCP dose in mg/kg, because of weight gain during treatment. No statistically significant relationships were found between initial DOCP dose and survival or post-treatment serum Na, K or Na : K, with the exception of one statistically significant result that suggested lower efficacy for higher doses.. Initial DOCP doses less than 2.2 mg/kg may be effective in controlling serum electrolyte concentrations in dogs with primary hypoadrenocorticism without adversely affecting survival. If confirmed by additional research, these findings would enable practitioners to reduce the cost of DOCP treatment by using lower initial doses, potentially saving the lives of dogs that would otherwise be euthanased because of treatment expense.

Topics: Adrenal Insufficiency; Animals; Desoxycorticosterone; Dog Diseases; Dogs; Dose-Response Relationship, Drug; Electrolytes; Female; Hydrocortisone; Male; Mineralocorticoids; Retrospective Studies; Treatment Outcome

A study was designed to evaluate the effects of desoxycorticosterone pivalate (DOCP) on blood pressure in 8 dogs with primary hypoadrenocorticism, and to attempt to identify other factors that might suggest overdosage of the drug. In 4 dogs, primary hypoadrenocorticism had been diagnosed immediately before entry of the dog into the study, and the dogs had not received any mineralocorticoid supplementation. In the other 4 dogs, primary hypoadrenocorticism had been diagnosed 1 to 6 years previously, and dogs were being treated with DOCP at the time of entry into the study. In all 8 dogs, DOCP (2.2 mg/kg of body weight, IM) was administered on days 0, 30, 60, and 90 of the study; each dog was examined on days 0, 30, 60, 75, 90, and 105. At the time of each visit, a medical history was obtained, a complete physical examination and serum biochemical analyses were performed, and body weight and blood pressure were measured. Doppler-shift ultrasonic sphygmomanometry was used to indirectly record systemic systolic and diastolic pressures. None of the dogs developed hypernatremia or hypokalemia or any clinical signs suggestive of hypoadrenocorticism during the study. However, in 6 dogs (3 that had not been previously treated with mineralocorticoids and 3 that had been), there was a significant increase in body weight over the course of the study. Compared with baseline (day 0) arterial blood pressure, neither systolic nor diastolic blood pressure was significantly increased during the study, and all systolic and diastolic blood pressure measurements were within reference ranges at all evaluation times.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenal Insufficiency; Animals; Blood Pressure; Blood Pressure Determination; Body Weight; Desoxycorticosterone; Dog Diseases; Dogs; Female; Male; Potassium; Sodium

Desoxycorticosterone pivalate was administered IM to juvenile Beagles at 0, 2.2, 6.6, or 11 mg/kg of body weight daily over a consecutive 3-day period every 28 days (equivalent to a cumulative monthly dosage of 0, 6.6, 19.8, or 33 mg/kg) for 6 months. Polyuria, polydipsia, and decreases in serum potassium and BUN concentrations were detected while the dogs were being treated. Transient increases in serum sodium concentrations also were detected. The treated males had significant decreases in body weight gain, resulting in an 18% decrease in body weight in the 11-mg/kg dosage group, compared with the controls. The weights of the adrenal glands, epididymides, and testes also were lower in the treated males. Organ weights for the 2.2, 6.6, and 11-mg/kg dosage groups were: 86, 79, and 69%, respectively, of the controls (adrenal glands); 80, 70, and 68%, respectively, of the controls (epididymides); and, 79, 75, and 67%, respectively, of the controls (testes). When normalized to body weight, these decreases in organ weight were still dosage-dependent, but the differences were less remarkable. In contrast, the relative weight (to body weight) of the kidneys (males and females) and of the thyroid and parathyroid glands (males) were higher dosage-dependently. All of the treatment-related effects, other than organ and body weight changes, appeared to be reversible following the cessation of treatment. On the basis of these results, it was concluded that treatment with desoxycorticosterone pivalate could be tolerated, even when given at dosage 15-fold the therapeutic dosage of 2.2 mg/kg every 25 days.

Topics: Adrenal Cortex Diseases; Adrenal Insufficiency; Animals; Body Weight; Desoxycorticosterone; Dog Diseases; Dogs; Drinking; Drug Tolerance; Eating; Female; Male; Organ Size; Potassium; Sodium

The efficacy of microcrystalline desoxycorticosterone pivalate (DOCP) therapy was evaluated in 60 dogs with hypoadrenocorticism. Fifty-one of the dogs were being treated with either DOCP or fludrocortisone acetate prior to entering the study. The disease had been recently diagnosed in 9 dogs that were not under maintenance treatment prior to entering the study. Desoxycorticosterone pivalate (2.2 mg/kg of body weight, IM) was administered on days 0, 25, and 50. Physical examination was performed, and blood samples were obtained for serum biochemical analysis (Na+, K+, and BUN concentrations) on days 0, 14, 25, 39, 50, 64, and 75. On day 75 of the study, a final physical examination was performed and the course of treatment was evaluated. Sixty-eight percent (41/60) of the dogs had normal physical findings on day 0 vs 87% (52/60) on day 75. Mean (+/- SD) body weight increased from 24.8 +/- 12.7 kg on day 0 to 26.2 +/- 13.7 kg on day 75. Mean serum Na+ (137.7 +/- 8.5 mEq/L) and K+ (5.6 1.0 mEq/L) concentrations and Na(+)-to-K+ ratio (25.4 +/- 5.0:1) were outside normal reference limits on day 0. By day 75, serum Na+ (144.3 +/- 4.8 mEq/L) and K+ (4.9 +/- 0.8 mEq/L) concentrations and Na(+)-to-K+ ratio (30.4 +/- 5.1:1) were normal and were significantly (P < 0.01) improved, compared with the corresponding values on day 0. Of the 60 dogs, 58 (97%) regained the loss in body weight, appetite, and muscular strength while given DOCP; once achieved, these improvements were maintained. These 58 dogs did not vomit or have diarrhea, common problems in dogs with hypoadrenocorticism.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenal Insufficiency; Animals; Blood Urea Nitrogen; Breeding; Desoxycorticosterone; Dog Diseases; Dogs; Female; Injections, Intramuscular; Male; Potassium; Sodium; Suspensions

Topics: Adrenal Insufficiency; Animals; Desoxycorticosterone; Dog Diseases; Dogs

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

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