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Dr. John
Dr. John, Texas Veterinarian
Category: Dog Veterinary
Satisfied Customers: 4997
Experience:  Over 14 years of clinical veterinary experience
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My dog has just taken the ACTH stim test, and we are

Customer Question

My dog has just taken the ACTH stim test, and we are waiting for results. Her potassium/sodium levels were normal, but her eosinophil count was elevated, she is a 2yr great dane/lab and has been exhibiting signs of lethargy, vomiting, and weakness (we took a thyroid test, and that was fine). Thus, if she has Addison’s the vet indicated it will most likely be atypical. I have been reading extensively to try to understand the disease and its treatment. The one thing I would like to clarify with you, so I can discuss and understand this more clearly with my own vet, is what was noted 3 yrs ago to another client:“The problem with "atypical" Addison's disease is that, at least most of the time, the dogs have never been worked up properly to differentiate primary from secondary hypoadrenocorticism. Most would define "atypical" Addison's simply as glucocorticoid-deficient hypoadrenocorticism but that doesn't help guide what replacement therapy may be needed or predict prognosis. In other words, if that "atypical" dog has primary Addison's disease with normal electrolytes, it is very possible or even likely that mineralocorticoid replacement will be needed. On the other hand, if a dog has secondary hypoadrenocorticism, mineralocorticoid replacement will never be needed.”I also found a lab document that said, “ A distinction between primary and secondary hypoadrenocorticism is not possible with the ACTH stimulation test”Does this mean that if the ACTH comes back as atypical Addison’s, that she would need another type of test to determine primary from secondary? And also, is there any other test that you feel should be performed, to rule out any other additional diseases, before the beginning of a prednisone treatment?Thank you!
Submitted: 9 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 9 months ago.

I believe I was the one to post that information 3 years ago! To answer you directly, yes, in order to differentiate secondary versus early primary hypoadrenocorticism, I need to measure Haley's endogenous ACTH.

A normal or high endogenous ACTH concentration probably indicates early primary hypoadrenocorticism. In that case, treatment consists of prednisone and monitoring serum potassium and sodium; if or when mild hyperkalemia (increased serum potassium) occurs, the treatment regimen is changed to include both glucocorticoids and mineralocorticoids.

A low endogenous ACTH concentration indicates secondary hypoadrenocorticism. In that case treatment consists of prednisone.

You're quite welcome. Please continue our conversation if you wish.

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