Whereas in Man the entire gland is destroyed by infection, the Canine variant may be divided into two parts.
Destruction of the topmost layer of the adrenal glands, the ZONA GLOMERULOSA, leads to loss of sodium. This comes out in the digestive system - causing ulcers, nausea and vomiting unless the dog is fed CARBONATED WATER (Soda-water).
It also comes out in the urine. Measurement of the pH of the urine allows this to be detected. This allows pet-owners to carry out a harmless test at home, prior to requesting that the vet carries out a RATIO test of sodium to potassium.
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Veterinarians are strongly advised to keep pH test strips available for sale to dog-owners. Some examples are shown on this site. Test-strips generally cost about ten cents (US), but as few lay-people will have reason to stock them, they could be sold singly at a higher price. The difference would cover the cost of explaining their use. |
The symptoms of sodium loss are sometimes the shaking of the head (to clear the "muzziness"), the lowering of the head and struggling with posture (a SERIOUS sign), frequent urination (poly-micturition) in ever-decreasing quantities as the day progresses, WITHOUT excessive drinking (polydipsia) and gasping.
It is this urination without drinking that leads to the concentrating of the blood, and the danger that the thick blood will generate fatal clots.
When the owner reports that the urine is alkaline - and increasingly so as the day progresses - the vet should order electrolyte tests. The RATIO of sodium to potassium should be above 27, or the dog probably has SODIUM-Addison`s disease. Below 23 is definite.
SODIUM-Addison`s disease appears to be due to the generation of an antibody to the C18-dehydrogenase (C18-oxydase) enzyme. This affects the mineral balance alone. This antibody is currently the subject of extensive research.
A SODIUM-Addison dog should be treated with fludrocortisone("Florinef") alone. The vet should watch out for disturbance of the ZONA FASCICULATA ALSO, because there may be more than one antibody developing.
Accordingly, before medication begins, the ACTH STIMULATION TEST - see below - should be carried out. This should be the case even if there is no brown coating on the tongue.
Destruction of the middle layer of the adrenal glands, the ZONA FASCICULATA, leads to loss of iron. This comes out on the tongue, and probably in the stools. The author is trying to find an existing cheap test for FERRITIN or for its variant HAEMOSIDERIN, based on the Prussian Blue reaction. This would help discover a SUGAR-Addison dog early.
In the absence of tests that can be done at home, the vet should advise the owner to scrape some of the brown gently off the tongue and put it in a glass or plastic bottle. Iron is a mineral, so there is no danger of fermentation spoiling the test. This sample should be sent to the laboratory to be tested for IRON.
If iron is found on the tongue, the ACTH stimulation test should be carried out.
If the tongue is yellow or café-au-lait in colour, as shown in the picture of the author`s tongue, there will probably be time to run the iron test. The author has had an ALMOST BLACK tongue when death was near. He was too sick to take a photo. Do not wait for laboratory tests if the tongue is almost black.
A dog confirmed as a SUGAR-Addison sufferer should be put on GLUCOCORTICOIDS such as betamethasone or dexamethasone - but not prednisone or prednisolone.
A dog confirmed with SUGAR-Addison`s disease should have the pH of its urine tested regularly so that the earliest sign of sodium loss is discovered if the C18 antibody also develops.
If a dog is found to have DUAL-Addison`s disease (SODIUM and SUGAR), it may be treated with prednisone or prednisolone - because the danger of creating IATROGENIC sodium-addison`s disease by virtue of the mineralocorticoid component of the "pred" no longer matters.
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It should be self-evident, however, that if the dog is clearly severely distressed and in danger the owner should not fuss with any kind of measurement, but should seek out immediate PROFESSIONAL treatment. It is the author`s experience in correspondence with pet-owners that they often over-rule the vet, and believing that owning a sick dog makes them wise, arrive at the most bizarre decisions. This must be discouraged. |
(C) 2002 Charles Douglas
Wehner.
Use freely but do not plagiarise.