Endrocrinology - Diagnosis and treatment of canine hypoadrenocorticism, with a primary focus on management tools

Endrocrinology - Diagnosis and treatment of canine hypoadrenocorticism, with a primary focus on management tools

Most dogs with primary hypoadrenocorticism (PH) suffer from immune-mediated destruction of the adrenal cortex, which results in absolute glucocorticoid and mineralocorticoid deficiency. Treatment of PH consists of life-long replacement with both hormones. Mineralocorticoids usually are replaced by either PO fludrocortisone acetate (FC) or SC injection of desoxycorticosterone pivalate (DOCP).
DOCP is a long-acting synthetic mineralocorticoid administered by SC or IM injection at approximately once monthly intervals. Treatment with DOCP replaces the mineralocorticoid actions of aldosterone and prevents clinical and biochemical abnormalities associated with aldosterone deficiency.

Decreasing arterial pressure and sodium load caused by aldosterone deficiency leads to hypersecretion of renin by the kidneys, and DOCP treatment also suppresses this increased renin activity in dogs with HA. Because the expense of DOCP can be a limiting factor for some owners, finding the lowest effective dose for each dog is important.

• Is it possible in the majority of dogs with clinical disease to be well controlled with substantially lower dosages than the recommended 2.2 mg/kg?
• Is the prolongation of the injection interval effective?
  Based on serum electrolyte concentrations and PRA, are dosages of 2.2 mg/kg currently considered “overtreatment”?

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