Baumstark M E, Sieber-Ruckstuhl N S, Müller C, Wenger M, Boretti F S, Reusch C E
Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
J Vet Intern Med. 2014 Jan-Feb;28(1):154-9. doi: 10.1111/jvim.12243. Epub 2013 Nov 15.
Some dogs with primary hypoadrenocorticism (HA) have normal sodium and potassium concentrations, a phenomenon called atypical Addison's disease. The assumption that the zona glomerulosa and aldosterone secretion in these dogs are normal seems widely accepted; however, aldosterone measurements are missing in most published cases.
To measure aldosterone in dogs with HA with and without electrolyte abnormalities and to determine the time point of aldosterone peak concentrations during ACTH stimulation.
Seventy dogs with HA, 22 dogs with diseases mimicking HA, and 19 healthy dogs.
Prospective study. Blood samples were taken before and 60 minutes after injection of 250 μg ACTH in all dogs. Additional blood samples were taken 15, 30, and 45 minutes after ACTH in 7 dogs with HA and in 22 with diseases mimicking HA.
Baseline and ACTH-stimulated aldosterone was significantly lower in dogs with HA than in the other groups. Aldosterone was low or undetectable in 67/70 dogs with HA independently of sodium and potassium levels. In 3 dogs, sodium/potassium concentrations were normal; in 1 dog, sodium was normal and potassium decreased. In all 4, ACTH-stimulated aldosterone concentrations were below the detection limit of the assay. Aldosterone concentrations were not different at 30, 45, or 60 minutes after ACTH administration.
Cortisol and aldosterone secretion is compromised in dogs with HA with and without electrolyte abnormalities. The term atypical Addison's disease, used for dogs with primary HA and normal electrolytes, must be reconsidered; other mechanisms allowing normal electrolyte balance without aldosterone should be evaluated in these dogs.
一些患有原发性肾上腺皮质功能减退症（HA）的犬只钠和钾浓度正常，这种现象称为非典型艾迪生病。这些犬只的球状带和醛固酮分泌正常这一假设似乎已被广泛接受；然而，在大多数已发表的病例中缺少醛固酮测量值。
测量有和没有电解质异常的HA犬只的醛固酮，并确定促肾上腺皮质激素（ACTH）刺激期间醛固酮峰值浓度的时间点。
70只患有HA的犬只、22只患有类似HA疾病的犬只和19只健康犬只。
前瞻性研究。对所有犬只在注射250μg ACTH前和注射后60分钟采集血样。对7只患有HA的犬只和22只患有类似HA疾病的犬只在ACTH注射后15、30和45分钟额外采集血样。
患有HA的犬只的基线和ACTH刺激后的醛固酮显著低于其他组。67/70只患有HA的犬只的醛固酮水平较低或无法检测到，与钠和钾水平无关。在3只犬中，钠/钾浓度正常；在1只犬中，钠正常而钾降低。在所有这4只犬中，ACTH刺激后的醛固酮浓度低于检测限。ACTH给药后30、45或60分钟时醛固酮浓度无差异。
无论有无电解质异常，患有HA的犬只的皮质醇和醛固酮分泌均受损。用于原发性HA且电解质正常的犬只的非典型艾迪生病这一术语必须重新考虑；应在这些犬只中评估允许在无醛固酮情况下维持正常电解质平衡的其他机制。
