Lathan Patty, Thompson Ann L
College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA,
School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.
Vet Med (Auckl). 2018 Feb 9;9:1-10. doi: 10.2147/VMRR.S125617. eCollection 2018.
Hypoadrenocorticism (HOAC; Addison's disease) is an endocrine condition seen in small animal practice. Dogs with this disease can present in a variety of ways from acute hypovolemic collapse to vague, chronic, waxing, and waning clinical signs. In the most common form of this disease, animals have both mineralocorticoid and glucocorticoid deficiency, resulting in hyponatremia and hyperkalemia, and signs of cortisol deficiency. The etiology may be immune-mediated destruction of the adrenal cortex, drug-induced adrenocortical necrosis (mitotane), enzyme inhibition (trilostane), or infiltrative processes such as neoplastic or fungal disease. Much less commonly, dogs have signs of cortisol deficiency, but no electrolyte changes. This is referred to as atypical HOAC. The veterinarian needs to have a clinical suspicion for HOAC to make a diagnosis in a timely manner. Treatment of dogs with an acute presentation prioritizes correcting the hypovolemia, hyperkalemia, acidosis, and hypoglycemia. Fluid therapy addresses most of these issues, but other directed therapies may be required in the most severe cases. For chronic management, all patients with Addison's disease will require replacement of glucocorticoids (usually prednisone), and most patients require replacement of mineralocorticoids with either desoxycorticosterone pivalate or fludrocortisone. Atypical Addisonians do not require mineralocorticoid supplementation, but electrolytes should be monitored in case the need arises in the future. The prognosis for dogs treated for HOAC promptly and appropriately is excellent; most patients die from other diseases. However, if the diagnosis is missed, patients may die as a consequence of HOAC. Thus, knowledge of the hallmarks of Addison's disease is imperative.
肾上腺皮质功能减退症（HOAC；艾迪生病）是小动物临床中常见的一种内分泌疾病。患有这种疾病的犬只可能有多种表现，从急性低血容量性休克到模糊、慢性、反复出现的临床症状。在这种疾病最常见的形式中，动物同时存在盐皮质激素和糖皮质激素缺乏，导致低钠血症和高钾血症以及皮质醇缺乏的症状。病因可能是肾上腺皮质的免疫介导性破坏、药物诱导的肾上腺皮质坏死（米托坦）、酶抑制（曲洛司坦）或诸如肿瘤或真菌疾病等浸润性过程。犬只出现皮质醇缺乏症状但无电解质变化的情况则少见得多，这被称为非典型HOAC。兽医需要对HOAC有临床怀疑，以便及时做出诊断。对于急性发病的犬只，治疗的重点是纠正低血容量、高钾血症酸中毒和低血糖。液体疗法可解决大部分这些问题，但在最严重的情况下可能需要其他针对性治疗。对于慢性管理，所有艾迪生病患者都需要补充糖皮质激素（通常是泼尼松），大多数患者需要用醋酸去氧皮质酮或氟氢可的松补充盐皮质激素。非典型艾迪生病患者不需要补充盐皮质激素，但应监测电解质以防未来出现需要补充的情况。及时且恰当地治疗HOAC的犬只预后良好；大多数患者死于其他疾病。然而，如果漏诊，患者可能会因HOAC而死亡。因此，了解艾迪生病的特征至关重要。
