Use of Plasma Renin Activity to Monitor Mineralocorticoid Treatment in Dogs with Primary Hypoadrenocorticism: Desoxycorticosterone Versus Fludrocortisone

Baumstark, M E; Nussberger, Jürg; Boretti, Felicitas S; Baumstark, Manfred W.; Riond, Barbara; Reusch, Claudia E; Sieber-Ruckstuhl, Nadja S

doi:10.1111/jvim.12426

Cited by 28 publications

(48 citation statements)

References 24 publications

(46 reference statements)

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“…Cortisol concentrations (before and 1 hour after ACTH stimulation) were undetectable, baseline aldosterone concentration was low (3.2 pg/mL) and serum renin activity was in the low reference range (0.45 ng/mL/h), which seemed consistent with secondary HA 13. This dog was treated with glucocorticoids only; 1.5 years later the dog was completely stable on glucocorticoid treatment alone.…”

Section: Resultsmentioning

confidence: 82%

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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BackgroundThe adrenocorticotropic hormone (ACTH) stimulation test is the gold standard for diagnosing hypoadrenocorticism (HA) in dogs. However, problems with the availability of synthetic ACTH (tetracosactrin/cosyntropin) and increased costs have prompted the need for alternative methods.ObjectivesTo prospectively evaluate the cortisol‐to‐ACTH ratio (CAR) as a screening test for diagnosing canine HA.AnimalsTwenty three dogs with newly diagnosed HA; 79 dogs with diseases mimicking HA; 30 healthy dogs.MethodsPlasma ACTH and baseline cortisol concentrations were measured before IV administration of 5 μg/kg ACTH in all dogs. CAR was calculated and the diagnostic performance of ACTH, baseline cortisol, CAR and sodium‐to‐potassium ratios (SPRs) was assessed based on receiver operating characteristics (ROC) curves calculating the area under the ROC curve.ResultsThe CAR was significantly lower in dogs with HA compared to that in healthy dogs and in those with diseases mimicking HA (P < .0001). There was an overlap between HA dogs and those with HA mimicking diseases, but CAR still was the best parameter for diagnosing HA (ROC AUC 0.998), followed by the ACTH concentration (ROC AUC 0.97), baseline cortisol concentration (ROC AUC 0.96), and SPR (ROC AUC 0.86). With a CAR of >0.01 the diagnostic sensitivity and specificity were 100% and 99%, respectively.Conclusion and Clinical ImportanceCalculation of the CAR is a useful screening test for diagnosing primary HA. As a consequence of the observed overlap between the groups, however, misdiagnosis cannot be completely excluded. Moreover, additional studies are needed to evaluate the diagnostic reliability of CAR in more dogs with secondary HA.

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Section: Resultsmentioning

confidence: 82%

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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“…In human beings with hypoadrenocorticism, the dosage of mineralocorticoid supplementation is guided by a combination of clinical examination, blood pressure measurement, sodium and potassium control and PRA concentration (Løvås and Husebye 2008, Charmandari and others 2014). Recent work has also confirmed the use of PRA in monitoring mineralocorticoid treatment in dogs with spontaneous hypoadrenocorticism (Baumstark and others 2014) . The PRA assay was not routinely available during the study period of this retrospective study and therefore was not assessed.…”

Section: Discussionmentioning

confidence: 84%

Factors that affect stabilisation times of canine spontaneous hypoadrenocorticism

2016

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The objective of this retrospective study was to examine factors that may have affected the stabilisation times of 50 dogs with spontaneous hypoadrenocorticism that were being treated with fludrocortisone acetate, with particular emphasis on dosing frequency and the concurrent use of prednisolone. Stabilisation was defined as an absence of clinical signs with a sodium:potassium ratio >27:1 and both electrolyte concentrations within a laboratory reference range. It was found that the median time till stabilisation was three months. The frequency of fludrocortisone treatment (once, twice or changed from once to twice a day) had no effect on the stabilisation time. The two groups of dogs that were started and stabilised on once a day or twice a day dosing had a median stabilisation time of two months. However, dogs that failed to stabilise on once a day dosing of fludrocortisone and were then changed onto twice a day dosing then stabilised a median of one month later. Concurrent use of prednisolone resulted in significantly faster stabilisation times. It was concluded that dogs with hypoadrenocorticism should be continued on prednisolone therapy until they are stabilised. If a dog is failing to stabilise on once a day fludrocortisone acetate, a change to twice a day administration could be considered.

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“…A recent study evaluated PRA in dogs with PH treated with fludrocortisone acetate or DOCP . All of the dogs treated with DOCP in that study exhibited a progressive decrease in PRA leading to complete suppression . Results from the aforementioned study emphasize the need to identify an alternative DOCP strategy to treat dogs with PH.…”

Section: Discussionmentioning

confidence: 98%

Desoxycorticosterone Pivalate Duration of Action and Individualized Dosing Intervals in Dogs with Primary Hypoadrenocorticism

Jaffey¹,

Nurre²,

Cannon

et al. 2017

Veterinary Internal Medicne

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BackgroundClinicians alter dosing for desoxycorticosterone pivalate (DOCP) to mitigate costs, but this practice has not been critically evaluated in a prospective clinical trial.Hypothesis/ObjectivesThe duration of action of DOCP is longer than 30 days in dogs with primary hypoadrenocorticism (PH).AnimalsA total of 53 client‐owned dogs with PH. Twenty‐four dogs with newly diagnosed PH (Group 1) and 29 dogs with treated PH (Group 2).MethodsProspective, multicenter, clinical trial. For phase I, DOCP was administered and plasma sodium and potassium concentrations were measured until the dog developed hyponatremia or hyperkalemia at a planned evaluation, or displayed clinical signs with plasma electrolyte concentrations outside of the reference interval independent of a planned evaluation, thus defining DOCP duration of action. Plasma electrolyte concentrations then were assessed at the end of the individualized dosing interval (IDI; i.e., DOCP duration of action minus 7 days, phase II and at least 3 months after concluding phase II, phase III).ResultsThe duration of action of DOCP in dogs in phase I with naïve PH (n = 24) ranged from 32 to 94 days (median, 62 days; 95% confidence interval [CI], 57, 65) and previously treated PH (n = 29) from 41 to 124 days (median, 67 days; CI, 56, 72). Overall, the final DOCP dosing interval for all dogs that completed phase II (n = 36) ranged from 38 days to 90 days (median, 58 days; CI, 53, 61). No dog that completed phase III (n = 15) required reduction in the IDI. The DOCP duration of action, independent of group, was not significantly associated with several baseline variables. The median drug cost reduction using IDI was approximately 57.5% per year.Conclusion and Clinical ImportanceThe duration of action of DOCP in dogs with PH is >30 days, and plasma sodium and potassium concentrations can be maintained with an IDI >30 days long term.

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Use of Plasma Renin Activity to Monitor Mineralocorticoid Treatment in Dogs with Primary Hypoadrenocorticism: Desoxycorticosterone Versus Fludrocortisone

Cited by 28 publications

References 24 publications

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Factors that affect stabilisation times of canine spontaneous hypoadrenocorticism

Desoxycorticosterone Pivalate Duration of Action and Individualized Dosing Intervals in Dogs with Primary Hypoadrenocorticism

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