What is Addison’s Disease And Why Am I Asking?

This morning, Cy and I became needle buddies… Yep, I finally did it. I accidentally pricked my finger with Cy’s IV needle. Honestly, lost in thought, I slipped putting on the cap while switching needles, and it went right into my pointer finger.

I’ve come to the realization that I am often lost in thought these days. Mainly because I haven’t quite accepted his diagnosis. I know he’s sick. But I haven’t stopped fighting the fact that there isn’t more that I can do.

I need to cover the bases. I need to rule out anything and everything else until I can fully accept the fact that I’m doing all I can. It’s not the diagnosis itself that bothers me, it’s the thought that I can or should do more. I can’t stop fighting for him… like I literally can’t stop.

I look over his labs daily. I read about everything hourly. And I’m lost every minute.

What is Addison’s?

My latest thoughts have been towards Addison’s Disease or Hypoadrenocorticism, often described as the opposite of Cushings syndrome or Hyperadrenocorticism. Basically, where Cushings is a disorder that occurs when your body makes too much of the destressing hormone cortisol over a long period of time, Addison’s is when your body doesn’t make enough cortisol. With Addison’s another key player is the hormone aldosterone, which regulates electrolyte balance. Both are autoimmune diseases. The adrenal glands, which produce both cortisol and aldosterone, play a large role in these diseases.

When it comes to causes Addison’s is identified as Primary or Secondary. In Primary Addison’s Disease, the most common form, the immune system starts attacking itself and destroying the adrenal gland. In Secondary cases, Addison’s results from a problem in the pituitary gland, located in the brain responsible for telling the adrenal gland to produce and release needed hormones. You’ll hear a lot about ACTH, a hormone that acts like a directive or marching order released by the pituitary to the adrenal glands. In testing for Addison’s disease doctors administer an ACTH simulation, injecting synthetic ACTH to see if the adrenal glands respond appropriately.

Causes vary including tumors, concurrent disease, toxin and other medications (some Cushing’s Disease patients develop Addison’s with prolonged use of steroids that might cause the adrenal glands to not produce enough or stop producing cortisol).

There are also different forms: Atypical and Classic. Atypical is when the adrenal glands don’t produce enough or any cortisol whereas Classic is a total shutdown of the adrenal glands when no cortisol nor aldosterone are produced.

The Great Pretender

Addison’s is also called the great pretender as it often is misdiagnoses and can present itself as other diseases. Addison’s is also often not diagnoses properly until the patient is in a crisis, or extreme situation. It is also becoming more common in dogs.

At first glance, Atypical dogs can seem like they have gastrointestinal problems. Dogs with Classic Addison’s present as if they have severe kidney failure.

This is where that little voice in the back of my head says, “there’s something happening.”

At first, I dismissed Addison’s because his diagnosed lab work on Sept. 4 came back with a normal Na/K ratio and normal blood pressure. I also remember his Sept 4 blood count for Eosinophils or EOS, a disease fighting white blood cell, being in normal range as well. Usually over 500 count is a key indicator of Addison’s.

The Why

The week after his 72-hour stay there was an extreme spike in his potassium level while his sodium levels decreased. And his Na/K ratio has remained low.

I thought it was diet related. But after talking to some pet parents with dogs with CKD and extreme Googling, they noted that chronic patients generally have lower potassium levels or are hypokalemic. While acute cases often are, some CKD dogs rarely but can become hyperkalemic, having elevated levels of potassium.

Through the lens of Addison’s disease, electrolyte imbalances like these are indicators of adrenal issues. An Na/K ratio lower than 27 should be looked into. At the same time, a potassium level higher than 6.0 could be life threatening (queue the internal panic screaming). And symptoms of Addison’s disease are so basic b that they cover all the symptoms of CKD as well.

It can also be triggered by stressful events like, I don’t know, adoption? Getting an eye removed?

Addison’s symptoms or episodes can come suddenly and strong, which is called an Addisonian Crisis. In crisis, dog’s can have seizures, heart issues and/or collapse. Symptoms can also “wax and wane” or come and go in various levels of severity.

A Common Thread

Random and coincidentally, when I met up with a few of my new(ish) coworkers after work the other day, one of them, Emily, immediately knew what Addison’s Disease was when I said I’m suspicious that Cy might have it. Turns out one of Emily’s close relatives has Addison’s.

I started working at my current company when quarantine started earlier this year and have not had many opportunities to connect with a lot of my coworkers as you would in a shared workspace.

When it was announced that we would be fully remote indefinitely, it meant if I were to get to know them it would need to be more intentional.

I met Emily in my interview process and since then, over six months ago, haven’t been able to reconnect. So, we had planned to meet up and work together at a coffee spot the morning after, something I’ve been wanting to do with Cy since we rescued him. Sitting at home is boring for him but at the same time, it wasn’t until recently that places opened up enough to work away from home.

Unfortunately, these days getting to know me also means getting to know the most recent thing I’m stressing about when it comes to Cy’s health. The old journalist in me could not help but ask Emily tons questions about the disease, which fortunately for me and Cy, Emily was kind and open enough to share.

Her story made me sad, hopeful and inspired. Sad about how this disease has impacted her family. Hopeful that there’s treatment for maintenance. And inspired by her strength and how she was able to handle the situation and be there for her family.

So… On Monday, we’re getting the adrenal test and new set of ultrasounds to look specifically at and measure his adrenal glands.