ENDOCRINOLOGY
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mal - then withhold the medication for that day
and perform an ACTH stim test (on the same
day if possible). Do not administer any further
lysodren until you have your results.
The target of induction is a post stim cortisol of
25 – 125nmol/L. Unless the dog is showing clinical signs of addisons disease - don’t panic - you
have stopped the treatment and the decrease will
flatten out. If the cortisol is <25nmol/L you may
supplement with 1mg/kg prednisilone for a few
days. I generally wait 1 week after this sample
and then start the weekly maintenance regimen.
If the cortisol was <25nmol/L you may want to repeat the ACTH stim to make sure it is in the target
range before starting the maintenance therapy this may take a few weeks in some cases.
Maintenance: Lysodren 50mg/kg, 1 – 2 x/week
• Once on maintenance therapy repeat the ACTH
stimulation test after 4-8 weeks to see where the
maintenance dose is keeping the cortisol. The
target once again is 25 – 125nmol/L. I personally
find this a bit low - especially if sampled just prior
to next dose (trough level) and am happier with a
level between 50 – 150nmol/L. (vdM)
• Note timing of sampling is important: peak effect
(i.e. lowest cortisol) a day or so after dosing, lowest effect (i.e. highest cortisol) just before next
dose. Make a note of this for proper comparison
of cortisol levels
• If your patient is ill /otherwise stressed (e.g. kennelled, going hunting) you may need to supplement low doses of cortisol (prednisone) on those
days.
Complications:
• Approximately 25% of dogs show one or more
adverse effects during inductio