Tilly, a 3 year old Cairn Terrier, first came to see us when she was feeling a bit under the weather. She was being sick and was quite lethargic. Initially, as Tilly has finished her season a few weeks before, an important problem we wanted to rule out was a pyometra (infection in her uterus). On an ultrasound scan however, this was not evident. We therefore treated Tilly symptomatically for her vomiting, with a check-up booked for a few days later.
Although Tilly hadn’t continued to be sick she wasn’t feeling much better so we opted to investigate further, starting with some blood work. Although no major changes showed up on Tilly’s bloods we kept her in on some fluids, as she still wasn’t feeling 100%. Tilly soon started to feel a bit brighter and was eating, so she was discharged the following day.
Over the next few weeks Tilly was much happier, however she then had another few episodes of vomiting. As Tilly’s bloods had previously been normal we were concerned about a foreign body being stuck in Tilly’s stomach or some gastritis (inflammation of her stomach). Therefore we took some x-rays of Tilly’s abdomen to ensure we couldn’t see an obvious foreign body. The only change we could see on Tilly’s x-ray was a slightly small liver. Therefore she went home again on some medication for gastritis.
Unfortunately a few days later Tilly was feeling poorly again, not wanting to eat, and feeling very lethargic. She came back into the hospital for supportive care and a drip. As Tilly had not improved since we last checked her blood work, this was repeated. Given the nature of Tilly’s episodes and her lack of improvement we were concerned about other diseases such as pancreatitis or Addison’s disease which can be less common. With these diseases we would usually see some changes on blood work, however there are also have more specific tests that can be used. The test for Addison’s disease is called an ACTH stimulation test. As Tilly’s bloods had been normal when we last checked them we also took blood for this specific test as well.
With Addison’s disease the body’s natural steroid levels can become very low, meaning that the animal has little capacity to respond to any stressful situation. Unfortunately the clinical signs for this disease, such as vomiting, lethargy and inappetance, can be very non-specific, and fit with many different problems as we had previously considered.
Whilst we were waiting for Tilly’s blood results to come back, she stayed in the hospital so that we could continue supportive care. Whilst in the hospital she had a strange episode, where she became very weak and was unable to lift her head, even though she was aware of her surroundings. This was concerning and we were worried that Tilly was deteriorating. We therefore referred her to the University of Liverpool Small Animal Hospital as an emergency.
Liverpool confirmed that Tilly had Addison’s disease. However this only became apparent following repeat blood tests and the specific ACTH stimulation test. Tilly was a particularly challenging case to diagnose as her initial tests did not fit with Addison’s disease, even though later tests confirmed it.
To control Tilly’s Addison’s she needs to stay on two types of steroid which supplement her body’s natural steroid. She is likely to need this for life, even if we manage to reduce her medication slightly. She is particularly vulnerable to times of stress and she may need her medication managed accordingly. However she otherwise should lead a normal life and had been doing very well since she started her medication.
