Help with my article please!

[Beverleycuddy]

I am writing something for Dogs Today and would welcome some help on my information box out. Particularly what breeds are most affected by Addisons and if anyone has any better figures on rates of occurrence and generally if what I have written is right or not?
I have read that there is primary and secondary Addisons, is it worth mentioning? Any point in bringing it up?

What is Addison's Disease? (Is there anything that explains it better to the lay person?)
Addison's disease is an endocrine problem that occurs when the adrenal glands fail to produce enough hormones. The adrenal glands – located above the kidneys – secrete glucocorticoids (such as cortisol) and mineralocorticoids (such as aldosterone). If the metabolic and electrolyte balance is upset because these secretions stop or slow the amount of potassium, salt and water in the body will become unbalanced. The disease is also known as hypoadrenocorticism, adrenal insufficiency, or hypocortisolism, and is fatal if left untreated.

Which breeds are most affected?

(Has anyone ranked the breeds? Some of these breeds have very small populations and by having any diagnosed cases it would seem that per 1000 population they would be high ranking. But GSDs for e.g. are so popular that per thousand the rate of Addisons may be much rarer in those populations?)
I note that Staffies aren't on this list but I have corresponded with at least one Staffie owner. Any other breeds that should be listed?

Poodles
Bearded Collies
Leonberger
Novas Scotia Duck Tolling Retrievers
Great Danes
Newfoundlands
Portuguese Water Dogs
West Highland White Terriers
Rottweilers
English Springer Spaniels
German Shorthaired Pointers
Soft-Coated Wheaten Terrier
German shepherds
Saint Bernards
Airedales

Is there a sex bias?
70% of cases are in females but both males and females in Beardies and Poodles seem to be equally susceptible.

Cause?
Generally thought to be genetic. (Any other causes I can mention? Triggers? Damage due to drug use? Cancer? TB?)   

How common is it?
About one case in every 3,000 dogs. A vet might see a case every few years, owners of breeds in the list may want to suggest it as it is hard to diagnose Addisons as it so infrequently seen and symptoms can be often be confused with lots of other conditions. Plus the onset can be very gradual.

Typical age for diagnosis?
Middle age, although there have been exceptions.

Helpful resources:
Cimda – started by Jo Tucker in 2000 after her beloved Beardie Bonnie died. She had AIHA but received incorrect treatment. Many of these immune-mediated problems are so rare misdiagnosis and mistreatment can be a real hazard. Jo started CIMDA (Canine Immune Mediated Disease Awareness) to support owners who were desperately trying to cope and nurse their dogs through these potentially life threatening diseases. It is brilliant and has been a massive help. Great forum and help on all the other immune mediated problems.
http://cimda.co.uk

[patp]

My Whippet has Addisons and I think it is known in the breed (among other auto immune problems) and just kept quiet.

Willow was one year old when she was diagnosed so not always middle aged.

There is "talk" that it is triggered by environmental factors like vaccines etc but, in my experience ( I was a vet nurse) breeders blame all their woes on vaccines and, now, spot on flea treatments.
As far as I know, with Willow, there was no trigger. Her mother was diagnosed, at a later date, with a different auto immune condition.

I would like awareness raised of the vague nature of the symptoms. I was back and forwards to the vet pre diagnosis ( I do not do that lightly) until one said "not you again"! Eventually a young, bright, vet put the symptoms together and we got a diagnosis.

[Clover]

As far as drug-induced Addison's, it can be triggered by too quickly withdrawing from prednisone without tapering the dose after long term usage.

[Jo CIMDA]

Whippets most definitely are genetically predisposed to Addison's. 

I think it is important to mention both Primary and Atypical Addison's disease.

Primary is when both the mineralocorticoid and the glucocorticoid hormones are no longer produced due to an immune destruction of the part of the adrenal gland that produces these hormones.  Primary Addison's affects the sodium and potassium, and other electrolyte values and this leads to kidney and heart failure and death if not diagnosed and treated in time. 

Atypical is when only the glucocorticoid hormone is unable to be produced and therefore the electrolytes are not affected.   Atypical is sometimes called 'secondary' but this is technically not correct.  Secondary is, as Clover has said,  secondary to abrupt withdrawal of glucocorticoid (prednisolone) treatment.  When  a dog is being treated with prednisolone and there is an excess of glucocorticoid hormone in the body the adrenal glands shut down because it is being artificially supplied.  As the drug is gradually reduced the intelligent adrenal glands will gradually start to work again because it detects a lack of supply.  If prednisolone is stopped or reduced too quickly the adrenal glands will not have time to start working again and the body will experience adrenal insufficiency.   This is life threatening.  A dog does not have to be predisposed to Addison's disease to have a secondary 'drug' induced Addisonian crisis.  The disease process has nothing to do with the genetic form of Primary or Atypical Addison's disease which are both seen in genetically predisposed animals and occur as a result of an immune destruction of either one part or two parts of the adrenal glands. 

If Addison's disease is diagnosed in time it is rarely fatal because treatment is instigated.  However, it is always fatal if left undiagnosed. The problem is raising awareness among vets and getting them to recognise the symptoms, and at least to seriously consider it in their list of differential diagnoses. A dog with clinical signs of Addison's is easy to diagnose if it is tested. A vet has to know what he or she is looking for.   

Andrea Short (Manchester University) has a lot of information about the breeds known to have a predisposition to Addison's disease.  You may try contacting her. She is very helpful.

Good luck

Jo