Introduction/Aim: In Addisons disease, patient-self maintenance of adequate cortisol levels is essential. Optimising cortisol control is challenging and well documented. Traditional management aims to ensure adequate daily cortisol levels, management of stressful situations/acute illness, avoiding over replacement. Alert dogs are currently used to support patients with hypoglycaemia unawareness. Recent reported international studies of alert dogs in primary and secondary ACTH deficiency is limited. These studies have produced some evidence to suggest that dogs can be trained to detect low cortisol. Further investigation is essential to establish the importance of the use of alert dogs. This case study seeks to establish how an alert dog can have an impact on optimising ACTH deficiency and improve patient outcomes.
Methods: We studied one patient and her dog, which is being trained using Pavlovian conditioning to alert the patient to low cortisol levels. To ensure that subjective issues could be discussed, the patient was interviewed using a mix of open and rating scale questions. The previous results of dynamic testing were compared with those collected during the investigation with the alert dog.
Results: The Hydrocortisone Day Curve (HCDC) results collected during the study demonstrate that the patient requirement for hydrocortisone is less. In the previous HCDC requirement was 30 mg (15-10-5) and subsequent HCDC demonstrated a reduction to 25 mg (10-10-5). The dog alerted the patient each time when her cortisol levels went below 180 nmol/l. The questionnaire showed multiple benefits of having an alert dog. This includes enhanced levels of independence, confidence and well-being.
Conclusion/Discussion: Preliminary data suggests that an alert dog can successfully be trained to detect low cortisol levels. Patients ability to manage steroid requirements is optimized; quality of life demonstrates significant improvement. Further investigation includes single-centre study or multi-centre. There are limitations to this study.