Hormonal failure in cats: a list of possible diseases leading to a violation (symptoms, treatment). Cushing's disease in cats Treatment is carried out in three directions

Cushing's syndrome in animals is called an endocrine pathology, which develops as a result of a violation of the combined activity of the pituitary and adrenal glands. This leads to increased production of adrenal hormones and the development of hypercortisolism. Most often, aging dogs and cats face the disease.

The reasons

As a rule, increased synthesis of adrenal hormones (cortisol and hydrocortisone) is associated with damage to brain structures such as the hypothalamus or pituitary gland. Also, the cause of the formation of this syndrome may be the pathology of the adrenal cortex itself. We are talking, for example, about hormone-dependent tumors of this organ.

Disease pathogenesis

Normally, the synthesis of cortisol and hydrocortisone is regulated by the hypothalamus and pituitary adrenocorticotropic hormone. The hypothalamus produces corticoliberin. This substance is responsible for stimulating the formation and release of adrenocorticotropic hormone. As a result of an increase in the synthesis of this hormone, a bilateral growth of the adrenal cortex develops. This is manifested by an increase in the production of corticosteroids. With an increase in the level of cortisol in the blood, there is an increase in insulin production and excessive formation of adipose tissue. Therefore, we can assume that the development of Cushing's syndrome in dogs and cats is based on a disorder of fat metabolism. There is also damage to the skin and bone apparatus. This is accompanied by the development of osteoporosis.

An increase in the content of corticosteroids leads to an acceleration of the formation of active forms of vitamin D. As a result, the absorption of calcium from feed is reduced. In this case, the bones are poorly saturated with calcium and other minerals. This leads to the development of osteomalacia and osteoporosis. It is also possible to form calcium kidney stones. This is due to a violation of its excretion from the body. Also at the heart of the development of this syndrome is a decrease in potassium levels and subsequent muscle weakness.

Clinical picture of the disease

In most cases, Cushing's syndrome in animals is manifested by obesity, skin pathology and muscle weakness. As a rule, the localization of fat deposits are the thighs, the subcutaneous layer of the abdomen, the shoulder girdle, the sacro-lumbar region. There is thinning and hyperpigmentation of the skin. It is also possible her pustular lesion. The weakening of muscle tone is characteristic. In sick dogs and cats, curved limbs and spine are detected. The tendency to frequent fractures of the ribs and tubular bones is also determined. The radiographic sign of this pathology is the phenomenon of osteoporosis.

Diagnostics

A blood test reveals a decrease in the level of lymphocytes and eosinophils. The potassium content is also reduced. To confirm the diagnosis, it is planned to study the level of corticosteroids and adrenocorticotropic hormone.

Treatment of the disease

The main goal of treatment is to optimize the production of adrenal and pituitary hormones. Hormone-dependent tumors are subject to removal. As drug therapy, drugs are used that suppress the secretion of cortisol and adrenocorticotropic hormone. We are talking about bromocriptine, hydrochloride, etc.

To optimize bone metabolism, calcium absorption from the intestinal wall is improved. For this, derivatives of vitamin D3 (oxidevit) are used. To increase the level of calcium in the bone apparatus, drugs with fluorotridine and osein are prescribed. The main indication for their use is osteoporosis.

Endocrine diseases in cats are relatively rare. However, there are some of the most common:

Diabetes

hyperthyroidism

Obesity

Itsenko-Cushing syndrome

Hypothyroidism

Diabetes

It is characterized by a violation of carbohydrate metabolism caused by insufficient production of the pancreatic hormone - insulin.

Diabetes is the most common endocrine disease in cats. The saddest thing is that by the time obvious symptoms appear, the disease often progresses, sometimes to such an extent that all insulin reserves in the body are already depleted.

What happens in diabetes?

The formation of carbohydrates is increased, and their absorption by the cells of the body is impaired, which leads to an increase in sugar in the blood and tissues, and this, in turn, causes the destruction of pancreatic cells and a decrease in insulin production. Thus, a vicious circle is created that aggravates the course of the disease. All these changes lead to an increased breakdown of proteins and a decrease in their synthesis. Gradually, not only carbohydrate and protein metabolism is disturbed, but also fat, water and mineral metabolism.

The reasons that can give impetus to the development of the disease are as follows: metabolic disorders, any infectious processes, injuries of the pancreas or its changes - inflammation, atrophy (reduction in size and dysfunction), sclerosis (replacement of the glandular connective tissue), hereditary predisposition.

Symptoms. As a rule, the first signs of the disease appear a month and a half before the bright clinical manifestations of diabetes mellitus - the cat consumes a lot of liquid, urination becomes more frequent, the amount of daily urine increases. It is characteristic that urine does not have its own specific smell, it becomes lighter. As the disease progresses, the animal's well-being deteriorates sharply: the cat refuses to eat, the general condition is depressed, and asthenia develops. Sometimes there is a single vomiting, but it can become more frequent if you continue to try to feed the animal. At this stage of the disease, the smell of acetone appears from the mouth.

Treatment.

Prescribed drugs that lower blood sugar:

short, medium, long-acting insulin is administered;

drugs for oral administration;

The choice of the drug, its dosage, method and frequency of administration depends on the general condition of the animal and the level of sugar in the blood.

hyperthyroidism

It is characterized by increased thyroid function. It is the second most common endocrine disease in cats.

Cats of all breeds, both females and males, and at any age can get sick with hyperthyroidism. However, the most susceptible to this disease are animals older than 9-10 years on average. It has been observed that Siamese and Himalayan cat breeds are less prone to hyperthyroidism.

What happens in hyperthyroidism?

The main function of thyroid hormones is to regulate metabolism (the speed of cells) in the body, and their excessive production leads to the fact that all processes in organs and tissues occur faster.

The reasons. The most common is an adenoma (benign tumor of the thyroid gland). Somewhat less often, adenocarcinoma (a malignant tumor) can become the cause that triggers the development of hyperthyroidism. An important role in the development of the disease is given to an increased content of iodine in feed, a certain habitat, and the harmful effects of insecticides, herbicides, and fertilizers.

Symptoms. The animal is losing weight despite eating well. The cat's hair may partially fall out, she drinks a lot, strives to be in cool places. The animal is overly active, but gets tired quickly. There is an increase in the amount of daily urine, sometimes there is diarrhea and / or vomiting.

Treatment is carried out in three directions:

surgical removal of the thyroid gland;

the appointment of drugs that block the excessive production of thyroxine (thyroid hormone);

radioactive iodine treatment - a drug is administered that accumulates in the thyroid gland and destroys tissue with increased function;

Obesity

It is quite widespread among cats, it affects about 40% of pets. The disease is characterized by excessive deposition of fat. The most prone to obesity are cats of the Persian and British breeds.

The causes of obesity are numerous. First of all, they lie in the malnutrition of the animal, the passion for delicacies with a sedentary lifestyle. In second place are any endocrine disorders (hypothyroidism, hormonal changes after castration or sterilization), chronic diseases (arthritis), taking certain medications (glucocorticoids). In addition, there are predisposing factors - old age, stressful situations, heredity.

Symptoms generally depend on the degree of obesity. However, most often the disease manifests itself as follows:

the animal's stomach sags, a characteristic waddle gait appears, pronounced fat deposits on the hips are visible;

the cat is lethargic and drowsy, it is difficult for her to jump;

Treatment includes eliminating the cause that led to the development of obesity, prescribing a balanced diet (reducing the portion size and amount of carbohydrates, eliminating fats) and increasing energy expenditure by increasing physical activity.

Itsenko-Cushing syndrome

It is characterized by increased function of the adrenal cortex. The prevalence in cats is low.

The disease proceeds in the form of two syndromes - primary (the pathological process develops in the adrenal cortex) and secondary (the function of brain structures that control the work of the adrenal cortex is impaired). The last option is the most common.

The reasons for which Itsenko-Cushing's syndrome can develop are not so numerous, they include damage to the adrenal cortex and the hypothalamic-pituitary system (it controls the production of hormones by the adrenal cortex and is located in the brain). It can be tumors (adenoma), injuries. In addition, the impetus for the development of the disease can be given by the intake of certain medications, for example, glucocorticoids.

Symptoms. There is a redistribution of fat - excessive deposition of adipose tissue in certain places (stomach). The skin is dry to the touch, it can be easily injured, it has areas of hyperpigmentation. Muscle tone decreases, hair falls out. The animal has increased thirst and increased urination. The cat has a hard time with physical activity.

Treatment carried out in two directions: 1) surgical removal of the tumor; 2) the appointment of drugs that suppress excessive function of the adrenal glands.

Hypothyroidism

A disease of the thyroid gland, characterized by a decrease in its function. It is extremely rare in cats. With hypothyroidism, all metabolic processes in the body slow down.

The reasons. The most common cause is removal of the thyroid gland or radiation therapy for hyperthyroidism. In addition, hypothyroidism can be caused by insufficient intake of iodine in the body with food. Sometimes the disease is congenital - there is an underdevelopment of the thyroid gland, or a congenital insufficient production of thyroxine

Symptoms varied and appear gradually. A sick animal becomes lethargic, drowsy, quickly gets tired. Due to the fact that metabolic processes are slowed down (heat transfer exceeds heat production), the cat's body temperature decreases, it is constantly looking for warmer places. As the disease progresses, the animal's coat becomes dull and falls out on almost the entire surface of the skin (alopecia totalis). The skin becomes cold and tight to the touch, and edematous in appearance. The animal is gaining weight.

Treatment consists in the appointment of drugs containing thyroid hormone.

annotation
Hyperadrenocorticism in cats is a disease that, just like in dogs, in humans is associated with excessive levels of
glucocorticoids in the blood, caused by a hormone-secreting tumor of the pituitary or adrenal glands. Development mechanism
disease is similar to Cushing's syndrome in dogs, but in cats this disease is much less common, its diagnosis
is more complex, response to therapy is less predictable, and the prognosis is more cautious and often unfavorable. Classic
symptoms characteristic of dogs, such as polydipsia-polyuria and symmetric non-inflammatory alopecia, are not
dominant in cats. The absence in most cases of a significant increase in alkaline phosphatase, so characteristic
for dogs, makes our initial suspicions more difficult, since the more characteristic complaints from owners would be bad
controlled diabetes mellitus, and possibly skin fragility syndrome.

Summary
Hyperadrenocorticism in cats is disease, which causes by excessive levels of glucocorticoids in blood, which produce by hormone-secreting
tumour of pituitary, or adrenal glands. In feline species, the mechanism of development is similar to dogs, but this disease occurs
less frequently. Diagnostics of Cushing's syndrome in cats is more complicated; response on therapy is less predictable, and prognosis
is more cautious. Classical symptoms, which are specific for dogs, like polyuria/ polidypsia, symetrical, non-inflammatory alopecia are not
dominate in cats. More frequent compliances of cats" owners, are uncompensative diabetes mellitus, sometimes, skin fragility. Increase
of alkaline phosphatase is not typical in cats, like in dogs, that's why, our primary suspicions are complicated.

Occurrence
Hyperadrenocorticism (HAC) in cats is a rare pathology, in the literature one can find publications on isolated cases.
HAC in cats. To date, just over one hundred cases of GAC have been described in cats, confirmed by a characteristic clinical picture, the results of dynamic tests and imaging studies. Cats of middle and advanced age are ill, more often - elderly. In publications, the age of cats with HAK ranged from 3 to 17 years. No breed or sex predisposition was noted. Just like in dogs, in cats, in 85% of cases, pituitary HAC is observed, caused in most cases by pituitary adenoma, in 15% - ad-
renal HAK, more often caused by unilateral neoplasm of the adrenal glands. With a long course of pituitary HAC, a bilateral increase in both adrenal glands can be observed, caused by excessive stimulation of ACTH produced by adeno-
pituitary noma.

Clinical picture
HAC in cats is rarely detected at the onset of the disease. As a rule, clinically ill animals with signs of decompensated diabetes mellitus are admitted. Polydipsia-polyuria (PD-PU) is more pronounced in animals with concurrent diabetes mellitus, and as it stabilizes, the symptoms of PD-PU decrease, while polyphagy may persist regardless of glucose stability in diabetic patients. A characteristic feature of Cushingoid cats, even against the background of increased appetite, is weight loss, regardless of the presence or absence of diabetes mellitus (and its compensation), which is associated with the catabolic effect of excess steroids. Weight loss against the background of insulin resistant diabetes mellitus is one of the important differential signs, since in acromegaly, another endocrine disease that causes insulin resistance, the weight of animals does not decrease, even increases with increasing insulin dose and compensating for diabetes mellitus. The next characteristic symptom of HAC in dogs is symmetrical non-inflammatory alopecia, but this is not characteristic of cats. In cats, non-growth of hair after shearing, alopecia in the tail area (“rat's tail”), in the withers area can be observed.
A more characteristic symptom is thinning and fragility of the skin as a direct consequence of excess steroids. fragility syndrome
skin is well known in humans and cats with HAC, but is not common in dogs. In dogs, HAC may be accompanied by the formation of skin calcifications, which, to date, has not been described in cats.
Ear tip drooping, associated with decreased strength of the ear cartilage due to excessive iatrogenic steroid intake, is uncommon in cats suffering from spontaneous OAC. In addition to HAC, the occurrence of skin fragility syndrome in
cats with diabetes mellitus (however, the author has never observed this syndrome in diabetic cats).
When using steroids or progestogens, fragility syndrome may also occur.
skin. It has been described in cats with severe liver disease: hepatolipidosis, cholangiohepatitis, and, in addition, cholangiocarcinoma.
Fragile skin syndrome has been described in cats with dysautonomia and nephrosis. Sometimes it fails to install
relationship with a particular disease, and speak of idiopathic skin fragility syndrome.
From dermatological signs, general neglect, disheveledness, dullness of the skin, seborrhea, secondary infection with bacterial and fungal microflora can be observed,

If you have at least some understanding of medicine, then you almost certainly know what danger hormonal disorders bring with them. Even in a first-class clinic, it is far from always possible to hope for improvement. Unfortunately, a complete cure is often out of the question. Alas, these misfortunes also did not pass our pets. There is such a Cushing's syndrome in cats, which we will consider in the framework of this article.

This is the name of an extremely rare pathology that occurs when the adrenal glands of an animal produce an excessive amount of cortisol. An excess of this hormone causes complex consequences, among which the most prominent are:

• Severe behavioral changes. In this case, for the time being, a complacent cat can even rush at its owners!

• Severe weakness, apathy.

Important! In cats, this pathology is less common than in dogs, but its consequences are much more severe, and this disease can be treated much worse. But that's no reason to give up without a fight!

What causes this syndrome?

Read also: Dermatophytes in cats: ways of infection, diagnosis and treatment

However, in the latter case, the cat will die faster from functional disorders in the liver, so there will simply be no time left for the development of the syndrome. Another theory is the genetic predisposition of some animals. Given the extreme rarity of this pathology, the assumption may well be correct.

Are we healing or hurting?

No matter how much doctors and veterinarians talk about the dangers of uncontrolled use of hormonal drugs, a rare animal owner listens to them. Everyone imagines themselves to be at least Parcels, and therefore easily and naturally follow the advice of "specialists" from the Internet. “Treat” a cat with hormonal ointment from a pharmacy? Yes Easy! But then you don’t need to be surprised that your pet has “something wrong” with health.

As you might have guessed, problems with the pituitary gland may well be provoked precisely by the uncontrolled use of various “drugs” without the appointment of a veterinarian. A particular danger of hormonal disorders of this class is that they do not develop suddenly and far from immediately. Having "treated" your cat's eyes with hormonal drops a couple of years ago, you will in no way connect Cushing's disease in cats with this fact. And the veterinarian will only be tormented by guesses about what specifically caused the onset of the disease in this particular case.

natural causes

But maybe you shouldn't blame yourself? There are many cases when this pathology manifests itself for quite natural reasons! True, this applies exclusively to animals of middle and old age. What is it connected with? The fact is that a ten-year-old cat, translated into human chronology, is a deep old woman. And old people, as you know, very often suffer from oncology.

Read also: Deafness in cats - causes and signs of hearing loss

So, the variant of the appearance of a tumor (quite possibly, even benign) near the pituitary gland is not excluded. Compression of this organ can lead to various consequences, among which is Cushing's syndrome.

How is it manifested?

In principle, we have already described some of the symptoms at the very beginning of the article, but now it is time to talk about them in more detail. You should be especially alert if your pet exhibits the following:

• The cat is constantly drinking and pissing.

• At the same time, the animal shows a brutal appetite, but its mass remains the same, although the stomach grows. Of course, this can be attributed to pregnancy, but if you have a cat, it is still unlikely ...

• Over time, the cat loses mobility, her muscles become weak and flabby.

• The condition of the coat is constantly deteriorating: it becomes thin and brittle, and the skin loses its elasticity. The latter symptom is so serious that in some animals, deep abrasions and cracks form at the slightest mechanical impact.

Please note that the combination of all these symptoms

Cushing's syndrome is an endocrine disease caused by impaired function of the combined dysfunction of the pituitary and adrenal glands and the system of their relationship with the predominance of hypercortisolism. The disease is more common in aging animals, and since dogs and cats live longer than other species, the pathology occurs more often in them.

Etiology. Hypercortisolism - excessive secretion (increased synthesis of cortisol and hydrocortisone) occurs due to damage to the hypothalamus and pituitary gland or directly to the adrenal cortex. In the vast majority of cases, spontaneous hypercortisolism in dogs occurs as a result of hyperstimulation of the adrenal cortex due to excessive production of ACTH in the pituitary gland, and this occurs with pituitary adenoma and excessive ACTH. In addition, the cause of hypercortisolism can be a hormonally active tumor of the adrenal cortex - glucosteroma: a benign tumor is small, a malignant tumor is large, thus increasing the amount of glandular tissue that produces hormones.

Pathogenesis. The synthesis of glucocorticoids (cortisol, hydrocortisone, etc.) by the adrenal cortex occurs under the control of the hypothalamus and adrenocorticotropic hormone (ACTH) of the pituitary gland. Corticoliberin. synthesized in the hypothalamus, stimulates the formation and release of ACTH. Increased synthesis of ACTH leads to bilateral hyperplasia of the adrenal cortex, an increase in the synthesis of corticosteroids, primarily cortisol. Cortisol itself affects the formation of ACTH and corticoliberin. With hypertrophy or adenoma of the hypothalamus or pituitary gland, the secretion of corticoliberin and ACTH increases, and the concentration of cortisol in the blood increases. With adenoma (glucosteroma) of a benign or malignant adrenal cortex, the secretion of glucocorticoids also increases. Hypersecretion of cortisol is accompanied by an increase in insulin secretion, stimulation of glycogenesis with excessive formation of adipose tissue. Violation of fat metabolism is considered one of the main pathogenetic links of hypercortisolism and, in particular, glucosteroma. There comes a violation of protein metabolism, nutrition of the skin, its defeat. With Cushing's syndrome, deep dystrophic processes develop in the bone tissue, ending in osteoporosis.

Glucocorticoids inhibit the processes of hydroxylation of calciferol, converting it into active forms of vitamin D, which leads to a decrease in the absorption of calcium from feed. At the same time, there is an increase in urinary excretion of calcium, a decrease in the content of organic matter in bone tissue (collagen, mucopolysaccharides), a decrease in alkaline phosphatase activity, and poor saturation of the skeleton with calcium and other mineral elements. Osteomalacia and osteoporosis develop. Violation of calcium excretion by the kidneys can lead to nephrocalcinosis, the formation of kidney stones and the appearance of pyelonephritis. Glucocorticoids contribute to the retention of sodium in the body and the acceleration of potassium excretion, the development of hypokalemia and muscle weakness.

Symptoms. The leading place in the symptoms of the disease is occupied by obesity or redistribution of fat, skin lesions and muscle weakness. In most cases, the disease manifests itself in excessive deposition of adipose tissue in certain areas of the body - in the subcutaneous layer of the abdomen, shoulder girdle, sacro-lumbar region, and thighs. The skin is dry, thinned and easily injured, hyperpigmented, cold to the touch, pyoderma (pustular lesions) is observed in the corners of the lips and other areas, and bedsores in the places of protrusions. The hairline is sparse, with patches of alopecia. Muscle tone is weakened (myopathy). Sick animals show signs of osteoporosis (curvature of the limbs, spine, fracture of the ribs, tubular bones, etc.). The general condition is depressive, the animals are indifferent to the environment. X-rays reveal osteoporosis of the ribs, tubular bones.

diagnostic criteria. Selective sites of fat deposition. Characteristic changes in the skin and hairline (thinning, dryness, hyperpigmentation, cold snap, alopecia, etc.). Muscle weakness (myopathy). Signs of osteodystrophy with a predominance of symptoms of osteoporosis, the presence of bone fractures.

Laboratory in the blood establish lymphocytopenia, eosinopenia, neutrophilic leukocytosis, hypokalemia (below 16 mg / 100 ml, 4.10 mmol / l). Confirmation of the diagnosis is an increase in the blood content of ACTH and corticosteroids (cortisol). Find characteristic pathomorphological changes in the hypothalamus, pituitary gland and adrenal cortex. On radiographs of the bone, lesions characteristic of osteomalacia and osteoporosis are established. It is possible to use the results of an adrenal scan.

In differential diagnosis, hypocorticism and other endocrine diseases are meant.

Treatment. Treatment is aimed at normalizing the production of ACTH and cortisol, restoring metabolic processes in bone tissue, correcting the function of the cardiovascular system, kidneys and other organs. Normalization of the production of ACTH and cortisol is achieved by removing tumors in the hypothalamus, pituitary gland or adrenal glands and using the drug method.

The drug method of treatment includes the use of drugs that suppress the secretion of ACTH and cortisol: chloditan (mitotane), bromocreptine, cyproheptadine hydrochloride, etc.

Chloditan (mitotane) is an inhibitor of the function of the adrenal cortex. Suppresses the secretion of corticosteroids, blocks the steroid action of ACTH, can cause destructive changes in normal and tumor tissue of the adrenal glands. Give inside to dogs at a dose of 25 mg / kg 2-3 times a day for 2-3 weeks until cortisol in the blood decreases to a level of 50-100 nmol / l. Then switch to a dose of 50 mg / kg (once a week). Monitor the health of the animal. The drug is produced in tablets of 0.5 g.

Bromokreptin (parlodel, bromergon, pravidel) - a synthetic activator of defomin receptors, suppresses the secretion of the hormone of the anterior pituitary gland prolactin, reduces the secretion of ACTH, suppresses physiological lactation. The drug for Cushing's syndrome is given to dogs and cats at first in a daily dose (approximately 0.1 mg / kg of body weight), then the dose is halved and after 2-3 weeks a maintenance therapeutic dose of 0.05 mg / kg is prescribed. The course of treatment is 6-8 weeks.

Cyproheptadine hydrochloride (peritol, adekin, cyprodine, etc.) has antihistamine (blockade of H[-receptors), antiserotonin (blockade of S-receptors) and anticholinergic (blockade of M-cholinergic receptors) action. Inhibits the biosynthesis of somatotropin and ACTH, enhances the secretion of the pancreatic gland. Used for many allergic reactions, Cushing's syndrome, pancreatitis. Produced in the form of tablets of 4 mg, syrup in vials of 100 ml (in 1 ml of the drug 0.4 mg). Assign inside to horses, cattle at a dose of 0.04-0.06 mg / kg, sheep, goats and pigs - 0.07-0.08 mg / kg, dogs - 0.09-0.1 mg / kg 3 times a day. day. The course of treatment is 2-4 weeks.

Ketoconazole (oranozol, nizoral, fungoral) is an antimycotic drug (Krka, Slovenia). Produced in tablets of 200 mg. It is indicated for Cushing's syndrome in dogs due to the fact that the disease is accompanied by skin lesions, possibly of fungal origin. Dogs are administered orally at a dose of 10 mg/kg during the first week, 20 mg/kg during the second week, 30 mg/kg during the third week 2 times a day.

With pituitary adenoma, which provokes Cushing's syndrome in dogs, N. Grange (2005), in addition to the use of dexamethasone and imitotone, used the method of radiotherapy using an electronic accelerator; total dose 36 Gy.

Normalization of bone metabolism is achieved to a certain extent by improving the absorption of calcium from the intestine, fixing it with a bone matrix, and restoring the organic component of bone tissue.

Derivatives of vitamin D3, in particular oksidevit or a-DrTeBa preparation, or fat- or water-soluble vitamin D preparations, contribute to an increase in calcium absorption. vitamin D - orally at a dose of 500 IU / kg of body weight.

Perhaps the use of drugs containing fluorotridine, osein. Tridin in the form of tablets is manufactured by Rotta-karm. One tablet contains 150 mg of calcium ions (in the form of calcium gluconate and citrate), 5 mg of fluoride ions (in the form of L-glutamine monofluorophosphate). The drug is designed to compensate for calcium deficiency and fix it in the bone tissue. In medicine, it is indicated for primary osteoporosis. Contraindicated in osteomalacia, impaired renal function, during growth, pregnancy, lactation, hypercalcemia and hypercalciuria.

Osein (Corberon) is a drug, 1 tablet of which contains 20 mg of sodium fluoride. In medicine, it is prescribed orally to normalize bone metabolism, correct the imbalance between the growth and resorption of bone tissue, and reduce bone fragility. Used in individual doses for a long time. Contraindications are the same as for tridine. Supplied from Germany.

Surgical treatment consists in removing a tumor of the pituitary or hypothalamus, one or even two affected adrenal glands. In these cases, postoperative treatment with the means indicated above is carried out.