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Issue 135 Spring 2020

Endocrinologist > Spring 2020 > Nurses' News

Cortisol alert dog: improving patient outcomes?

Helen Loo | Nurses' News

Helen receiving the Annette Louise Seal Memorial Award from the Addison’s Disease Self-Help Group at SfE BES 2019, alongside (far left) Dr Helen Turner (Consultant Endocrinologist, Oxford Centre for Diabetes, Endocrinology and Metabolism). ©H Loo

Helen receiving the Annette Louise Seal Memorial Award from the Addison’s Disease Self-Help Group at SfE BES 2019, alongside (far left) Dr Helen Turner (Consultant Endocrinologist, Oxford Centre for Diabetes, Endocrinology and Metabolism). ©H Loo

Often hailed as a human’s best friend, dogs have been the topic of many scientific studies looking into how they might boost our well-being.

I am fortunate to work within a highly specialised team where current evidence is applied to practice and where we aspire to an innovative clinical approach. The phenomenon of medical alert assistance dogs came to my attention while I was caring for a patient with actual/imminent multiple adrenal crises. This experience formed the basis of a poster which I presented at the recent Society for Endocrinology BES conference,1 where I was delighted to be awarded the Annette Louise Seal Memorial Award from the Addison’s Disease Self-Help Group.


The charity Medical Detection Dogs2 defines what a medical alert assistance dog does and how it works, as follows.

‘Our dogs are trained to alert someone to an impending episode, and allow the person to take preventative medication or safety measures, to either prevent the episode or limit its effects. In order for a dog to alert a person, we must be confident that a chemical process has happened and triggered an odour change in the person that the dog can detect.

‘Whilst we acknowledge that a dog also brings about other health benefits, such as companionship, reduced blood pressure and reduced anxiety, evidence shows that medical alert assistance dogs reduce severity of episodes, as well as reducing injuries and visits to hospital.

‘They are not trained as emotional support dogs, to provide companionship, friendship and emotional comfort for mental health conditions and, therefore, will not be placed with people who have a predominantly psychological illness.

‘Our medical alert assistance dogs are accredited by ADUK (Assistance Dogs UK), working under the umbrella of Assistance Dogs International. Any dog that carries the ADUK badge on its jacket has been shown to meet international standards for obedience and public access requirements, as well as accuracy and reliability for its specific role. These qualities are assessed every year to ensure that the dog and its handler (your patient) continue to meet these high standards.

‘Dogs have an amazing sense of smell, with over 300 million olfactory cells compared to just 5 million cells in humans. We know that changes in the health status of humans can lead to a change in odour, and dogs, with their exceptional sense of smell, are able to detect these minute changes. Evidence now shows that dogs can detect traces of particular types of cancer, low blood glucose levels and types of bacteria from a range of samples, by detecting the distinct change in odour.’

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In Addison’s 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, including stressful situations/acute illness, while avoiding over-replacement.

As mentioned above, dogs are currently used to support patients with hypoglycaemia unawareness. Recent, reported, international studies of equivalent dogs in primary and secondary adrenocorticotrophic hormone (ACTH) deficiency are limited. 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 such dogs.

In the case study we reported at the Society for Endocrinology BES conference 2019, we sought to establish how a medical alert assistance dog could have an impact on optimising ACTH deficiency and improve patient outcomes. We studied one patient and her dog, which was 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 mixture of open and rating scale questions. The previous results of dynamic testing were compared with those collected during the investigation with the medical alert assistance dog.

The questionnaire showed multiple benefits of having this type of dog. These include enhanced levels of independence, confidence, calmness and well-being. In the patient’s words, ‘the increased confidence I felt in not missing low cortisol levels made me feel less scared to be on my own and that I’m not taking too much cortisol’.

Preliminary data suggested that a medical alert assistance dog can be successfully trained to detect low cortisol levels. The patient’s ability to manage steroid requirements was optimised; her quality of life demonstrated significant improvement.

As an Endocrine Specialist Nurse, this has greatly motivated me, as I have seen the positive impact on patient care and outcomes for this rare, specialist group of patients. I am excited about the future developments and research, which we plan to direct from Oxford, and which the Addison’s Disease Self-Help Group and the charity Medical Detection Dogs are keen to support.

Helen Loo, Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford


  1. Medical Detection Dogs 2020
  2. Loo HM et al. 2019 Endocrine Abstracts 65 P338


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