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Da Silva AJ, Gunn E, Ramos PJG, Shiel RE, Bree L, Mooney CT. Comparison between typical primary and eunatraemic, eukalaemic hypoadrenocorticism: 92 cases. Ir Vet J 2024; 77:18. [PMID: 39342294 PMCID: PMC11439219 DOI: 10.1186/s13620-024-00280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Naturally occurring hypoadrenocorticism is an uncommon endocrine disorder in dogs but has significant morbidity and mortality. Some dogs present with apparent glucocorticoid deficiency alone as evidenced by eunatraemia and eukalaemia. Few studies have compared dogs with hypoadrenocorticism with or without electrolyte disturbances and there are no large case series of affected dogs from Ireland. METHODS Retrospective observational study. RESULTS Ninety-two cases diagnosed with hypoadrenocorticism subdivided into those with supportive electrolyte disturbances (Group 1; n = 72) and those without (Group 2; n = 20). Dogs in Group 1 were significantly (p = 0.001) younger (4.0 (3.0-6.0) years) than dogs in Group 2 (6.0 (4.75-8.25) years). Dogs in Group 1 presented significantly more commonly with vomiting (Group 1: 52/71 (73.2%), Group 2: 6/20 (30.0%); p < 0.001), total hyperproteinaemia (Group 1: 21/71 (29.6%), Group 2: 1/20 (5.0%); p = 0.023), increased urea (Group 1: 52/72 (72.2%), Group 2: 5/20 (25.0%); p < 0.001), increased creatinine (Group 1: 31/72 (43.1%), Group 2: 3/20 (15.0%); p = 0.021) and hyperphosphataemia (Group 1: 40/71 (56.3%), Group 2: 2/20 (10.0%); p < 0.001), and significantly less commonly with reticulocytosis (Group 1: 4/38 (10.5%), Group 2: 5/13 (38.5%), p = 0.023). An undetectable basal aldosterone concentration had a positive predictive value of 94.3% for diagnosing undetectable post-ACTH aldosterone concentration. Of the thirteen dogs in Group 2 that had aldosterone concentrations measured and secondary disease excluded, 7 (53.8%) had or subsequently developed evidence of aldosterone deficiency, although not always with electrolyte abnormalities. CONCLUSIONS Dogs with hypoadrenocorticism from Ireland are similar to other reported cases. An undetectable basal aldosterone concentration is highly predictive of mineralocorticoid deficiency. Dogs with apparent glucocorticoid deficiency alone can progress to more typical disease and should be monitored appropriately.
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Affiliation(s)
| | - Eilidh Gunn
- North Downs Specialist referrals, Bletchingley, UK
| | | | | | - Laura Bree
- London Veterinary Specialists, London, UK
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Del Baldo F, Corsini A, Tardo AM, Tirolo A, Sapignoli A, Tumbarello M, Vasylyeva K, Fracassi F. Hypothalamic-pituitary-adrenal axis recovery after intermediate-acting glucocorticoid treatment in client-owned dogs. J Vet Intern Med 2024; 38:942-950. [PMID: 38321784 PMCID: PMC10937487 DOI: 10.1111/jvim.16979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In dogs, duration of hypothalamic-pituitary-adrenal (HPA) axis suppression after systemic glucocorticoid treatment is reported to vary from a few days to up to 7 weeks after glucocorticoid discontinuation. These data are derived mainly from experimental studies in healthy dogs and not from animals with spontaneous disease. HYPOTHESIS AND OBJECTIVE To determine the timeline for recovery of the HPA axis in a group of ill dogs treated with intermediate-acting glucocorticoids (IAGCs). ANIMALS Twenty client-owned dogs that received IAGC for at least 1 week. METHODS Single-center prospective observational study. An ACTH stimulation test, endogenous ACTH concentration, serum biochemistry profile, and urinalysis were performed at T0 (2-6 days after IAGC discontinuation) and then every 2 weeks (eg, T1, T2, T3) until HPA axis recovery was documented (post-ACTH cortisol concentration > 6 μg/dL). RESULTS The median time of HPA axis recovery was 3 days (range, 2-133 days). Eleven of 20 dogs showed recovery of the HPA axis at T0, 6/20 at T1, and 1 dog each at T2, T5, and T9. Dose and duration of treatment were not correlated with timing of HPA axis recovery. Activities of ALT and ALP were significantly correlated with the post-ACTH cortisol concentration (rs = -0.34, P = .03; rs = -0.31, P = .05). Endogenous ACTH concentration was significantly correlated with pre (r = 0.72; P < .0001) and post-ACTH cortisol concentrations (r = 0.35; P = .02). The timing of HPA axis recovery of the dogs undergoing an alternate-day tapering dose was not different compared to dogs that did not (3.5 vs 3 days, P = .89). CONCLUSION AND CLINICAL IMPORTANCE Most dogs experienced HPA axis recovery within a few days after IAGC discontinuation. However, 2/20 dogs required >8 weeks.
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Affiliation(s)
- Francesca Del Baldo
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Andrea Corsini
- Department of Veterinary Medical SciencesUniversity of ParmaParmaItaly
| | - Antonio Maria Tardo
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Alessandro Tirolo
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Ada Sapignoli
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Michele Tumbarello
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Kateryna Vasylyeva
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
| | - Federico Fracassi
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'EmiliaItaly
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3
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Strey S, Mischke R, Rieder J. [Polyendocrine syndromes in dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:313-325. [PMID: 37956663 DOI: 10.1055/a-2183-0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The autoimmune polyendocrine syndrome (APS) refers to a combination of autoimmune endocrine disorders. It is rarely described in dogs. The most common combinations are hypoadrenocorticism and hypothyroidism, followed by diabetes mellitus, and less often hypoparathyroidism and orchitis. The diagnosis of the APS is based on the diagnosis of each endocrinopathy, as is the therapy, which involves the substitution of deficient hormones. If a patient was previously stable under treatment and is showing further signs (e.g. polyuria, polydipsia, or weight loss), the development of additional endocrinopathies like hypoadrenocorticism or diabetes mellitus should be considered. The diagnosis of the initially diagnosed endocrinopathy should also be critically questioned. This article summarizes some cases of our own animal hospital and selected cases published in the available literature.
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Affiliation(s)
- Sina Strey
- Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Hannover
| | - Reinhard Mischke
- Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Hannover
| | - Johanna Rieder
- Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Hannover
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4
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HATOYA S, KANEGI R, NABETANI T, OJI S, IZAWA T, HIRAI S, SUGIURA K. Atypical hypoadrenocorticism with intact zona glomerulosa of the adrenal cortex after long-term observation: a case report of a dog. J Vet Med Sci 2023; 85:9-13. [PMID: 36372430 PMCID: PMC9887220 DOI: 10.1292/jvms.22-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An 8-year-old intact male pointer presented with lethargy and hypoalbuminemia. On abdominal ultrasonography, both adrenal glands were reduced in thickness. Based on the ACTH stimulation test results and the absence of electrolyte abnormalities, the dog was diagnosed with atypical hypoadrenocorticism. After treatment with low-dose prednisolone, his general condition improved, and blood tests normalized. The dog died 818 days later, and a complete autopsy was performed. Histologically, the architecture of the zonae fasciculata and reticularis was disrupted in both adrenal glands; however, the zona glomerulosa remained relatively normal. In summary, in this study, we detailed the pathological presentation of atypical hypoadrenocorticism without electrolyte abnormalities.
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Affiliation(s)
- Shingo HATOYA
- Laboratory of Cell Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Cell Pathobiology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan,Correspondence to: Hatoya S: , Laboratory of Cell Pathobiology, Graduate School of Veterinary
Sciences, Osaka Metropolitan University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Ryoji KANEGI
- Veterinary Medical Center, Osaka Prefecture University, Osaka, Japan,Present address: Veterinary Medical Center, Osaka Metropolitan University, Osaka, Japan
| | - Tomoyo NABETANI
- Veterinary Medical Center, Osaka Prefecture University, Osaka, Japan,Present address: Veterinary Medical Center, Osaka Metropolitan University, Osaka, Japan
| | - Shoko OJI
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Takeshi IZAWA
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Veterinary Pathology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan
| | | | - Kikuya SUGIURA
- Laboratory of Cell Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Cell Pathobiology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan
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5
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Guzmán Ramos PJ, Bennaim M, Shiel RE, Mooney CT. Diagnosis of canine spontaneous hypoadrenocorticism. Canine Med Genet 2022; 9:6. [PMID: 35505424 PMCID: PMC9066729 DOI: 10.1186/s40575-022-00119-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Hypoadrenocorticism is characterized by a reduction in mineralocorticoid and/or glucocorticoid production by the adrenal glands. Several subtypes have been described with different clinical and clinicopathological consequences. Most affected dogs have vague and non-specific signs that precede an eventual life-threatening crisis. This review aims to appraise classification, the available data on epidemiology and the clinical and laboratory features of naturally occurring canine hypoadrenocorticism. Canine hypoadrenocorticism is a relatively uncommon endocrine disease that can present with a wide variety of clinical signs resulting from cortisol or aldosterone deficiency or both. Hypoadrenocorticism should be considered in all dogs with severe illness and typical electrolyte abnormalities but also in those with waxing and waning clinical signs. Multiple clinical and laboratory features are suggestive of the disease and should prompt evaluation of adrenal function. The ACTH stimulation test is the best test for diagnosing hypoadrenocorticism but, in those cases without the typical presentation, evaluation of aldosterone secretory capacity and endogenous ACTH concentrations should be performed to distinguish primary from secondary disease. In this review we discuss the pathophysiology of the disease, the clinical signs and laboratory features that should raise suspicion of hypoadrenocorticism and the performance of the different diagnostic tests.
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Affiliation(s)
- Pedro J Guzmán Ramos
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland.
| | - Michael Bennaim
- Centre Hospitalier Vétérinaire Anicura Aquivet, Eysines, France
| | - Robert E Shiel
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland
| | - Carmel T Mooney
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland
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6
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Hwang SY, An JH, Lee JH, Park SM, Kyu Chae H, Kim KB, Song WJ, Youn HY. Autoimmune polyendocrine syndrome with hypoadrenocorticism and diabetes mellitus in a dog: A rare case. Vet Med Sci 2021; 7:2120-2123. [PMID: 34480407 PMCID: PMC8604114 DOI: 10.1002/vms3.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Autoimmune polyendocrine syndrome, also called polyglandular autoimmune syndrome, is a rare immune-mediated disorder that involves various endocrine glands. PURPOSE To report autoimmune polyendocrine syndrome in a dog. METHODS A 9-year-old spayed female miniature poodle diagnosed with insulin-dependent diabetes mellitus emergently visited our clinic for anorexia, severe depression, and vomiting. Hyponatremia, hypochloridemia, and recurrent hypoglycaemia were found. Hypoadrenocorticism was diagnosed based on consistent clinical signs and repeated adrenocorticotropic hormone stimulation tests. RESULTS After injecting deoxycorticosterone pivalate and increasing the oral prednisolone dose, the patient's systemic condition improved. CONCLUSIONS To the best of our knowledge, this is the first case report of hypoadrenocorticism concurrent with diabetes mellitus in a dog. Furthermore, we would like to present the probability of an immune-mediated disorder with multiple organs involved, like type IV autoimmune polyendocrine syndrome in humans.
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Affiliation(s)
- Seo-Young Hwang
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Ju-Hyun An
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Jeong-Hwa Lee
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Su-Min Park
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Hyung Kyu Chae
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Kyung-Bo Kim
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Woo-Jin Song
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute of Veterinary Science, Jeju National University, Jeju, Republic of Korea
| | - Hwa-Young Youn
- Labolatory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
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7
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Kuijlaars M, Yool DA, Ridyard AE. Autoimmune polyendocrine syndrome in a standard poodle with concurrent non‐endocrine immune‐mediated diseases. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Margaux Kuijlaars
- University of Glasgow Small Animal Hospital, Division of Small Animal Clinical Sciences, School of Veterinary Medicine Glasgow UK
| | - Donald A. Yool
- University of Glasgow Small Animal Hospital, Division of Small Animal Clinical Sciences, School of Veterinary Medicine Glasgow UK
| | - Alison E. Ridyard
- University of Glasgow Small Animal Hospital, Division of Small Animal Clinical Sciences, School of Veterinary Medicine Glasgow UK
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8
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Furukawa S, Meguri N, Koura K, Koura H, Matsuda A. A Case of Canine Polyglandular Deficiency Syndrome with Diabetes Mellitus and Hypoadrenocorticism. Vet Sci 2021; 8:vetsci8030043. [PMID: 33800028 PMCID: PMC8000634 DOI: 10.3390/vetsci8030043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
This report describes the first clinical case, to our knowledge, of a dog with polyglandular deficiency syndrome with diabetes mellitus and hypoadrenocorticism. A six-year-old female Cavalier King Charles Spaniel presented with a history of lethargy and appetite loss. The dog was diagnosed with diabetic ketoacidosis based on hyperglycemia and renal glucose and ketone body loss. The dog’s condition improved on intensive treatment of diabetes mellitus; daily subcutaneous insulin detemir injection maintained an appropriate blood glucose level over half a year. However, the dog’s body weight gradually decreased from day 207, and on day 501, it presented with a decreased appetite; the precise cause could not be determined. Based on mild hyponatremia and hyperkalemia, hypoadrenocorticism was suggested; the diagnosis was made using an adrenocorticotropic hormone stimulation test. Daily fludrocortisone with low-dose prednisolone oral administration resulted in poor recovery of the blood chemistry abnormalities; however, monthly desoxycorticosterone pivalate (DOCP) subcutaneous injection with daily low-dose prednisolone oral administration helped in the significant recovery of the abnormalities. Therefore, clinicians should consider the possibility of coexistence of hypoadrenocorticism in dogs with diabetes mellitus presenting with undifferentiated weight loss. Additionally, DOCP (not fludrocortisone) may be useful in treating dogs with diabetes mellitus complicated with hypoadrenocorticism.
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Affiliation(s)
- Sho Furukawa
- Earth Animal Hospital, 4-3-43 Hokushin-cho, Kitami, Hokkaido 090-0052, Japan; (S.F.); (N.M.); (H.K.)
| | - Natsuko Meguri
- Earth Animal Hospital, 4-3-43 Hokushin-cho, Kitami, Hokkaido 090-0052, Japan; (S.F.); (N.M.); (H.K.)
| | - Kazue Koura
- Bihoro Animal Hospital, 51-8 Aoyamakita, Bihoro, Hokkaido 092-0066, Japan;
| | - Hiroyuki Koura
- Earth Animal Hospital, 4-3-43 Hokushin-cho, Kitami, Hokkaido 090-0052, Japan; (S.F.); (N.M.); (H.K.)
| | - Akira Matsuda
- Earth Animal Hospital, 4-3-43 Hokushin-cho, Kitami, Hokkaido 090-0052, Japan; (S.F.); (N.M.); (H.K.)
- Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari, Ehime 794-8555, Japan
- Correspondence: ; Tel.: +81-898-52-9240
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9
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Reagan KL, Reagan BA, Gilor C. Machine learning algorithm as a diagnostic tool for hypoadrenocorticism in dogs. Domest Anim Endocrinol 2020; 72:106396. [PMID: 32006871 DOI: 10.1016/j.domaniend.2019.106396] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022]
Abstract
Canine hypoadrenocorticism (CHA) is a life-threatening condition that affects approximately 3 of 1,000 dogs. It has a wide array of clinical signs and is known to mimic other disease processes, including kidney and gastrointestinal diseases, creating a diagnostic challenge. Because CHA can be fatal if not appropriately treated, there is risk to the patient if the condition is not diagnosed. However, the prognosis is excellent with appropriate therapy. A major hurdle to diagnosing CHA is the lack of awareness and low index of suspicion. Once suspected, the application and interpretation of conclusive diagnostic tests is relatively straight forward. In this study, machine learning methods were employed to aid in the diagnosis of CHA using routinely collected screening diagnostics (complete blood count and serum chemistry panel). These data were collected for 908 control dogs (suspected to have CHA, but disease ruled out) and 133 dogs with confirmed CHA. A boosted tree algorithm (AdaBoost) was trained with 80% of the collected data, and 20% was then utilized as test data to assess performance. Algorithm learning was demonstrated as the training set was increased from 0 to 600 dogs. The developed algorithm model has a sensitivity of 96.3% (95% CI, 81.7%-99.8%), specificity of 97.2% (95% CI, 93.7%-98.8%), and an area under the receiver operator characteristic curve of 0.994 (95% CI, 0.984-0.999), and it outperforms other screening methods including logistic regression analysis. An easy-to-use graphical interface allows the practitioner to easily implement this technology to screen for CHA leading to improved outcomes for patients and owners.
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Affiliation(s)
- K L Reagan
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Ave, Davis, CA 95616, USA
| | - B A Reagan
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO, USA
| | - C Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA.
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10
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Abstract
There are many autoimmune diseases that are recognized in domestic animals. The descriptions of diseases provide examples of the magnitude of immune targets and the variable nature of autoimmune diseases. Other autoimmune diseases that are recognized in dogs, cats, and horses include immune-mediated thrombocytopenia, VKH (Vogt-Koyanagi-Harada) ocular disease (dogs), and Evans syndrome (which includes both immune-mediated anemia and immune-mediated thrombocytopenia).
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11
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Reusch CE, Fracassi F, Sieber-Ruckstuhl NS, Burkhardt WA, Hofer-Inteeworn N, Schuppisser C, Stirn M, Hofmann-Lehmann R, Boretti FS. Altered Serum Thyrotropin Concentrations in Dogs with Primary Hypoadrenocorticism before and during Treatment. J Vet Intern Med 2017; 31:1643-1648. [PMID: 29024024 PMCID: PMC5697207 DOI: 10.1111/jvim.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/18/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Thyrotropin (TSH) can be increased in humans with primary hypoadrenocorticism (HA) before glucocorticoid treatment. Increase in TSH is a typical finding of primary hypothyroidism and both diseases can occur concurrently (Schmidt's syndrome); therefore, care must be taken in assessing thyroid function in untreated human patients with HA. Objective Evaluate whether alterations in cTSH can be observed in dogs with HA in absence of primary hypothyroidism. Animals Thirty dogs with newly diagnosed HA, and 30 dogs in which HA was suspected but excluded based on a normal ACTH stimulation test (controls) were prospectively enrolled. Methods cTSH and T4 concentrations were determined in all dogs and at selected time points during treatment (prednisolone, fludrocortisone, or DOCP) in dogs with HA. Results cTSH concentrations ranged from 0.01 to 2.6 ng/mL (median 0.29) and were increased in 11/30 dogs with HA; values in controls were all within the reference interval (range: 0.01–0.2 ng/dL; median 0.06). There was no difference in T4 between dogs with increased cTSH (T4 range 1.0‐2.1; median 1.3 μg/dL) compared to those with normal cTSH (T4 range 0.5‐3.4, median 1.4 μg/dL; P=0.69) and controls (T4 range 0.3‐3.8, median 1.8 μg/dL; P=0.35). After starting treatment, cTSH normalized after 2–4 weeks in 9 dogs and after 3 and 4 months in 2 without thyroxine supplementation. Conclusions and Clinical Relevance Evaluation of thyroid function in untreated dogs with HA can lead to misdiagnosis of hypothyroidism; treatment with glucocorticoids for up to 4 months can be necessary to normalize cTSH.
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Affiliation(s)
- C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - F Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - N S Sieber-Ruckstuhl
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - W A Burkhardt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - N Hofer-Inteeworn
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C Schuppisser
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Stirn
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - R Hofmann-Lehmann
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - F S Boretti
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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12
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Doi T, Tomonari Y, Kawasako K, Yamada N, Tsuchitani M. Lymphocytic adrenal medullitis and lymphocytic thyroiditis in a laboratory beagle dog. J Vet Med Sci 2017; 79:255-257. [PMID: 27885217 PMCID: PMC5326927 DOI: 10.1292/jvms.16-0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lymphocytic adrenal medullitis characterized by inflammation and atrophy in the medulla
of the bilateral adrenal glands was observed in an 18-month-old male laboratory beagle
dog. It might be that the present lymphocytic adrenal medullitis is an autoimmune-mediated
disease as the histological characteristics are consistent with an autoimmune
pathogenesis. However, the actual cause remains unclear as the existence of serum
autoantibodies against the adrenal medulla could not be confirmed. Although this dog also
contracted lymphocytic thyroiditis along with serum thyroglobulin autoantibodies,
indicating that the thyroiditis occurred with an autoimmune basis; the relation between
the adrenal medullitis and thyroiditis is unknown.
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Affiliation(s)
- Takuya Doi
- Pathology Department, Kashima Laboratory, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu, Ibaraki 314-0255, Japan
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13
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Cartwright JA, Stone J, Rick M, Dunning MD. Polyglandular endocrinopathy type II (Schmidt's syndrome) in a Dobermann pinscher. J Small Anim Pract 2016; 57:491-4. [DOI: 10.1111/jsap.12535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/11/2015] [Accepted: 12/16/2015] [Indexed: 10/21/2022]
Affiliation(s)
- J. A. Cartwright
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies; The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre; Roslin Midlothian EH25 9RG
| | - J. Stone
- Pride Veterinary Centre; Derbyshire DE24 8HX
| | - M. Rick
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine; Michigan State University; Lansing Michigan MI 48910-8104 USA
| | - M. D. Dunning
- School of Veterinary Medicine and Science; University of Nottingham; Leicestershire NG7 2RD
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14
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Abstract
Hypoadrenocorticism is an uncommon disease in dogs and rare in humans, where it is known as Addison disease (ADD). The disease is characterized by a deficiency in corticosteroid production from the adrenal cortex, requiring lifelong hormone replacement therapy. When compared with humans, the pathogenesis of hypoadrenocorticism in dogs is not well established, although the evidence supports a similar autoimmune etiology of adrenocortical pathology. Several immune response genes have been implicated in determining susceptibility to Addison disease in humans, some of which are shared with other autoimmune syndromes. Indeed, other types of autoimmune disease are common (approximately 50%) in patients affected with ADD. Several lines of evidence suggest a genetic component to the etiology of canine hypoadrenocorticism. Certain dog breeds are overrepresented in epidemiologic studies, reflecting a likely genetic influence, supported by data from pedigree analysis. Molecular genetic studies have identified similar genes and signaling pathways, involved in ADD in humans, to be also associated with susceptibility to canine hypoadrenocorticism. Immune response genes such as the dog leukocyte antigen (DLA) and cytotoxic T-lymphocyte-associated protein 4 (CTLA4) genes seem to be particularly important. It is clear that there are genetic factors involved in determining susceptibility to canine hypoadrenocorticism, although similar to the situation in humans, this is likely to represent a complex genetic disorder.
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Affiliation(s)
- Alisdair M Boag
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Scotland.
| | - Brian Catchpole
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, Hatfield, UK
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15
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Baumstark ME, Sieber-Ruckstuhl NS, Müller C, Wenger M, Boretti FS, Reusch CE. Evaluation of aldosterone concentrations in dogs with hypoadrenocorticism. J Vet Intern Med 2013; 28:154-9. [PMID: 24428320 PMCID: PMC4895548 DOI: 10.1111/jvim.12243] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/29/2013] [Accepted: 09/25/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Some dogs with primary hypoadrenocorticism (HA) have normal sodium and potassium concentrations, a phenomenon called atypical Addison's disease. The assumption that the zona glomerulosa and aldosterone secretion in these dogs are normal seems widely accepted; however, aldosterone measurements are missing in most published cases. OBJECTIVES To measure aldosterone in dogs with HA with and without electrolyte abnormalities and to determine the time point of aldosterone peak concentrations during ACTH stimulation. ANIMALS Seventy dogs with HA, 22 dogs with diseases mimicking HA, and 19 healthy dogs. METHODS Prospective study. Blood samples were taken before and 60 minutes after injection of 250 μg ACTH in all dogs. Additional blood samples were taken 15, 30, and 45 minutes after ACTH in 7 dogs with HA and in 22 with diseases mimicking HA. RESULTS Baseline and ACTH-stimulated aldosterone was significantly lower in dogs with HA than in the other groups. Aldosterone was low or undetectable in 67/70 dogs with HA independently of sodium and potassium levels. In 3 dogs, sodium/potassium concentrations were normal; in 1 dog, sodium was normal and potassium decreased. In all 4, ACTH-stimulated aldosterone concentrations were below the detection limit of the assay. Aldosterone concentrations were not different at 30, 45, or 60 minutes after ACTH administration. CONCLUSION AND CLINICAL IMPORTANCE Cortisol and aldosterone secretion is compromised in dogs with HA with and without electrolyte abnormalities. The term atypical Addison's disease, used for dogs with primary HA and normal electrolytes, must be reconsidered; other mechanisms allowing normal electrolyte balance without aldosterone should be evaluated in these dogs.
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Affiliation(s)
- M E Baumstark
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
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16
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McGonigle KM, Randolph JF, Center SA, Goldstein RE. Mineralocorticoid before glucocorticoid deficiency in a dog with primary hypoadrenocorticism and hypothyroidism. J Am Anim Hosp Assoc 2012; 49:54-7. [PMID: 23033468 DOI: 10.5326/jaaha-ms-5820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A dog with an unexpected presentation of primary hypoadrenocorticism was evaluated for clinical signs and electrolyte abnormalities characteristic of Addison's disease. Although the initial adrenocorticotropic hormone (ACTH) stimulation test documented serum cortisol concentrations within the reference range, subsequent assessments confirmed hypoaldosteronism. Mineralocorticoid replacement promptly normalized electrolytes and transiently improved clinical illness. Six weeks after initial ACTH stimulation testing, the dog became glucocorticoid deficient. Concurrent primary hypothyroidism was also documented. Hypoaldosteronism preceding hypocortisolemia is a unique presentation of canine Addison's disease.
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Affiliation(s)
- Kathryn M McGonigle
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
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17
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Blois SL, Dickie E, Kruth SA, Allen DG. Multiple endocrine diseases in dogs: 35 cases (1996–2009). J Am Vet Med Assoc 2011; 238:1616-21. [DOI: 10.2460/javma.238.12.1616] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Adissu HA, Hamel-Jolette A, Foster RA. Lymphocytic Adenohypophysitis and Adrenalitis in a Dog With Adrenal and Thyroid Atrophy. Vet Pathol 2010; 47:1082-5. [DOI: 10.1177/0300985810382520] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 4.5-year-old spayed female Great Pyrenees with hypothyroidism and hypoadrenocorticism had a slightly enlarged pituitary gland and bilaterally atrophic adrenal and thyroid glands. Lymphocytic adenohypophysitis and adrenalitis were found in which B lymphocytes and plasma cells dominated the adenohypophysitis but T cells dominated the adrenalitis. The thyroid gland had extensive follicular atrophy and collapse. The combination of primary hypothyroidism and hypoadrenocorticism resembles type II autoimmune polyendocrine syndrome or Schmidt syndrome in humans. Adenohypophysitis is rare in dogs and not reported in polyendocrine disease in animals.
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Affiliation(s)
- H. A. Adissu
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - A. Hamel-Jolette
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R. A. Foster
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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19
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Blois SL, Dickie EL, Kruth SA, Allen DG. Multiple endocrine diseases in cats: 15 cases (1997-2008). J Feline Med Surg 2010; 12:637-42. [PMID: 20580584 PMCID: PMC10911494 DOI: 10.1016/j.jfms.2010.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2010] [Indexed: 11/17/2022]
Abstract
The objective of this retrospective study was to characterize a population of cats from a tertiary care center diagnosed with multiple endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Medical records of 15 cats diagnosed with more than one endocrine disorder were reviewed. The majority of cats were domestic shorthairs, and the mean age at the time of diagnosis of the first disorder was 10.3 years. The most common combination of disorders was diabetes mellitus and hyperthyroidism. Two cats had concurrent diabetes mellitus and hyperadrenocorticism, one cat had concurrent central diabetes insipidus and diabetes mellitus. A mean of 25.7 months elapsed between diagnoses of the first and second endocrine disorder, but this was variable. This study suggests the occurrence of multiple endocrine disorders is uncommon in cats.
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Affiliation(s)
- Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College Teaching Hospital, University of Guelph, Guelph, Ontario, Canada.
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20
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Husebye ES, Løvås K. Immunology of Addison's disease and premature ovarian failure. Endocrinol Metab Clin North Am 2009; 38:389-405, ix. [PMID: 19328418 DOI: 10.1016/j.ecl.2009.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Autoimmune Addison's disease and autoimmune ovarian insufficiency are caused by selective targeting by T and B lymphocytes to the steroidogenic apparatus in these organs. Autoantibodies toward 21-hydroxylase are a clinically useful marker for autoimmune Addison's disease. Autoantibodies to 21-hydroxylase are found in premature ovarian insufficiency, but others also can be present, notably antibodies against side-chain cleavage enzyme. The autoimmune response primarily targets the theca cells, yielding elevated concentrations of inhibin, which is emerging as a useful diagnostic marker for autoimmune etiology of ovarian insufficiency. Little is known about its immunogenetics, but in contrast to Addison's disease, several experimental models of autoimmune premature ovarian insufficiency are available for study.
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Affiliation(s)
- Eystein S Husebye
- Section of Endocrinology, Institute of Medicine, University of Bergen, Bergen, Norway.
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21
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Abstract
Autoimmune Addison's disease is caused by autoreactivity towards the adrenal cortex involving 21-hydroxylase autoantibodies and autoreactive T cells. Autoimmune destruction of the adrenal cortex is triggered by hitherto unknown environmental factors in individuals with genetic susceptibility. Several genes have been identified, of which the major histocompatibility complex haplotypes DR3-DQ2 and DR4-DQ8 are most strongly associated. In addition, other genes also implicated in other autoimmune diseases are linked to Addison's disease, such as cytotoxic T lymphocyte antigen 4 (CTLA-4), protein tyrosine phosphatase non-receptor type 22 (PTPN22), major histocompatibility complex class II transactivator (CIITA), and most recently the C-lectin type gene (CLEC16A). Studies employing T cells in humans and animal models, and the collection of large patient cohorts facilitating genome-wide screening projects, will hopefully improve the understanding of the pathogenesis of the disease in the near future.
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Affiliation(s)
- Eystein Husebye
- Department of Medicine, Haukeland University Hospital, Section of Endocrinology, Institute of Medicine, University of Bergen, Bergen, Norway.
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22
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Schwarz BC, Sallmutter T, Nell B. Keratoconjunctivitis sicca attributable to parasympathetic facial nerve dysfunction associated with hypothyroidism in a horse. J Am Vet Med Assoc 2008; 233:1761-6. [PMID: 19046036 DOI: 10.2460/javma.233.11.1761] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 6-year-old 680-kg (1,496-lb) German Warmblood gelding was evaluated because of bilateral blepharospasm and head shaking. CLINICAL FINDINGS Moderate blepharospasm was evident bilaterally, and both eyes had hyperemic and edematous conjunctivas and lusterless corneas. For each eye, the Schirmer tear test value was only 7 mm/min. The horse's nasal mucosa was dry. Abnormal behaviors included mild repetitive vertical movement of the head, snorting, and flehmen response (classic signs of head shaking). Touching the horse's nostrils and face revealed paresthesia and dysesthesia with slight nasolabial muscle hypertrophy bilaterally. Cranial nerve examination revealed no other abnormalities. Serum thyroxine concentration was low, and results of thyrotropin-releasing hormone and thyroid-stimulating hormone stimulation tests were negative, indicating that the horse had hypothyroidism. The diagnoses included keratoconjunctivitis sicca and dry nares attributable to parasympathetic facial nerve dysfunction, head-shaking syndrome with paresthesia and dysesthesia of the face attributable to sensory trigeminal nerve disorder, and hypothyroidism. The 2 nerve dysfunctions were considered peripheral neuropathies that were most likely caused by hypothyroidism. TREATMENT AND OUTCOME Treatment of both eyes was initiated with topical applications of cyclosporine, 0.5% sodium hyaluronate, and vitamin A ointment. Levothyroxine (20 microg/kg [9.1 microg/lb], PO, q 24 h) was administered. Within 3 weeks to 4 months, serum thyroxine concentration was within reference range, and clinical signs and Schirmer tear test values improved. CLINICAL RELEVANCE Hypothyroidism should be considered as a differential diagnosis in horses with peripheral neuropathy or keratoconjunctivitis sicca. In affected horses, administration of levothyroxine may lead to resolution of neurologic signs.
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Affiliation(s)
- Bianca C Schwarz
- Clinic for Internal Medicine and Infectious Diseases, Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Vienna, Austria
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23
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Chapter 12 Autoimmune Polyendocrine Syndromes (APS) or Multiple Autoimmune Syndromes (MAS). HANDBOOK OF SYSTEMIC AUTOIMMUNE DISEASES 2008. [DOI: 10.1016/s1571-5078(07)00212-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Williams DL, Pierce V, Mellor P, Heath MF. Reduced tear production in three canine endocrinopathies. J Small Anim Pract 2007; 48:252-6. [PMID: 17425694 DOI: 10.1111/j.1748-5827.2007.00349.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Previous reports have suggested that hypothyroid and diabetic patients can be predisposed to keratoconjunctivitis sicca. This study aimed to measure tear production in dogs with diabetes, hypothyroidism and hyperadrenocorticism using the Schirmer tear test and to compare these results with Schirmer tear test values for a group of normal dogs. METHODS Schirmer tear tests were performed on 16 dogs with hyperadrenocorticism, 18 with diabetes and 12 with hypothyroidism together with 100 control dogs. Corneal sensitivity was also measured in 12 of the 18 diabetic dogs with a Cochet Bonnet aesthesiometer and compared with age- and breed-matched normal dogs. RESULTS Schirmer tear test values in dogs with hypothyroidism, hyperadrenocorticism and diabetes were 12.3+/-3.2, 14.0+/-4.0 and 12.3+/-5.3 mm/minutes, respectively. Schirmer tear test values were significantly lower than that for the control group (19.6+/-4.2 mm/minutes) in all dogs with an endocrinopathy. Only in two hypothyroid dogs and three diabetics, this was manifested as profound keratoconjunctivitis sicca with Schirmer tear test value lower than 5 mm/minutes. Diabetic dogs had significantly reduced corneal sensitivity compared with a matched set of control dogs. CLINICAL SIGNIFICANCE This study shows a significant reduction in tear production in animals with diabetes mellitus, hypothyroidism and hyperadrenocorticism. Further research is needed to elucidate the mechanisms by which this reduction in tear production occurs. Assessment of tear production should be undertaken in animals diagnosed with these endocrinopathies, as these animals may progress to clinical keratoconjunctivitis sicca.
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Affiliation(s)
- D L Williams
- Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES
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25
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Javadi S, Galac S, Boer P, Robben JH, Teske E, Kooistra HS. Aldosterone-to-Renin and Cortisol-to-Adrenocorticotropic Hormone Ratios in Healthy Dogs and Dogs with Primary Hypoadrenocorticism. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02896.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Betterle C, Lazzarotto F, Presotto F. Autoimmune polyglandular syndrome Type 2: the tip of an iceberg? Clin Exp Immunol 2004; 137:225-33. [PMID: 15270837 PMCID: PMC1809126 DOI: 10.1111/j.1365-2249.2004.02561.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2004] [Indexed: 02/02/2023] Open
Abstract
Autoimmune polyglandular syndromes (APS) are conditions characterized by the association of two or more organ-specific disorders. Type 2 APS is defined by the occurrence of Addison's disease with thyroid autoimmune disease and/or Type 1 diabetes mellitus. Clinically overt disorders are considered only the tip of the autoimmune iceberg, since latent forms are much more frequent. Historical, clinical, genetic, and immunological aspects of Type 2 APS are reviewed. Furthermore, data on 146 personal cases of Type 2 APS are also reported.
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Affiliation(s)
- C Betterle
- Unit of Endocrinology, Department of Medical and Surgical Sciences, University of Padua, Italy.
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27
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Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev 2002; 23:327-64. [PMID: 12050123 DOI: 10.1210/edrv.23.3.0466] [Citation(s) in RCA: 323] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent progress in the understanding of autoimmune adrenal disease, including a detailed analysis of a group of patients with Addison's disease (AD), has been reviewed. Criteria for defining an autoimmune disease and the main features of autoimmune AD (history, prevalence, etiology, histopathology, clinical and laboratory findings, cell-mediated andhumoral immunity, autoantigens and their autoepitopes, genetics, animal models, associated autoimmune diseases, pathogenesis, natural history, therapy) have been described. Furthermore, the autoimmune polyglandular syndromes (APS) associated with AD (revised classification, animal models, genetics, natural history) have been discussed. Of Italian patients with primary AD (n = 317), 83% had autoimmune AD. At the onset, all patients with autoimmune AD (100%) had detectable adrenal cortex and/or steroid 21-hydroxylase autoantibodies. In the course of natural history of autoimmune AD, the presence of adrenal cortex and/or steroid 21-hydroxylase autoantibodies identified patients at risk to develop AD. Different risks of progression to clinical AD were found in children and adults, and three stages of subclinical hypoadrenalism have been defined. Normal or atrophic adrenal glands have been demonstrated by imaging in patients with clinical or subclinical AD. Autoimmune AD presented in four forms: as APS type 1 (13% of the patients), APS type 2 (41%), APS type 4 (5%), and isolated AD (41%). There were differences in genetics, age at onset, prevalence of adrenal cortex/21-hydroxylase autoantibodies, and associated autoimmune diseases in these groups. "Incomplete" forms of APS have been identified demonstrating that APS are more prevalent than previously reported. A varied prevalence of hypergonadotropic hypogonadism in patients with AD and value of steroid-producing cells autoantibodies reactive with steroid 17alpha-hydroxylase or P450 side-chain cleavage enzyme as markers of this disease has been discussed. In addition, the prevalence, characteristic autoantigens, and autoantibodies of minor autoimmune diseases associated with AD have been described. Imaging of adrenal glands, genetic tests, and biochemical analysis have been shown to contribute to early and correct diagnosis of primary non-autoimmune AD in the cases of hypoadrenalism with undetectable adrenal autoantibodies. An original flow chart for the diagnosis of AD has been proposed.
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Affiliation(s)
- Corrado Betterle
- Chair of Clinical Immunology and Allergy, Department of Medical and Surgical Sciences, University of Padova, I-35128, Padova, Italy.
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Abstract
The following review is based on notes used in the teaching of clinical immunology to veterinary students. Immune diseases of the dog are placed into six different categories: (1) type I or allergic conditions; (2) type II or auto- and allo-antibody diseases; (3) type III or immune complex disorders; (4) type IV or cell-mediated immune diseases; (5) type V conditions or gammopathies; and (6) type VI or immunodeficiency disorders. Separate discussions of transplantation immunology and the use of drugs to regulate unwanted immune responses are also included.
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Affiliation(s)
- N C Pedersen
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis 95616, USA
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29
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van Vonderen IK, Kooistra HS, Rijnberk A. Influence of veterinary care on the urinary corticoid:creatinine ratio in dogs. Vet Med (Auckl) 1998; 12:431-5. [PMID: 9857335 DOI: 10.1111/j.1939-1676.1998.tb02146.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Physical and emotional stresses are known to increase the production and secretion of glucocorticoids by the adrenal cortex in both humans and experimental animals. The urinary corticoid: creatinine (C:C) ratio is increasingly used as a measure of adrenocortical function. In this study we investigated whether a visit to a veterinary practice for vaccination, a visit to a referral clinic for orthopedic examination, or hospitalization in a referral clinic for 1.5 days resulted in increases of the urinary C:C ratio in pet dogs. In experiment 1, owners collected voided urine samples from 19 healthy pet dogs at specified times before and after taking the dogs to a veterinary practice for yearly vaccination. In experiment 2, 12 pet dogs were evaluated in a similar way before and after an orthopedic examination at a referral clinic. In experiment 3, 9 healthy pet dogs were hospitalized for 1.5 days and urine samples were collected before, during, and after this stay. Basal urinary C:C ratios in all experiments ranged from 0.8 to 8.3 x 10(-6). In experiment 1, the urinary C:C ratio after the visit to the veterinary practice ranged from 0.9 to 22.0 x 10(-6). Six dogs had a significantly increased urinary C:C ratio (responders), but in 5 of these dogs the ratio was < or = 10 x 10(-6). In experiment 2, 8 of 12 dogs responded significantly with urinary C:C ratios ranging from 3.1 to 27.0 x 10(-6). In experiment 3, 8 of 9 dogs had significantly increased urinary C:C ratios, ranging from 2.4 to 24.0 x 10(-6), in some or all urine samples collected during hospitalization. In 4 dogs urinary C:C ratios 12 hours after hospitalization were still significantly higher than the initial values. Thus, a visit to a veterinary practice, an orthopedic examination in a referral clinic, and hospitalization can be considered stressful conditions for dogs. A large variation occurs in response, and in individual dogs the increases in urinary C:C ratios can exceed the cutoff level for the diagnosis of hyperadrenocorticism. Therefore, urine samples for measurement of the C:C ratio in the diagnosis of hyperadrenocorticism should be collected in the dog's home environment, to avoid the influence of stress on glucocorticoid secretion.
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Affiliation(s)
- I K van Vonderen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
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Abstract
A four-year-old Labrador retriever was presented with lethargy and exercise intolerance. Clinical examination was unremarkable. A subnormal cortisol response to adrenocorticotrophin hormone (ACTH) was demonstrated (plasma cortisol concentrations before and after administration of ACTH were both below the detection limit of the assay) but plasma aldosterone concentrations were within the normal range. Endogenous plasma ACTH concentrations were high, indicating primary adrenocortical disease. Following glucocorticoid supplementation at a replacement dose (prednisolone 0.1 mg/kg) the dog made a full clinical recovery.
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Affiliation(s)
- K J Dunn
- Department of Clinical Veterinary Medicine, University of Cambridge
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