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Sieber-Ruckstuhl NS, Harburger L, Hofer N, Kümmerle C, Müller C, Riond B, Hofmann-Lehmann R, Reusch CE, Boretti FS. Clinical features and long-term management of cats with primary hypoadrenocorticism using desoxycorticosterone pivalate and prednisolone. J Vet Intern Med 2023; 37:420-427. [PMID: 36809682 DOI: 10.1111/jvim.16658] [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: 09/09/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Primary hypoadrenocorticism (PH) is rare in cats and knowledge about treatment is sparse. OBJECTIVE To describe cats with PH with a focus on long-term treatment. ANIMALS Eleven cats with naturally occurring PH. METHODS Descriptive case series with data on signalment, clinicopathological findings, adrenal width, and doses of desoxycorticosterone pivalate (DOCP) and prednisolone during a follow-up period of >12 months. RESULTS Cats ranged from 2 to 10 years (median 6.5); 6 cats were British Shorthair. Most common signs were reduced general condition and lethargy, anorexia, dehydration, obstipation, weakness, weight loss, and hypothermia. Adrenal glands on ultrasonography were judged small in 6. Eight cats could be followed for 14 to 70 months (median: 28). Two were started on DOCP doses ≥2.2 mg/kg (2.2; 2.5) and 6 < 2.2 mg/kg (1.5-2.0 mg/kg, median 1.8) q28 days. Both high-dose cats and 4 low-dose cats needed a dose increase. Desoxycorticosterone pivalate and prednisolone doses at the end of the follow-up period were 1.3 to 3.0 mg/kg (median: 2.3) and 0.08 to 0.5 mg/kg/day (median: 0.3), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Desoxycorticosterone pivalate and prednisolone requirements in cats were higher than what is currently used in dogs; thus, a DOCP starting dose of 2.2 mg/kg q28 days and a prednisolone maintenance dose of 0.3 mg/kg/day titrated to the individual need seems warranted. Small adrenal glands (width < 2.7 mm) on ultrasonography in a cat suspected of hypoadrenocorticism can be suggestive of the disease. The apparent predilection of British Shorthaired cats for PH should be further evaluated.
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Affiliation(s)
| | - Livia Harburger
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Natalie Hofer
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Claudia Kümmerle
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Claudia Müller
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Barbara Riond
- Clinical Laboratory Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Claudia E Reusch
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Felicitas S Boretti
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
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Oliveira J, Dias MJ, Fontes AP, Englar RE, Vicente G, Ferreira RL, Galac S, Leal RO. Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study. Vet Sci 2022; 9:vetsci9080420. [PMID: 36006335 PMCID: PMC9413254 DOI: 10.3390/vetsci9080420] [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] [Received: 07/17/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.
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Affiliation(s)
- João Oliveira
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Maria Joana Dias
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Ana Paula Fontes
- School of Healthcare, University of Algarve, 8005-139 Faro, Portugal
| | - Ryane E. Englar
- College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd., Oro Valley, AZ 85737, USA
| | - Gonçalo Vicente
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Rui Lemos Ferreira
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Sara Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 Utrecht, The Netherlands
| | - Rodolfo Oliveira Leal
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
- Correspondence:
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Gaisbauer S, Zeugswetter FK, Tichy A, Rowan C, Ludewig E. Assessment of Adrenal Computed Tomography Characteristics in Cats with Nonadrenal Disease. J Am Anim Hosp Assoc 2022; 58:113-120. [PMID: 35576401 DOI: 10.5326/jaaha-ms-7140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/11/2022]
Abstract
Adrenal computed tomography characteristics (aCTc) in healthy cats are known, but reference intervals for diseased cats are lacking. aCTc of cats without evidence of adrenal disease (NAD group) were compared to parameters of cats with possible concurrent adrenal disease (PAD group). The PAD group was assessed for adrenal masses or other morphological deviations using the NAD group as reference. Associations of aCTc with patient variables were explored, and all results were compared with published aCTc of healthy cats. No incidental adrenal masses were identified in the PAD group (n = 92), and only few aCTc differed compared to the NAD group (n = 30). The NAD group showed similar associations of patient variables and aCTc as length (right: 11.5 ± 2.2 mm, left: 11.8 ± 1.7 mm), width (right: 6.4 ± 1.2 mm, left: 5.4 ± 0.8 mm), height (right: 4.5 ± 0.9 mm, left: 4.5 ± 0.8 mm), attenuation (right: 33.1 ± 5.0 Hounsfield units, left: 32.5 ± 5.3 Hounsfield units) and position, but markedly more mineralization (right: 10%, left: 13.3%) than reported in healthy cats. This study provides references of aCTc for diseased cats without evidence of adrenal disease. The result suggests that adrenal incidentalomas seem to be rare in cats.
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Affiliation(s)
- Stefanie Gaisbauer
- From the Department for Companion Animals and Horses, University Clinic for Small Animals (F.K.Z., C.R., E.L., S.G.), Platform Bioinformatics and Biostatistics (A.T.), the University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florian Karl Zeugswetter
- From the Department for Companion Animals and Horses, University Clinic for Small Animals (F.K.Z., C.R., E.L., S.G.), Platform Bioinformatics and Biostatistics (A.T.), the University of Veterinary Medicine Vienna, Vienna, Austria
| | - Alexander Tichy
- From the Department for Companion Animals and Horses, University Clinic for Small Animals (F.K.Z., C.R., E.L., S.G.), Platform Bioinformatics and Biostatistics (A.T.), the University of Veterinary Medicine Vienna, Vienna, Austria
| | - Conor Rowan
- From the Department for Companion Animals and Horses, University Clinic for Small Animals (F.K.Z., C.R., E.L., S.G.), Platform Bioinformatics and Biostatistics (A.T.), the University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eberhard Ludewig
- From the Department for Companion Animals and Horses, University Clinic for Small Animals (F.K.Z., C.R., E.L., S.G.), Platform Bioinformatics and Biostatistics (A.T.), the University of Veterinary Medicine Vienna, Vienna, Austria
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Pérez-López L, Wägner AM, Saavedra P, Jaber JR, Melián C. Ultrasonographic evaluation of adrenal gland size in two body weight categories of healthy adult cats. J Feline Med Surg 2021; 23:804-808. [PMID: 33236660 PMCID: PMC10812194 DOI: 10.1177/1098612x20974962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adrenal gland size and its association with body weight have been rarely evaluated in cats. This study was undertaken to assess the association between feline body weight and adrenal gland thickness, and to propose reference intervals (RIs) for adrenal gland thickness in healthy cats. METHODS This was a cross-sectional study in which 39 healthy cats were included. The cats were divided into two weight categories, classified as ⩽4.0 kg and >4-8 kg of ideal body weight (with 13 and 26 cats in each group, respectively), which took into consideration the body condition score of the cats. All cats underwent an ultrasound examination that was taken from a subcostal position. Maximum dorsoventral thicknesses of the left (MTL) and right (MTR) adrenal glands were measured in a sagittal plane. RIs were obtained for the maximum thickness (MT), which included the MTLs and MTRs of each cat. RIs with the 90% confidence intervals were calculated according to American Society for Veterinary Clinical Pathology guidelines on RIs. RESULTS No statistical differences for adrenal gland thickness were observed between the left and right (P = 0.543) adrenal glands or between male and female cats (P = 0.943). Mean MT was significantly greater in the group of cats weighing >4-8 kg compared with the group of cats weighing ⩽4 kg (3.7 ± 0.6 vs 3.2 ± 0.4 mm; P <0.005). The lower limit of the RI for MT was 2.4 mm (range 2.2-2.6 mm) in the group weighing ⩽4 kg and 2.6 mm (range 2.4-2.8 mm) in the group weighing >4-8 kg. The upper limit of the RI for MT was 3.9 mm (range 3.7-4.1 mm) in the group of cats weighing ⩽4 kg and 4.8 mm (range 4.6-5.1 mm) in the group of cats weighing >4-8 kg. CONCLUSIONS AND RELEVANCE The use of RIs based on two group sizes allows for a more accurate ultrasonographic evaluation of adrenal gland thickness in cats. The maximum normal adrenal gland thickness is lower in smaller cats (3.9 mm for those weighing ⩽4 kg and 4.8 mm for those weighing >4-8 kg).
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Affiliation(s)
- Laura Pérez-López
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
| | - Ana María Wägner
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Arucas, Spain
| | - Jose Raduan Jaber
- Department of Morphology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - Carlos Melián
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas, Las Palmas, Spain
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Cook AK, Evans JB. Feline comorbidities: Recognition, diagnosis and management of the cushingoid diabetic. J Feline Med Surg 2021; 23:4-16. [PMID: 33403912 PMCID: PMC11163885 DOI: 10.1177/1098612x20979507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRACTICAL RELEVANCE Diabetes mellitus (DM) is a common feline endocrinopathy, and is often driven by underlying insulin resistance with associated pancreatic beta (β)-cell dysfunction. Although spontaneous hyperadrenocorticism (HAC) with hypercortisolemia (hypercortisolism) is relatively uncommon in cats, it is a well-established cause of insulin resistance and is routinely associated with DM in this species. CLINICAL CHALLENGES Many of the clinical signs associated with feline HAC are subtle and may be attributed to concurrent DM or the aging process. Failure to recognize HAC in the diabetic cat can impact patient wellbeing and predispose the patient to progressive compromise. Unfortunately, it can be difficult to establish a diagnosis of HAC, as test results may be influenced by poor diabetic regulation, and protocols are different to those used in canine patients. Treatment options depend on the underlying cause, and often require careful, ongoing assessment and modulation of both adrenal function and insulin requirements. However, various approaches have been shown to either improve glycemic control in cats with sustained insulin dependence, or facilitate diabetic remission. EVIDENCE BASE This review summarizes the current literature on feline HAC, with a particular focus on cats with concurrent DM. The clinical findings that suggest HAC are discussed, along with an outline of diagnostic options and their limitations. Published outcomes for various medical options, surgical procedures and radiation therapy are provided. The authors also share their thoughts on the safe and effective management of cats with HAC and DM, with an emphasis on the anticipation and recognition of changing insulin requirements.
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Affiliation(s)
- Audrey K Cook
- BVM&S, MSc Vet Ed, MRCVS, Dip ACVIM-SAIM, Dip ECVIM-CA, Dip ABVP (Feline)
| | - Jeremy B Evans
- DVM, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- BVSc, Ce666rtAVP, DipECVDI, Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Mallol C, Altuzarra R, Espada Y, Tobón Restrepo M, Serrano E, Novellas R. CT characterisation of feline adrenal glands. J Feline Med Surg 2020; 22:285-291. [PMID: 30942657 PMCID: PMC10814666 DOI: 10.1177/1098612x19840090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were to describe the CT characteristics of the adrenal glands in healthy cats, to provide normal reference biometry for adrenal gland size and attenuation values, and to investigate the association with age, sex, laterality and body weight. METHODS Retrospective evaluation of 30 CT studies of healthy adult cats recruited from September 2013 to July 2015 was performed. Healthy cats >1 year of age were included based on the absence of clinical signs, unremarkable physical examination, normal results of the complete blood count, biochemical profile, feline immunodeficiency virus, feline leukaemia virus and Bartonella species infection tests. The relationship between gland biometry (size and attenuation values) and the age, sex, laterality and body weight of cats were tested by two-way ANOVA. The intraclass correlation coefficient was assessed and mean, SD, range and reference interval provided. RESULTS Twenty-seven cats were included. Bilobed, arrowhead and oval adrenal gland shape patterns were recognised, the first being most common. No statistically significant differences were observed between the biometric parameters (length, height and attenuation values) and age, sex, laterality or body weight of the cats. Regarding the width of the adrenal glands, there was a statistically significant effect of sex and laterality. The length (11.6 ± 2.1 mm) and height (6.1 ± 1.3 mm) were the most consistent biometrical parameters to describe adrenal glands. CONCLUSIONS AND RELEVANCE Adrenal gland shape, size and attenuation CT data of healthy feline patients are provided in this study, as well as normal reference intervals for morphometric characterisation based on adrenal length and height.
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Affiliation(s)
- Claudia Mallol
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Raúl Altuzarra
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Yvonne Espada
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Mauricio Tobón Restrepo
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Emmanuel Serrano
- Wildlife Ecology and Health Group and Wildlife Ecopathology Service (SEFaS), Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Rosa Novellas
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
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Boland LA, Barrs VR. Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment. J Feline Med Surg 2017; 19:933-947. [PMID: 28838299 PMCID: PMC11128894 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).
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Affiliation(s)
- Lara A Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, 2006, Australia
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Fryers A, Elwood C. Hypokalaemia in a hyperthyroid domestic shorthair cat with adrenal hyperplasia. J Feline Med Surg 2014; 16:853-7. [PMID: 24621855 PMCID: PMC11112226 DOI: 10.1177/1098612x14527474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 13-year-old female domestic shorthair cat presented with polyphagia and weight loss. Marked systolic hypertension was found on examination. Elevated total thyroxine levels confirmed hyperthyroidism, and hypokalaemia was also documented. A euthyroid state and normotension were achieved following 4 weeks of treatment with carbimazole and amlodipine. Despite potassium supplementation, the hypokalaemia worsened. Abdominal ultrasonography revealed left adrenomegaly. Plasma aldosterone concentrations were initially in the lower half of the reference interval and, when repeated 2 months later, were undetectable. Urea and creatinine remained in the lower half of the reference interval throughout treatment, and urine specific gravity suggested good urine concentrating ability. The fractional excretion of potassium confirmed a renal source of potassium loss. Blood gas analysis was unremarkable. It was theorised that an aldosterone precursor was causing signs of mineralocorticoid excess and undetectable plasma aldosterone levels. Treatment with an aldosterone receptor antagonist successfully increased the serum potassium concentration. Owing to difficulties administering medication and associated effects on life quality the cat was euthanased. Adrenal hyperplasia was apparent on post-mortem histopathology.
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Valentin SY, Cortright CC, Nelson RW, Pressler BM, Rosenberg D, Moore GE, Scott-Moncrieff JC. Clinical findings, diagnostic test results, and treatment outcome in cats with spontaneous hyperadrenocorticism: 30 cases. J Vet Intern Med 2014; 28:481-7. [PMID: 24433386 PMCID: PMC4858028 DOI: 10.1111/jvim.12298] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/07/2013] [Accepted: 12/05/2013] [Indexed: 12/25/2022] Open
Abstract
Background Spontaneous hyperadrenocorticism (HAC) is rare in cats. Clinical findings, diagnostic test results, and response to various treatment options must be better characterized. Objectives To report the clinical presentation, clinicopathologic findings, diagnostic imaging results, and response to treatment of cats with HAC. Animals Cats with spontaneous HAC. Methods Retrospective descriptive case series. Results Thirty cats (15 neutered males, 15 spayed females; age, 4.0–17.6 years [median, 13.0 years]) were identified from 10 veterinary referral institutions. The most common reason for referral was unregulated diabetes mellitus; dermatologic abnormalities were the most frequent physical examination finding. Low‐dose dexamethasone suppression test results were consistent with HAC in 27 of 28 cats (96%), whereas ACTH stimulation testing was suggestive of HAC in only 9 of 16 cats (56%). Ultrasonographic appearance of the adrenal glands was consistent with the final clinical diagnosis of PDH or ADH in 28 of 30 cats (93%). Of the 17 cats available for follow‐up at least 1 month beyond initial diagnosis of HAC, improved quality of life was reported most commonly in cats with PDH treated with trilostane. Conclusions and Clinical Importance Dermatologic abnormalities or unregulated diabetes mellitus are the most likely reasons for initial referral of cats with HAC. The dexamethasone suppression test is recommended over ACTH stimulation for initial screening of cats with suspected HAC. Diagnostic imaging of the adrenal glands may allow rapid and accurate differentiation of PDH from ADH in cats with confirmed disease, but additional prospective studies are needed.
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Affiliation(s)
- S Y Valentin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Combes A, Pey P, Paepe D, Rosenberg D, Daminet S, Putcuyps I, Bedu AS, Duchateau L, de Fornel-Thibaud P, Benchekroun G, Saunders JH. Ultrasonographic appearance of adrenal glands in healthy and sick cats. J Feline Med Surg 2013; 15:445-57. [PMID: 23234721 PMCID: PMC10816315 DOI: 10.1177/1098612x12469523] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The first part of the study aimed to describe prospectively the ultrasonographic features of the adrenal glands in 94 healthy cats and 51 chronically sick cats. It confirmed the feasibility of ultrasonography of adrenal glands in healthy and chronically sick cats, which were not statistically different. The typical hypoechoic appearance of the gland surrounded by hyperechoic fat made it recognisable. A sagittal plane of the gland, not in line with the aorta, may be necessary to obtain the largest adrenal measurements. The reference intervals of adrenal measurements were inferred from the values obtained in the healthy and chronically sick cats (mean ± 0.96 SD): adrenal length was 8.9-12.5 mm; cranial height was 3.0-4.8 mm; caudal height was 3.0-4.5 mm. The second part of the study consisted of a retrospective analysis of the ultrasonographic examination of the adrenal glands in cats with adrenal diseases (six had hyperaldosteronism and four had pituitary-dependent hyperadrenocorticism) and a descriptive comparison with the reference features obtained in the control groups from the prospective study. Cats with hyperaldosteronism presented with unilateral severely enlarged adrenal glands. However, a normal contralateral gland did not preclude a contralateral infiltration in benign or malignant adrenal neoplasms. The ultrasonographic appearance of the adrenal glands could not differentiate benign and malignant lesions. The ultrasonographic appearance of pituitary-dependent hyperadrenocorticism was mainly a symmetrical adrenal enlargement; however, a substantial number of cases were within the reference intervals of adrenal size.
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Affiliation(s)
- Anaïs Combes
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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