1
|
Tardo AM, Reusch CE, Galac S, Fornetti S, Tirolo A, Golinelli S, Shehdula D, Fracassi F. Feline plasma adrenocorticotropic hormone: validation of a chemiluminescent assay and concentrations in cats with hypercortisolism, primary hypoadrenocorticism and other diseases. J Feline Med Surg 2021; 23:67-73. [PMID: 32478637 PMCID: PMC10741360 DOI: 10.1177/1098612x20925686] [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] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aims of this study were to validate a commercially available chemiluminescent assay for measurement of feline plasma adrenocorticotropic hormone concentration (ACTH), to determine the normal reference interval (RI) of plasma ACTH in healthy cats, to assess plasma ACTH in cats with naturally occurring hypercortisolism (HC), primary hypoadrenocorticism (PH) and other diseases (OD), and to evaluate the effect of aprotinin on plasma ACTH degradation. METHODS Forty healthy cats, 10 with HC, 11 with PH and 30 with OD, were included. The chemiluminescent enzyme immunometric assay was evaluated by measurement of intra-assay precision, interassay precision and linearity. The RI for plasma ACTH in healthy cats was established using robust methods. Plasma ACTH of samples collected with and without aprotinin, stored at 4°C and assayed over a 6-day period, was measured. RESULTS The intra-assay coefficients of variance (CVs) ranged from 2.7% to 4.3% and interassay CVs from 3.3% to 10.7%. Dilution studies showed excellent accuracy (R2 >0.99). The RI for plasma ACTH in healthy cats was 32-370 pg/ml. Plasma ACTH was not significantly different between healthy cats and the OD group. Cats with pituitary-dependent hypercortisolism (PDH) and PH had significantly higher plasma ACTH than the other groups. Plasma ACTH did not show significant differences when samples collected with and without aprotinin were compared. CONCLUSIONS AND RELEVANCE The Immulite chemiluminescent assay is a valid technique for measuring plasma ACTH in cats and the RI of plasma ACTH is quite wide. Owing to the low overlap between healthy or OD cats and cats with HC or PH, the measurement of plasma ACTH appears to be useful and should be included in the diagnostic work-up when HC or PH are suspected. Furthermore, the measurement of plasma ACTH may be an accurate test for differentiating PDH from adrenal-dependent hypercortisolism.
Collapse
Affiliation(s)
- Antonio M Tardo
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Claudia E Reusch
- Clinic for Small Animal Internal
Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Sara Galac
- Department of Clinical Sciences, Faculty
of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sofia Fornetti
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Alessandro Tirolo
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Stefania Golinelli
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Dardan Shehdula
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Federico Fracassi
- Department of Veterinary Medical
Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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).
Collapse
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
| |
Collapse
|
4
|
Buckley FI, Mahony O, Webster CRL. Adrenal function in cats with cholestatic liver disease. J Vet Diagn Invest 2016; 29:14-19. [DOI: 10.1177/1040638716671978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cats with cholestatic liver disease experience significant morbidity and mortality when they undergo invasive procedures under anesthesia. Although inadequate adrenal response might account for these outcomes, adrenal function in cats with cholestatic liver disease has not been documented, to our knowledge. The goal of our study was to describe adrenal function in these cats. Twenty-seven cats with a serum bilirubin >230 µmol/L (3 mg/dL) and serum alanine aminotransferase >2 times the upper limit of normal had pre– and 60-min post–adrenocorticotropic hormone (ACTH) cortisol analysis after administration of 5 µg/kg cosyntropin intravenously. The change in cortisol concentrations (delta cortisol) was calculated. Pre- and post-ACTH cortisol concentrations were compared to reference values. Pre-ACTH, post-ACTH, and delta cortisol values were compared between cats surviving to discharge or for 30 d postdischarge. Mean pre-ACTH cortisol levels (205 ± 113 nmol/L [7.4 ± 4.2 µg/dL]) and post-ACTH cortisol levels (440 ± 113 nmol/L [15.9 ± 4.1 g/dL]) in cholestatic cats were significantly greater than reference values in clinically normal cats. There was no association of pre- or post-ACTH cortisol with survival. Cats with a delta cortisol <179 nmol/L (6.5 µg/dL) were more likely to be non-survivors at 30 d post-discharge ( p = 0.037) than cats with delta cortisol >179 nmol/L (6.5 µg/dL). Results indicate that cats with cholestasis have high basal and ACTH-stimulated cortisol values. A delta cortisol <179 nmol/L (6.5 µg/dL) defines a population of cats that have decreased 30-d survival.
Collapse
Affiliation(s)
- Faith I. Buckley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Orla Mahony
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Cynthia R. L. Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| |
Collapse
|
5
|
Mellett Keith AM, Bruyette D, Stanley S. Trilostane therapy for treatment of spontaneous hyperadrenocorticism in cats: 15 cases (2004-2012). J Vet Intern Med 2013; 27:1471-7. [PMID: 24011349 DOI: 10.1111/jvim.12178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 06/16/2013] [Accepted: 07/29/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical treatment with trilostane improves clinical signs, causes unclear insulin requirement changes, and variable survival times in cats. OBJECTIVES/HYPOTHESIS To characterize the long-term efficacy of trilostane in treating cats with hyperadrenocorticism (HAC). ANIMALS Fifteen client-owned cats with spontaneous HAC. METHODS Multicenter descriptive retrospective study with a search performed on all medical records for cats diagnosed with spontaneous HAC. RESULTS Clinical signs (13 of 15 cats) and ACTH stimulation testing results (13 of 15) improved with trilostane therapy. Diabetes mellitus was reported in 9/15 cases. Insulin requirements decreased by 36% within 2 months in 6/9 diabetic cats. Median survival time was 617 days for all cats (range 80-1,278 days). Complications included weight loss, urinary tract infections, chronic kidney disease, seizures, and recurrent pancreatitis. Hypocortisolemia was documented in 1 case. Cause of death occurred as a result of nonadrenal or nondiabetic illnesses (renal failure, seizures [caused by hypoglycemia or unknown]), or lymphoma. CONCLUSIONS AND CLINICAL IMPORTANCE Trilostane ameliorates clinical signs of HAC in cats, is tolerated well in the long term, and can lead to improved regulation of diabetes.
Collapse
Affiliation(s)
- A M Mellett Keith
- Section of Internal Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | |
Collapse
|
6
|
Eiler K, Bruyette D, Behrend E, Kemppainen R, Kass P. Comparison of Intravenous versus Intramuscular Administration of Corticotropin-Releasing Hormone in Healthy Cats. J Vet Intern Med 2013; 27:516-21. [PMID: 23480784 DOI: 10.1111/jvim.12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/22/2012] [Accepted: 01/21/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- K.C. Eiler
- VCA West Los Angeles Animal Hospital; Los Angeles CA
| | - D.S. Bruyette
- VCA West Los Angeles Animal Hospital; Los Angeles CA
| | - E.N. Behrend
- Department of Clinical Sciences; College of Veterinary Medicine; Auburn University; Auburn AL
| | - R.J. Kemppainen
- Department of Anatomy, Physiology and Pharmacology ; College of Veterinary Medicine; Auburn University; Auburn AL
| | - P.H. Kass
- Department of Population Health and Reproduction; University of California; Davis CA
| |
Collapse
|
7
|
Ramspott S, Hartmann K, Sauter-Louis C, Weber K, Wehner A. Adrenal function in cats with hyperthyroidism. J Feline Med Surg 2012; 14:262-6. [PMID: 22373912 PMCID: PMC10822515 DOI: 10.1177/1098612x11435893] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 07/10/2024]
Abstract
Adrenal function may be altered in animals with hyperthyroidism. The aim of the study was to assess adrenal function of hyperthyroid cats (n = 17) compared to healthy cats (n = 18) and cats with chronic diseases (n = 18). Adrenal function was evaluated by adrenocorticotropic hormone (ACTH) stimulation test and the urinary cortisol to creatinine ratio (UCCR) was determined. Length and width of both adrenal glands were measured via ultrasound. Hyperthyroid cats had significantly higher cortisol levels before and after stimulation with ACTH than the other groups. However, the UCCR was not elevated in hyperthyroid cats. The size of the adrenal glands of hyperthyroid cats was not significantly different from the size of those of healthy cats. The results indicate that cats with hyperthyroidism have a higher cortisol secretory capacity in a hospital setting. The normal size of the adrenal glands suggests that cortisol levels may not be increased permanently.
Collapse
Affiliation(s)
- Sabine Ramspott
- Clinic of Small Animal Medicine, LMU University of Munich, Veterinaerstrasse 13, Munich, Germany
| | | | | | | | | |
Collapse
|
8
|
Mahlum LM, Rollings C, Basseches J, Bracker K. Presumptive pseudohypoaldosteronism secondary to chronic urinary tract obstruction from sloughed urinary bladder mucosa and urinary tract infection in a cat. J Vet Emerg Crit Care (San Antonio) 2011; 20:601-10. [PMID: 21166982 DOI: 10.1111/j.1476-4431.2010.00596.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe a case of presumptive secondary pseudohypoaldosteronism (PHA) in a cat with urinary tract infection and chronic urethral obstruction. The obstruction was believed to have resulted from sloughed urinary bladder mucosa secondary to pressure necrosis. CASE SUMMARY A 5-year-old, 4 kg, castrated male Siamese cat presented for vomiting and stranguria. Medical history included a perineal urethrostomy for urethral obstruction. Physical examination revealed a large, painful, nonexpressible urinary bladder. Point-of-care testing demonstrated electrolyte derangements consistent with a postrenal azotemia and metabolic acidosis. Results of urine culture was positive for bacterial growth. Diagnostic imaging revealed presence of retroperitoneal fluid, marked urinary bladder wall thickening, bilateral hydroureter, mild bilateral pyelectasia, and small nephroliths. The patient was treated for a urinary tract obstruction and infection. In the 3 weeks following initial discharge, the patient was evaluated on multiple occasions for lethargy, intermittent vomiting, inappropriate urination, and progressive polyuria and polydipsia. Although the urinary bladder was easily expressed during repeat examinations, it was persistently distended and subjectively thickened upon palpation. Repeat ultrasound of the urinary tract showed evidence of sloughed tissue in the bladder lumen, likely secondary to chronic urethral obstruction and pressure necrosis. A cystotomy was performed to remove the necrotic tissue, and a revised perineal urethrostomy was done due to a partial urethral stricture. Bladder biopsies were obtained at this time. Postoperatively, the cat was reported by the owners to be urinating normally but continued to be polyuric and polydipsic in the week following discharge. One week after surgery, the cat presented in hypovolemic shock with laboratory findings consistent with a presumptive diagnosis of secondary PHA. NEW OR UNIQUE INFORMATION PROVIDED PHA has not been reported previously in a cat. This case report suggests that aldosterone resistance should be considered in cats with consistent laboratory findings and a history of documented obstructive uropathy and urinary tract infection.
Collapse
Affiliation(s)
- Lisa M Mahlum
- Emergency and Critical Care Department, Angell Animal Medical Center (AAMC), Boston, MA 02130, USA.
| | | | | | | |
Collapse
|
9
|
Iki T, Ahrens F, Pasche KH, Bartels A, Erhard MH. Relationships between scores of the feline temperament profile and behavioural and adrenocortical responses to a mild stressor in cats. Appl Anim Behav Sci 2011. [DOI: 10.1016/j.applanim.2011.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
DeClue AE, Martin LG, Behrend EN, Cohn LA, Dismukes DI, Lee HP. Cortisol and aldosterone response to various doses of cosyntropin in healthy cats. J Am Vet Med Assoc 2011; 238:176-82. [DOI: 10.2460/javma.238.2.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Schoeman JP, Herrtage ME. Adrenal response to the low dose ACTH stimulation test and the cortisol-to-adrenocorticotrophic hormone ratio in canine babesiosis. Vet Parasitol 2008; 154:205-13. [DOI: 10.1016/j.vetpar.2008.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/13/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
|
12
|
Naidenko SV, Antonevich AL, Erofeeva MN. Hormonal response to a synthetic analog of adrenocorticotropic hormone in lynx pups (Lynx lynx L.). DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2007; 416:341-4. [PMID: 18047013 DOI: 10.1134/s0012496607050055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S V Naidenko
- Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Leninskii pr. 33, Moscow, 117071 Russia
| | | | | |
Collapse
|
13
|
Abstract
Although only recently discovered, feline adrenal disorders are becoming increasingly more recognized. Feline adrenal disorders include diseases such as hyperadrenocorticism (Cushing's syndrome) and hyperaldosteronism (Conn's syndrome). The clinical signs of feline hyperadrenocorticism, which include unregulated diabetes mellitus and severe skin atrophy, are unique to the cat. Other signs of feline hyperadrenocorticism, such as potbellied appearance, polydipsia, polyuria, and susceptibility to infections are also seen in dogs with hyperadrenocorticism. Conn's syndrome has only recently been described in the cat and is in fact more common in cats than in dogs. Characterized by severe hypokalemia, hypertension, and muscle weakness, Conn's syndrome may be misdiagnosed as renal failure. The clinician should become familiar with the clinical signs of adrenal disorders in cats and the common diagnostic tests used to diagnose these syndromes in cats as they differ from those in the dog. Treatment of feline adrenal disorders may be challenging; the clinician should become familiar with common drugs used to treat adrenal disorders in cats.
Collapse
|
14
|
Chatdarong K, Ponglowhapan S, Karlsson A, Linde-Forsberg C. The effect of ACTH stimulation on cortisol and progesterone concentrations in intact and ovariohysterectomized domestic cats. Theriogenology 2006; 66:1482-7. [PMID: 16527341 DOI: 10.1016/j.theriogenology.2006.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective was to evaluate the adrenocortical capacity for cortisol and progesterone production in female cats, both while intact and after ovariohysterectomy. Five privately owned female cats, 1-3 years old, were used in two trials while intact at an inactive stage of the cycle, and again in two trials, 2 weeks after ovariohysterectomy. The four trials were: intact saline injection control trial; intact ACTH injection (0.125 mg); ovariohysterectomized saline injection control trial; and ovariohysterectomized ACTH injection. Blood samples were obtained by an indwelling cephalic vein catheter at -30 and 0 min (immediately before injections) and at 60, 90, 120 and 180 min after injection. The mean basal pre-treatment concentrations of cortisol in the intact and ovariohysterectomized cats were 33 +/- 19 and 32 +/- 19 nmol/L, respectively; the corresponding values for progesterone were 1.1 +/- 0.6 and 0.7 +/- 0.6 nmol/L, respectively. Saline did not alter the serum cortisol or progesterone concentrations. In contrast, both cortisol and progesterone were elevated after ACTH, with peak values at 90 min and returned to basal levels at approximately 180 min. There was a positive correlation between cortisol and progesterone concentrations (r = 0.8, P < 0.05). In some instances, the procedure used to restrain the cats during blood collection induced increases in cortisol and progesterone of the same magnitude as when the ACTH was administered; these effects of restraint could alter the results of assisted reproduction efforts.
Collapse
Affiliation(s)
- Kaywalee Chatdarong
- Department of Obstetrics, Gynaecology and Reproduction, Faculty of Veterinary Science, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand.
| | | | | | | |
Collapse
|
15
|
Neiger R, Witt AL, Noble A, German AJ. Trilostane Therapy for Treatment of Pituitary-Dependent Hyperadrenocorticism in 5 Cats. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb00156.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Affiliation(s)
- M Hoenig
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens 30602, USA
| |
Collapse
|