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Da Riz F, Pichard D, Maurey C, Kurtz M, Canonne M, Lavoué R, Trumel C, Buronfosse T, Desquilbet L, Benchekroun G. Phosphocalcic metabolism and its potential association with biomarkers of kidney disease in dogs with spontaneous hyperadrenocorticism. Vet J 2024; 305:106146. [PMID: 38788995 DOI: 10.1016/j.tvjl.2024.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/17/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
The pathogenesis of increased serum phosphate concentration and proteinuria in dogs with spontaneous hyperadrenocorticism (HAC) is unclear. A potential link between proteinuria and calcium/phosphate metabolism has never been studied in dogs with HAC. The aims of the study were: (1) To evaluate calcium/phosphate metabolism in dogs with spontaneous HAC and compare to healthy dogs as well as to dogs with non-HAC illness; (2) to look for associations between markers of calcium/phosphate metabolism and biomarkers of kidney disease in dogs with HAC. Fifty-four dogs were included in the study, classified as HAC (n=27), non-HAC disease (n=17), and healthy (n=10). Serum calcium, phosphate, 25(OH)Vitamin D, 1,25(OH)2Vitamin D, plasma intact parathyroid hormone concentration (iPTH), FGF23, and urinary fractional excretion of calcium and phosphate were evaluated in all dogs at diagnosis and compared between each group. The correlation between these variables and urine protein-to-creatinine ratio (UPC) and urinary N-acetylglucosaminidase-to-creatinine ratio (uNAG/C) was evaluated in the HAC group. Medians [range] of serum phosphate concentration, urinary fractional excretion of calcium (FE(Ca)), and iPTH were significantly higher in dogs with HAC than in dogs with non-HAC illness (P<0.01) and healthy dogs (P<0.01). Increased 1,25(OH)2Vitamin D/25(OH)Vitamin D was also observed (P<0.001). In HAC group, UPC was significantly negatively correlated with 25(OH)Vitamin D (r(s): -0.54; P<0.01). Urinary NAG/C was significantly positively correlated with serum phosphate (r(s): 0.46; P=0.019). Increased serum phosphate, urinary excretion of calcium, and hyperparathyroidism were observed in dogs with HAC. Vitamin D metabolism may be shifted towards increased 1-alpha hydroxylation.
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Affiliation(s)
- F Da Riz
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - D Pichard
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - C Maurey
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Kurtz
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Canonne
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole nationale vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France
| | - R Lavoué
- IRSD, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - C Trumel
- CREFRE, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - T Buronfosse
- VetAgro Sup, Service de Biochimie, Marcy l'Etoile 69280, France
| | - L Desquilbet
- Ecole nationale vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France
| | - G Benchekroun
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole nationale vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France.
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Menard M, Kurtz M, Duclos A, Vial J, Maurey C, Canonne-Guibert M, Fabrès V, Rosenberg D, Coyne M, Murphy R, Trumel C, Lavoué R, Benchekroun G. Description of serum symmetric dimethylarginine concentration and of urinary SDS-AGE pattern in dogs with ACTH dependent hyperadrenocorticism. Vet J 2024; 305:106108. [PMID: 38580156 DOI: 10.1016/j.tvjl.2024.106108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Serum symmetric dimethylarginine (SDMA) and patterns of urinary protein separated by sodium dodecyl sulfate agarose gel electrophoresis (SDS-AGE) have not been investigated as biomarkers in dogs with ACTH-dependent hyperadrenocorticism (ADHAC). This exploratory prospective study aimed to evaluate SDMA, serum creatinine (sCR), and SDS-AGE in dogs with ADHAC with and without proteinuria (ADHAC-P and ADHAC-nP, respectively). Thirty-five pet dogs classified as ADHAC-P (n=16), ADHAC-nP (n=6) and healthy (n=13) were included. Renal biomarkers were evaluated in all dogs at diagnosis. Baseline concentration of SDMA was not significantly different between the three groups (P = 0.15) whereas sCr was significantly lower in dogs in ADHAC dogs compared to healthy dogs (88.0 µmol/L [70.4-132.6; 79.2-114.4]) whether they had proteinuria or not (P = 0.014 and 0.002, respectively). However, baseline concentrations of sCr and SDMA were not significantly different between dogs with ADHAC-P dogs (SDMA, 8 µg/dL [5-12; 7-9]; sCr, 57.2 µmol/L [35.2-212.2; 52.8-92.4]) and ADHAC-nP dogs (SDMA, 8.5 µg/dL [7-13; 8-10]; sCr, 70.4 µmol/L [61.6-79.2; 61.6-70.4]) (P = 0.35 and P = 0.41, respectively). Proteinuria in dogs with ADHAC-P was mainly of glomerular origin (SDS-AGE pattern: glomerular in 10/16 dogs; mixed glomerular/tubular in four dogs). In our study, SDMA was neither significantly different in dogs with ADHAC whether they were proteinuric or not, nor between ADHAC and healthy dogs. Urinary electrophoresis provides additional information to the UPC and further investigations are needed to determine whether it may help identify dogs with ADHAC-P requiring specific antiproteinuric treatment.
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Affiliation(s)
- M Menard
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Kurtz
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - A Duclos
- IRSD, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - J Vial
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - C Maurey
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Canonne-Guibert
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France
| | - V Fabrès
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - D Rosenberg
- Department of Internal Medicine, Micen Vet, Créteil, France
| | - M Coyne
- IDEXX Laboratories, Inc., Westbrook, ME, United States
| | - R Murphy
- IDEXX Laboratories, Inc., Westbrook, ME, United States
| | - C Trumel
- CREFRE, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - R Lavoué
- IRSD, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - G Benchekroun
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France.
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Pérez-López L, Mendoza P, Melián C. Effects of concurrent canine Cushing's syndrome and diabetes Mellitus on insulin requirements, trilostane dose, and survival time. Res Vet Sci 2023; 161:62-68. [PMID: 37321012 DOI: 10.1016/j.rvsc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
Trilostane and insulin requirements and survival time of dogs with concurrent naturally-occurring Cushing's syndrome (CS) and diabetes mellitus (DM) has not been fully investigated. This retrospective study evaluated trilostane and insulin doses in dogs with concurrent CS and DM compared to dogs with only CS or DM. Additionally, a survival analysis was performed using a Kaplan-Meier survival curve. Survival time was compared through Log-rank test. Cox proportional regression method was used to screen predictor factors of death in dogs with CS, DM or concurrent CS and DM. A total of 95 dogs were included, 47 dogs had CS, 31 dogs had DM and 17 dogs had concurrent CS and DM. After long-term follow-up, dogs with concurrent CS and DM required higher final median doses of insulin than dogs with DM [0.90 (0.73-1.1) vs 0.67 (0.55-0.73) u/kg/12 h; P = 0,002]. Conversely, the median trilostane requirements in dogs with concurrent CS and DM did not differ from the median trilostane requirements of dogs with CS [1.52 (0.76-2.80) vs 1.64 (1.19-4.95) mg/kg/day; P = 0.283]. No statistical difference was found for the median survival time between dogs with CS and dogs with concurrent CS and DM (1245 vs 892 days; p = 0.152). Although, median survival time of dogs with DM was not reached, it was longer than median survival time of dogs with CS and DM (892 days; P = 0.002). In conclusion, diabetic dogs with concurrent CS need higher insulin doses and have a shorter survival time compared to diabetic dogs without CS.
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Affiliation(s)
- L Pérez-López
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Spain
| | - P Mendoza
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413, Arucas, Las Palmas, Spain
| | - C Melián
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Spain; Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413, Arucas, Las Palmas, Spain; Clínica Veterinaria Atlántico - VetPartners, Pi y Margall, 42, 35006 Las Palmas de Gran Canaria, Spain.
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Lamb CR. Applying the concept of major and minor findings: guidance for trainees and exam candidates. Vet Radiol Ultrasound 2022; 63:649-652. [PMID: 35959995 DOI: 10.1111/vru.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 01/07/2023] Open
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Melián C, Blanco B, Ginel PJ, Pérez-López L. Evaluation of the ACTH stimulation test using a low dose of a depot formulation in healthy dogs and in dogs with untreated Cushing's syndrome. Res Vet Sci 2022; 152:207-211. [PMID: 35994839 DOI: 10.1016/j.rvsc.2022.08.010] [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: 09/28/2021] [Revised: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
The sensitivity of the adrenocorticotropic hormone (ACTH) stimulation test to detect Cushing's Syndrome (CS) using a depot formulation needs to be evaluated. The aims of this study were to propose a reference interval (RI) for cortisol values 1-hour after administration of a low-dose of depot ACTH in healthy dogs, and to evaluate the sensitivity of this test to detect CS, differentiating among types of CS based on ultrasound findings. Forty-one healthy dogs (20 males, 21 females) were prospectively included. Additionally, 90 dogs with CS (31 males, 59 females) were retrospectively included. Dogs with CS were ultrasonographically classified as follows: 44 dogs with symmetrical adrenomegaly consistent with pituitary-dependent hypercortisolism (PDH), 8 dogs with unilateral adrenomegaly and atrophy of the contralateral adrenal gland or unilateral or bilateral adrenomegaly with malignancy features consistent with adrenal-dependent hypercortisolism (ADH), 34 dogs with equivocal adrenal asymmetry (EAA) and 4 dogs with normal adrenal thickness. In healthy dogs, lower and upper limit of the 95% RI for 1-hour post-ACTH cortisol concentration and their 90% confidence intervals, were 4.4 (2.7-5.8) μg/dl and 18.4 (16.5-20.0) μg/dl, respectively. Post-ACTH cortisol concentration was above the RI in 90.0% (ci95%, 76.1-100) of dogs with CS. An elevated post-ACTH cortisol concentration was detected in 95.5% (ci95%, 76.1-100) of dogs with PDH, 62.5% (ci95%, 46.1-78.9) of dogs with ADH and 88.2% (ci95%, 69.1-100) of dogs with EAA. The sensitivity of the ACTH stimulation test using a low-dose of depot ACTH in high in dogs with CS.
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Affiliation(s)
- Carlos Melián
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35413 Arucas, Las Palmas, Spain; University Institute of Biomedical and Health Research, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Beatriz Blanco
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, University of Córdoba, 14005 Córdoba, Spain
| | - Pedro J Ginel
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, University of Córdoba, 14005 Córdoba, Spain
| | - Laura Pérez-López
- University Institute of Biomedical and Health Research, Paseo Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria, Spain.
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Lee D, Yun T, Koo Y, Chae Y, Chang D, Yang MP, Kang BT, Kim H. 18F-FDG PET/CT image findings of a dog with adrenocortical carcinoma. BMC Vet Res 2022; 18:15. [PMID: 34980137 PMCID: PMC8722145 DOI: 10.1186/s12917-021-03102-6] [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: 04/07/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background In human medicine, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been used to differentiate between benign and malignant adrenal tumors and to identify metastases. However, canine adrenocortical carcinomas identified by 18F-FDG PET/computed tomography (CT) have not been reported. Case presentation A 13-year-old, castrated male, Cocker Spaniel dog with severe systolic hypertension exhibited an adrenal mass approximately 3.6 cm in diameter on ultrasonography. There was no evidence of pulmonary metastasis or vascular invasion on thoracic radiography and abdominal ultrasonography, respectively. 18F-FDG PET/CT was performed to identify the characteristics of the adrenal mass and the state of metastasis. One hour after injection of 5.46 MBq/kg 18F-FDG intravenously, the peripheral region of the adrenal mass visually revealed an increased 18F-FDG uptake, which was higher than that of the liver, and the central region of the mass exhibited necrosis. The maximal standardized uptake value (SUV) of the adrenal mass was 3.24; and relative SUV, calculated by dividing the maximal SUV of the adrenal tumor by the mean SUV of the normal liver, was 5.23. Adrenocortical carcinoma was tentatively diagnosed and surgical adrenalectomy was performed. Histopathologic examination of the resected adrenal mass revealed the characteristics of an adrenocortical carcinoma. After adrenalectomy, systolic blood pressure reduced to below 150 mmHg without any medication. Conclusion This is the first case report of 18F-FDG PET/CT findings in a dog with suspected adrenocortical carcinoma and may provide valuable diagnostic information for adrenocortical carcinoma in dogs.
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Affiliation(s)
- Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Dongwoo Chang
- Department of Veterinary Imaging, Veterinary Teaching Hospital, College of Veterinary Medicine, Cheongju, Chungbuk, 28644, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea.
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Tanaka S, Suzuki S, Sato A, Teshima T, Mori A, Sako T, Tanaka A, Hara Y. Utility of a corticotropin-releasing hormone test to differentiate pituitary-dependent hyperadrenocorticism from cortisol-producing adrenal tumors in dogs. J Vet Intern Med 2021; 36:29-38. [PMID: 34859496 PMCID: PMC8783340 DOI: 10.1111/jvim.16336] [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: 02/03/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hyperadrenocorticism (HAC) is a common endocrine disorder in dogs; however, there are no reports on the use of the corticotropin‐releasing hormone test (CRHT) to differentiate between pituitary‐dependent hyperadrenocorticism (PDH) and cortisol‐producing adrenal tumors (CPATs), both causative of HAC. Objectives To evaluate the usefulness of CRHT as a tool to differentiate between PDH and CPAT in dogs and to determine the reference intervals for CRHT in healthy, PDH, and CPAT dogs. Animals Dogs diagnosed with PDH (n = 21), CPAT (n = 6), and healthy beagle dogs (n = 33). Methods This prospective study included dogs with a definitive diagnosis of PDH and CPAT and healthy beagle dogs, in which CRHT was performed, were prospectively evaluated. We investigated the correlations of CRHT (endogenous adrenocorticotropic hormone [ACTH] concentration, endogenous ACTH concentration [EAC], and poststimulation ACTH concentration [PAC]) with pituitary‐to‐brain ratio (PBR) (in PDH) and with indices of adrenal ultrasonography (smaller and larger adrenal gland dorsoventral thickness in PDH and CPAT). Results For EAC, the area under the curve (AUC) was 0.95, with a cutoff value of 26.3 pg/mL (sensitivity: 90.62%, specificity: 87.50%). The AUC for PAC was 0.96 with a cutoff value of 54.5 pg/mL (sensitivity: 100.00%, specificity: 66.67%). The 95% reference interval for CRHT in healthy (control) dogs ranged 5.00 to 79.8 pg/mL (1.10‐17.57 pmol/L) for EAC, and 1.92 to 153.42 pg/mL (0.42‐33.78 pmol/L) for PAC. There was no significant correlation between PBR and CRHT, nor adrenal size and CRHT. Conclusions and Clinical Importance CRHT appears to be a rapid and reliable test for differentiating PDH from CPAT in dogs.
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Affiliation(s)
- Sachiyo Tanaka
- Faculty of Veterinary Science, Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Shuji Suzuki
- Faculty of Veterinary Science, Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Asaka Sato
- Faculty of Veterinary Science, Azabu University Veterinary Teaching Hospital, Kanagawa, Japan
| | - Takahiro Teshima
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Akihiro Mori
- Faculty of Veterinary Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Toshinori Sako
- Faculty of Veterinary Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Aki Tanaka
- Faculty of Veterinary Science, Laboratory of Wildlife Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yasushi Hara
- Faculty of Veterinary Science, Laboratory of Veterinary Surgery, Nippon Veterinary and Life Science University, Tokyo, Japan
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Lauteri E, Mariella J, Beccati F, Roelfsema E, Castagnetti C, Pepe M, Peric T, Barbato O, Montillo M, Rouge S, Freccero F. Adrenal Gland Ultrasonographic Measurements and Plasma Hormone Concentrations in Clinically Healthy Newborn Thoroughbred and Standardbred Foals. Animals (Basel) 2021; 11:ani11061832. [PMID: 34205258 PMCID: PMC8233797 DOI: 10.3390/ani11061832] [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: 05/28/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary The hypothalamic–pituitary–adrenal axis regulates many physiologic and metabolic functions and plays a central role in the inflammatory response to illness. Clinically, hypothalamic–pituitary–adrenal axis function can be evaluated by combined assessment of adrenal hormones, adrenocorticotropin plasma concentrations and ultrasonographic examination of the adrenal glands in other species. Multiple individual variables have been demonstrated to affect ultrasonographic measurements of adrenal glands in several species. Ultrasonographic measurements of the adrenal glands and plasma concentration of adrenocorticotropin, cortisol, dehydroepiandrosterone, progesterone, aldosterone and adrenocorticotropin/adrenal hormone ratios were assessed and compared between Thoroughbred and Standardbred healthy neonatal foals. The effect of age, weight and sex on ultrasonographic measurements of the adrenal glands was also investigated. The width of whole adrenal glands and the medulla differed significantly between Thoroughbreds and Standardbreds. Cortisol and adrenocorticotropin were, respectively, higher and lower in Thoroughbreds than in Standardbreds. The cortisol/dehydroepiandrosterone ratio was higher in Thoroughbreds than in Standardbreds. The results of this study provide reference ranges for healthy neonatal Thoroughbred and Standardbred foals and suggest the presence of breed-related differences in ultrasonographic measurements, plasmatic cortisol and adrenocorticotropin concentrations. The higher cortisol/dehydroepiandrosterone ratio of Thoroughbred foals may suggest a different response to stress and environmental stimulation between the two breeds. Abstract Adrenal hormones, ACTH plasma concentrations and the ultrasonographic evaluation of the adrenal glands are considered complementary in clinical evaluations of the hypothalamic–pituitary–adrenal (HPA) axis function in several species. In dogs, age, size and weight have a significant effect on the ultrasonographic size of the adrenal glands. In neonatal foals, ultrasonographic evaluation and measurements of the adrenal glands have been demonstrated to be reliable; however, the effect of individual variables on ultrasonographic features has not been investigated, and the clinical usefulness of adrenal gland ultrasonography is still not known. The aims of this study were: (i) to provide and compare adrenal glands ultrasound measurements in healthy newborn Thoroughbred and Standardbred foals, and assess any effect of age, weight and sex on them; (ii) to assess and compare ACTH and steroid hormone concentrations in healthy neonatal foals of the two breeds. Venous blood samples and ultrasonographic images of the adrenal glands were collected from 10 healthy neonatal Thoroughbred and 10 healthy neonatal Standardbred foals. Ultrasonographic measurements of the adrenal glands were obtained and adrenocorticotropin (ACTH), cortisol, dehydroepiandrosterone (DHEA), progesterone (P4) and aldosterone plasma concentrations were assessed. The ACTH/cortisol, ACTH/progesterone, ACTH/aldosterone, ACTH/DHEA and cortisol/DHEA ratios were calculated. A significant positive correlation was found between the height of the right adrenal gland and the foal’s weight; the width of the right and left adrenal gland and the medulla was significantly lower in Thoroughbreds than in Standardbreds. Cortisol and ACTH plasma concentrations were significantly higher and lower, respectively, in Thoroughbreds compared with Standardbreds. The cortisol/DHEA ratio was significantly higher in Thoroughbreds. This study provides reference ranges for neonatal Thoroughbred and Standardbred foals, and suggests the presence of breed-related differences in ultrasonographic adrenal gland measurements, plasmatic cortisol and ACTH concentrations. The higher cortisol/DHEA ratio detected in Thoroughbred foals could suggest a different response to environmental stimulation in the two breeds.
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Affiliation(s)
- Eleonora Lauteri
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (F.B.); (M.P.); (O.B.); (S.R.)
- Clinèquine, VetAgro Sup, University of Lyon, 1 Avenue Bourgelat, Marcy-l’Etoile, 69280 Lyon, France
- Correspondence: ; Tel.: +39-340-924-9803
| | - Jole Mariella
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (J.M.); (C.C.); (F.F.)
| | - Francesca Beccati
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (F.B.); (M.P.); (O.B.); (S.R.)
| | - Ellen Roelfsema
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands;
| | - Carolina Castagnetti
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (J.M.); (C.C.); (F.F.)
- Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, 40126 Bologna, Italy
| | - Marco Pepe
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (F.B.); (M.P.); (O.B.); (S.R.)
| | - Tanja Peric
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, Via Sondrio 2/B, 33100 Udine, Italy; (T.P.); (M.M.)
| | - Olimpia Barbato
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (F.B.); (M.P.); (O.B.); (S.R.)
| | - Marta Montillo
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, Via Sondrio 2/B, 33100 Udine, Italy; (T.P.); (M.M.)
| | - Stefanie Rouge
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (F.B.); (M.P.); (O.B.); (S.R.)
| | - Francesca Freccero
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (J.M.); (C.C.); (F.F.)
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Muñoz-Prieto A, Rubić I, Horvatic A, Rafaj RB, Cerón JJ, Tvarijonaviciute A, Mrljak V. Metabolic profiling of serum from dogs with pituitary-dependent hyperadrenocorticism. Res Vet Sci 2021; 138:161-166. [PMID: 34147706 DOI: 10.1016/j.rvsc.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/09/2021] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
Hyperadrenocorticism (HAC) is one of the most common endocrine diseases in dogs characterized by excessive cortisol production caused by an adrenocorticotropic hormone (ACTH)-secreting tumor, namely pituitary-dependent HAC (PDH) or cortisol-secreting adrenal tumor. Metabolomics presents the ability to identify small molecule metabolites. Thus, the use of metabolomics techniques in canine PDH can provide information about the pathophysiology and metabolic changes in this disease. This study aimed to identify and compare differences in serum metabolites between dogs with PDH and healthy dogs. The metabolomic profile of 20 dogs diagnosed with PDH was compared with 20 healthy dogs using liquid chromatography/mass spectrometry (LC/MS), and metabolite discrimination was performed using partial least squares-discriminant analysis (PLS-DA), the variable important in projection (VIP) and fold changes (FC) group-wise comparisons. The hypergeometric test identified the significantly altered pathways. A total of 21 metabolites were found to be significantly different between the two groups. The major alterations were found in arachidonic and decanoic acid, and phospholipids related to phosphatidylcholine (PC), phosphatidylethanolamine (PE) and phosphatidylinositol (PI). These metabolites are related to insulin resistance and other complications (i.e. hypertension). Our results indicate that PDH produces changes in serum metabolites of dogs, and the knowledge of these changes can aid to better understanding of pathophysiological processes involved and contribute to potentially detect new biomarkers for this disease.
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Affiliation(s)
- Alberto Muñoz-Prieto
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, Zagreb 10000, Croatia
| | - Ivana Rubić
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, Zagreb 10000, Croatia
| | - Anita Horvatic
- Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia
| | - Renata Baric Rafaj
- Department for Chemistry and Biochemistry, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - José Joaquín Cerón
- Interlab-UMU, Regional Campus of International Excellence "Mare Nostrum", University of Murcia, Murcia 30100, Spain
| | - Asta Tvarijonaviciute
- Interlab-UMU, Regional Campus of International Excellence "Mare Nostrum", University of Murcia, Murcia 30100, Spain.
| | - Vladimir Mrljak
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, Zagreb 10000, Croatia
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10
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Frank LA, Morandi F. Vitamin A failed to ameliorate clinical signs in dogs with pituitary-dependent hypercortisolaemia. Vet Dermatol 2021; 32:371-e104. [PMID: 33720445 DOI: 10.1111/vde.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In dogs with pituitary-dependent hypercortisolaemia, retinoic acid was shown to lower cortisol, reduce pituitary tumour size and decrease clinical signs when administered for six months. Oral vitamin A (retinol) has been used to treat various canine dermatoses in which retinoic acid has been efficacious. OBJECTIVES To determine if orally administered vitamin A lowers cortisol and reduces clinical signs in dogs with pituitary-dependent hypercortisolaemia over a five month period. METHODS AND MATERIALS Five dogs were enrolled in this study. Diagnosis of hypercortisolaemia was based on the presence of at least three clinical signs and one abnormal screening test. Diagnosis of pituitary-dependent disease was based on low dose dexamethasone suppression (LDDS) test results and symmetrical adrenal glands on ultrasound. Adrenocorticotropic hormone (ACTH) stimulation testing and adrenal ultrasound were performed at each visit. Plasma was collected at each visit and stored at -80°C for batch analysis of endogenous ACTH at conclusion of the study. RESULTS Four dogs completed the study. A fifth dog died from complications of hypercortisolaemia before the third month. One dog showed improvement in clinical signs, yet there was no significant decrease in adrenal gland size or cortisol concentrations. Endogenous ACTH concentrations at the fifth month were decreased from baseline in two dogs and increased from baseline in one dog. The treatment had no adverse effects. CONCLUSIONS AND CLINICAL IMPORTANCE Results from this study failed to show an improvement in clinical signs or cortisol concentration after five months of oral daily vitamin A in dogs with hypercortisolaemia.
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Affiliation(s)
- Linda A Frank
- Department Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Drive, Knoxville, TN, 37996, USA
| | - Federica Morandi
- Department Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Drive, Knoxville, TN, 37996, USA
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11
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Zeugswetter FK, Carranza Valencia A, Glavassevich K, Schwendenwein I. Patterns of the low-dose dexamethasone suppression test in canine hyperadrenocorticism revisited. Vet Clin Pathol 2021; 50:62-70. [PMID: 33728722 PMCID: PMC8252562 DOI: 10.1111/vcp.12958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The low-dose dexamethasone suppression test (LDDT) is considered an accurate screening and valuable differentiation test in dogs with suspected hyperadrenocorticism (HAC). A recent study showed that the different response patterns not only provide complementary information about etiology, but also the probability of HAC in these patients. OBJECTIVES We aimed to determine the diagnostic test performance of LDDT response patterns in a population of dogs from an animal hospital. METHODS The electronic database was retrospectively searched for dogs suspected of HAC that were given an LDDT. Dogs with acute non-adrenal illnesses during the test were excluded. Response patterns were classified as complete suppression, lack of suppression, partial suppression, escape, inverse, and increasing patterns. Cortisol concentrations ≥ 27.59 nmol/L (≥1 µg/dL) 8 hours after dexamethasone administration were considered positive results irrespective of the patterns observed. Calculations included likelihood ratios (LRs) and predictive values (PVs). RESULTS HAC and non-adrenal illness were diagnosed in 115 (54%) and 62 (46%) dogs, respectively. The positive (+) LRs (95% CI) for the lack of suppression, partial suppression, escape, and an inverse pattern to diagnose HAC were infinite, 8.09 (2-32.72), 3.23 (0.75-14), and 0.2 (0.06-0.73), respectively. CONCLUSIONS The study confirms that the "lack of suppression" pattern strongly supports a diagnosis of HAC. It shows that the "partial suppression" pattern moderately increases, and the "inverse" pattern decreases the likelihood of HAC. The fact that the study found no association between the "escape" pattern and a diagnosis of HAC, does not support its integration into decision making.
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Affiliation(s)
- Florian K Zeugswetter
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Kerstin Glavassevich
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ilse Schwendenwein
- Department of Pathobiology, Central Laboratory, University of Veterinary Medicine Vienna, Vienna, Austria
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12
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Melián C, Pérez-López L, Saavedra P, Ravelo-García AG, Santos Y, Jaber JR. Ultrasound evaluation of adrenal gland size in clinically healthy dogs and in dogs with hyperadrenocorticism. Vet Rec 2021; 188:e80. [PMID: 33891740 DOI: 10.1002/vetr.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Precise reference intervals of adrenal gland thickness are required for detection of adrenomegaly in dogs with hyperadrenocorticism (HAC). METHODS Eighty-six clinically healthy dogs were prospectively included, and 91 dogs with untreated HAC were retrospectively evaluated. Dorso-ventral adrenal gland thickness was ultrasonographically measured on the sagittal plane. Dogs were classified into four body weight categories, and those with HAC were also ultrasonographically classified as consistent with pituitary-dependent HAC (PDH), adrenal-dependent HAC (FAT), equivocal adrenal asymmetry (EAA), or normal adrenal thickness. RESULTS The upper limits for left adrenal gland in clinically healthy dogs were 5.1 mm (≥2.5-5 kg), 5.5 mm (>5-10 kg), 6.4 mm (>10-20 kg), and 7.3 mm (>20-40 kg), and for right adrenal gland the upper limits were 5.3 mm (≥2.5-5 kg), 6.8 mm (>5-10 kg), 7.5 mm (>10-20 kg), and 8.7 mm (>20-40 kg). The sensitivity of ultrasound to detect adrenomegaly in dogs with HAC was 95.6%. Most dogs with HAC (56.0%) had ultrasound findings consistent with either PDH or FAT; however, EAA was commonly occurring in 39.6% of dogs with HAC. CONCLUSIONS The sensitivity of ultrasonography to detect adrenomegaly in dogs with HAC is high when using four weight categories. EAA is common in dogs with HAC.
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Affiliation(s)
- Carlos Melián
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,University Institute of Biomedical and Health Research, Las Palmas de Gran Canaria, Spain
| | - Laura Pérez-López
- University Institute of Biomedical and Health Research, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio G Ravelo-García
- Institute for Technological Development and Innovation in Communications, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Yaiza Santos
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - José Raduan Jaber
- Department of Morphology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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13
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Soler Arias EA, Trigo RH, Miceli DD, Vidal PN, Hernandez Blanco MF, Castillo VA. Urinary vanillylmandelic acid:creatinine ratio in dogs with pheochromocytoma. Domest Anim Endocrinol 2021; 74:106559. [PMID: 32980593 DOI: 10.1016/j.domaniend.2020.106559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Pheochromocytoma diagnosis in dogs is challenging because biochemical tests are not always available. In humans, urinary vanillylmandelic acid (VMA) is part of a pheochromocytoma biochemical diagnostic profile, whereas its diagnostic accuracy is currently unknown in dogs with pheochromocytoma. Prospectively, VMA was determined by HPLC and expressed as the ratio with respect to urinary creatinine (VMA:C). The diagnostic accuracy of the VMA:C ratio was evaluated by analyzing the receiver operating characteristic (ROC) curve in 10 healthy dogs, 8 dogs with pituitary-dependent hypercortisolism, 8 dogs with adrenal-dependent hypercortisolism, and 7 dogs with pheochromocytoma. The pheochromocytoma diagnosis was confirmed by histology and immunohistochemistry in all tumors. The VMA:C ratio was significantly higher in dogs with pheochromocytoma (158 [53.4 to 230.8] × 10-3) than in dogs with adrenal-dependent hypercortisolism (48.1 [24.3 to 144.9] × 10-3; P < 0.05), dogs with pituitary-dependent hypercortisolism (37.5 [32 to 47.1] × 10-3; P < 0.001), and healthy dogs (33.8 [13.3 to 87.9] × 10-3; P < 0.001). When using a VMA:C ratio >58.2 × 10-3 for pheochromocytoma diagnosis, a sensitivity of 85.7% and a specificity of 88.4% were obtained. Nevertheless, when using a cut-off ratio of 4 times the median VMA:C ratio determined in healthy dogs, there was no overlap (100% specificity). The area under the ROC curve indicated that the VMA:C ratio test could be used to discriminate between dogs with and without pheochromocytoma, what leads to the conclusion that it is useful for pheochromocytoma diagnosis in dogs.
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Affiliation(s)
- E A Soler Arias
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Av. Chorroarín 280 (1427), Ciudad Autónoma de Buenos Aires, Argentina; Endovett, Endocrinología Veterinaria, 3 de febrero 975 9B (1426), Ciudad Autónoma de Buenos Aires, Argentina.
| | - R H Trigo
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de patología, Av. San Martín 5285 (1427), Ciudad Autónoma de Buenos Aires, Argentina
| | - D D Miceli
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Av. Chorroarín 280 (1427), Ciudad Autónoma de Buenos Aires, Argentina
| | - P N Vidal
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Av. Chorroarín 280 (1427), Ciudad Autónoma de Buenos Aires, Argentina
| | - M F Hernandez Blanco
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Av. Chorroarín 280 (1427), Ciudad Autónoma de Buenos Aires, Argentina
| | - V A Castillo
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Clínica Médica de Pequeños Animales, Hospital Escuela de Medicina Veterinaria-U. Endocrinología, Av. Chorroarín 280 (1427), Ciudad Autónoma de Buenos Aires, Argentina
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Antibody Response to Canine Parvovirus Vaccination in Dogs with Hyperadrenocorticism Treated with Trilostane. Vaccines (Basel) 2020; 8:vaccines8030547. [PMID: 32961758 PMCID: PMC7563131 DOI: 10.3390/vaccines8030547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
It is unknown how dogs with hyperadrenocorticism (HAC) respond to vaccination. This study measured antibodies against canine parvovirus (CPV) in dogs with HAC treated with trilostane before and after CPV vaccination, and compared the immune response to that from healthy dogs. Eleven dogs with HAC, and healthy age-matched control dogs (n = 31) received a modified-live CPV vaccine. Antibodies were determined on days 0, 7, and 28 by hemagglutination inhibition. Univariate analysis was used to compare the immune response of dogs with HAC and healthy dogs. Pre-vaccination antibodies (≥10) were detected in 100% of dogs with HAC (11/11; 95% CI: 70.0–100) and in 93.5% of healthy dogs (29/31; 95% CI: 78.3–99.2). No ≥4-fold increase in antibody titer was observed in dogs with HAC while in 22.6% of healthy dogs, a ≥4-fold titer increase was observed (7/31; 95% CI: 11.1–40.1). Mild vaccine-associated adverse events (VAAEs) were detected in 54.5% of dogs with HAC (6/11; 95% CI: 28.0–78.8) and in 29.0% of healthy dogs (9/31; 95% CI: 15.9–46.8). There was neither a significant difference in presence of pre-vaccination antibodies (p = 1.000), or response to vaccination (p = 0.161), nor in the occurrence of VAAEs (p = 0.158). Immune function of dogs with HAC treated with trilostane seems comparable to that of healthy dogs.
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15
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Diagnostic contribution of individual components of adrenal function tests to diagnose canine hyperadrenocorticism. Vet J 2020; 263:105520. [PMID: 32928489 DOI: 10.1016/j.tvjl.2020.105520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022]
Abstract
There is limited information regarding the value of constitutive components of the ACTH stimulation test (ACTHST) and low-dose dexamethasone suppression test (LDDST) including serum baseline cortisol (BC), difference between post-ACTH stimulation cortisol (PC) and BC (ΔACTHC), cortisol concentration 4h after dexamethasone administration (4HC), difference between 4HC and BC (Δ4C), and the difference between cortisol concentration 8h after dexamethasone administration and 4HC (Δ8C). Therefore, the objective of this study was to determine if these components can predict hyperadrenocorticism, pituitary-dependent hyperadrenocorticism (PDH), or functional adrenocortical tumor (FAT) in dogs. Cortisol concentrations were normalized, as fold change (FC), to the PC reference interval upper limit. A total of 1267 dogs were included, with hyperadrenocorticism diagnosed in 537 (PDH, n=356; FAT, n=28; undetermined, n=153) and excluded in 730. The area under the receiver operating curves for BC, ΔACTHC, 4HC, Δ4C, and Δ8C to predict hyperadrenocorticism were 0.76 (95% confidence interval (CI), 0.73-0.79), 0.91 (95% CI, 0.89-0.93), 0.83 (95% CI, 0.80-0.87), 0.55 (95% CI, 0.50-0.60), and 0.67 (95% CI, 0.62-0.72), respectively. A diagnostic limit of ≥0.78 FC for ΔACTHC had excellent sensitivity (1.00; 95% CI, 0.74-1.00), but poor specificity (0.67; 95% CI, 0.64-0.71), to predict FAT in dogs with a positive ACTHST. A diagnostic limit of ≥-0.26 FC for Δ4C had excellent sensitivity (1.00; 95% CI, 0.79-1.00), but poor specificity (0.21; 95% CI, 0.18-0.26), to predict FAT in dogs with a positive LDDST. In hyperadrenocorticoid dogs that have positive ACTHST or LDDST results, ΔACTHC or Δ4C, respectively, could be used to exclude FAT.
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16
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García San José P, Arenas Bermejo C, Clares Moral I, Cuesta Alvaro P, Pérez Alenza MD. Prevalence and risk factors associated with systemic hypertension in dogs with spontaneous hyperadrenocorticism. J Vet Intern Med 2020; 34:1768-1778. [PMID: 32614466 PMCID: PMC7517838 DOI: 10.1111/jvim.15841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Systemic hypertension (SH) is common in dogs with hyperadrenocorticism (HAC) however there are not many studies assessing its prevalence and risk factors. Objectives To determine the prevalence and severity of SH in dogs with HAC and its association with clinical and laboratory findings to identify potential risk factors. Animals Sixty‐six client owned dogs with spontaneous HAC. Methods Retrospective cross‐sectional study. Medical records of dogs with HAC were reviewed. Systolic blood pressure (SBP) was measured using Doppler ultrasonography. Clinical signs, physical examination findings and clinicopathologic data (CBC, serum biochemistry and electrolytes, urinalysis and urinary culture, and adrenal function tests) were reviewed for analysis. Results Prevalence of SH (≥150 mm Hg) was 82% (54/66) and prevalence of severe SH (≥180 mm Hg) was 46% (30/66). All dogs with thrombocytosis had SH (P = .002), and a platelet count ≥438 × 103/μL was 100% specific and 61.1% sensitive to predict SH (AUC = .802, P = .001). Median potassium levels were lower in hypertensive dogs (4.1 mEq/L, range 3.1‐5.4 mEq/L) than in normotensive ones (4.5 mEq/L, range 4.0‐5.0 mEq/L) (P = .007). Dogs with UPC ≥ 0.5 had higher median SBP than those without proteinuria (P = .03). Dogs with concurrent diabetes mellitus seemed to have a reduced risk of SH (OR = .118, 95%CI = .022‐.626, P = .02). Conclusions and Clinical Importance Systemic hypertension is common in dogs with HAC and is frequently severe. Blood pressure should be routinely assessed in these dogs, especially if thrombocytosis, proteinuria or low potassium concentrations are present.
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Affiliation(s)
- Paula García San José
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | | | - Irene Clares Moral
- Veterinary Teaching Hospital Complutense, Complutense University of Madrid, Madrid, Spain
| | - Pedro Cuesta Alvaro
- Data Processing Center, Department of Political and Public Administration Sciences II, Political Sciences Faculty, Complutense University of Madrid, Madrid, Spain
| | - María Dolores Pérez Alenza
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
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17
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Pey P, Diana A, Rossi F, Mortier J, Kafka U, Veraa S, Groth A, MacLellan M, Marin C, Fracassi F. Safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal lesions in dogs: Perception of the procedure by radiologists and presentation of 50 cases. J Vet Intern Med 2020; 34:626-635. [PMID: 32159260 PMCID: PMC7096638 DOI: 10.1111/jvim.15743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
Background Percutaneous ultrasound (US)‐guided fine‐needle aspiration (FNA) of adrenal gland lesions is controversial in veterinary medicine. Objective To evaluate the frequency and radiologists' perception of the risk of the procedure as well as determining the incidence of complications. Methods Retrospective study. A first survey was submitted by e‐mail to all board‐certified radiologists of the American College of Veterinary Radiology (ACVR) and European College of Veterinary Diagnostic Imaging (ECVDI). A second survey was sent to radiologists who declared having performed the procedure at least once in their career (observational cross‐sectional case study). Results The first survey was sent to 977 diplomates and answered by 138. Of 138 diplomates, 40 currently performed the procedure and 98 did not; 44 of the 98 gave the hypertensive crisis risk in pheochromocytoma as a reason. To the second survey, 12 of 65 responded positively; 50 dogs with 58 lesions were recruited, including 23 pheochromocytomas. Complications were reported in 4 of 50 dogs; 3 hemorrhages (1 mild and 1 moderate) and 1 death from acute respiratory distress syndrome (possibly related to laryngeal paralysis). No hypertensive crisis was reported. There was no relationship between the method of FNA/type of needle used and occurrence of complications. Based on the recollection of these 65 radiologists, who performed approximately 200 FNA of adrenal lesions, a death rate of approximately 1% was estimated. Conclusions and Clinical Importance Percutaneous US‐guided FNA of adrenal lesions can be considered a minimally risky procedure, despite the negative perception by radiologists.
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Affiliation(s)
- Pascaline Pey
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessia Diana
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Jeremy Mortier
- Service of Diagnostic Imaging, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Ulrike Kafka
- James Cook University, Townsville, Queensland, Australia
| | - Stefanie Veraa
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht, The Netherlands
| | - Anna Groth
- North Downs Specialist Referrals, Bletchingley, United Kingdom
| | | | - Chiara Marin
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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18
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Bennaim M, Shiel RE, Mooney CT. Diagnosis of spontaneous hyperadrenocorticism in dogs. Part 2: Adrenal function testing and differentiating tests. Vet J 2019; 252:105343. [PMID: 31554584 DOI: 10.1016/j.tvjl.2019.105343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/07/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
Hyperadrenocorticism is a relatively common endocrine disorder in dogs that has been extensively described. However, its diagnosis remains challenging because there is no true reference standard test, and a myriad factors can affect the diagnostic performance of the commonly used adrenal function tests. Ultimately, the diagnosis is based on a combination of signalment, history and clinical findings, and a variety of diagnostic test results. The second part of this review aims to appraise available data on diagnostic performance of adrenal function tests in naturally occurring canine hyperadrenocorticism.
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Affiliation(s)
- Michael Bennaim
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland.
| | - Robert E Shiel
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
| | - Carmel T Mooney
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
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19
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Bennaim M, Shiel RE, Mooney CT. Diagnosis of spontaneous hyperadrenocorticism in dogs. Part 1: Pathophysiology, aetiology, clinical and clinicopathological features. Vet J 2019; 252:105342. [PMID: 31554593 DOI: 10.1016/j.tvjl.2019.105342] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
Abstract
Hyperadrenocorticism is a relatively common endocrine disorder in dogs. It occurs as a result of a functional pituitary or adrenal tumour, although other causes have been rarely reported. Canine hyperadrenocorticism has been extensively described but diagnosing this disease remains challenging. Few studies have investigated the clinical and clinicopathological features helpful in differentiating dogs with hyperadrenocorticism from dogs in which the disease is suspected but eventually excluded. Ultimately the diagnosis is based on a combination of multiple pieces of information emanating from the signalment, history, clinical findings, and a variety of diagnostic tests. The first part of this review aims to critically appraise the available data on epidemiology, clinical and laboratory features of naturally occurring canine hyperadrenocorticism.
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Affiliation(s)
- Michael Bennaim
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland.
| | - Robert E Shiel
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
| | - Carmel T Mooney
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
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20
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Ghavidel M, Mirshahi A, Azizzadeh M, Khoshnegah J. Evaluating the correlation between adrenal gland dimensions and aortic diameter in healthy dogs. Anat Histol Embryol 2019; 48:325-333. [PMID: 31006908 DOI: 10.1111/ahe.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/15/2019] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Abstract
In the present study, the relationship of normal adrenal dimensions with weight, aortic diameter, age and sex was evaluated. Moreover, a formula for estimating the normal dimensions of adrenal gland was provided. Thirty-two intact adult dogs that were considered healthy based on history, physical examination, routine blood works and specific adrenal tests as well as absence of any abnormal ultrasonographic findings were included. Adrenal glands and abdominal aorta were imaged in the sagittal plane by ultrasound. Length, maximal height of the cranial and caudal poles, area and circumference of the left and right adrenal glands and also the internal diameter of the abdominal aorta were measured. Analysis showed that there is a positive correlation between the adrenal gland dimensions and weight and aortic diameter. The ratio of adrenal gland dimensions and the aortic diameter was calculated, but this ratio showed a great amount of variability in tandem with a significant correlation to the weight; Meaning that the ratio of the adrenal gland dimensions to the aortic diameter was not a reliable index for evaluating the size of the normal adrenal gland in animals with different weights. Therefore, we used the weight along with adrenal measurements in a linear regression model, and then, we were able to estimate the adrenal gland dimensions in different weights. Knowing the relationship of normal adrenal dimensions with the indices such as weight, age, sex and diameter of abdominal aorta can help the clinicians to diagnose the adrenal gland diseases.
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Affiliation(s)
- Mahshid Ghavidel
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Mirshahi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohammad Azizzadeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Javad Khoshnegah
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
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21
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van Bokhorst KL, Kooistra HS, Boroffka SAEB, Galac S. Concurrent pituitary and adrenocortical lesions on computed tomography imaging in dogs with spontaneous hypercortisolism. J Vet Intern Med 2018; 33:72-78. [PMID: 30536676 PMCID: PMC6335443 DOI: 10.1111/jvim.15378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022] Open
Abstract
Background Spontaneous hypercortisolism or Cushing's syndrome in dogs is either pituitary or adrenal dependent, but concurrent pituitary and adrenal hypercortisolism also has been reported. Objective To determine how often concurrent pituitary and adrenal lesions are present in dogs with spontaneous hypercortisolism. Animals Two hundred one client‐owned dogs with spontaneous hypercortisolism. Methods Retrospective study. Pre‐ and post‐contrast computed tomography (CT) scans of the pituitary and adrenal glands were performed in dogs with confirmed hypercortisolism. Results In dogs with dexamethasone‐suppressible hypercortisolism (122/201), 78 dogs (64%) had an enlarged pituitary gland (median pituitary height/brain area [P/B], 0.43 × 10−2 mm−1; range, 0.32‐1.21 × 10−2 mm−1). Two of these 78 dogs had concurrent adrenal lesions. In the remaining dogs (44/122; 36%), the pituitary gland was not enlarged. In the dexamethasone‐resistant group (79/201), the pituitary gland was enlarged in 47 dogs (59%; median P/B, 0.57 × 10−2; range, 0.32‐1.50 × 10−2 mm−1). Eight of these 47 dogs (17%) had concurrent adrenal lesions. In the remaining 32 dexamethasone‐resistant dogs (41%), the pituitary gland was not enlarged. Among them, 27 dogs had adrenal lesions and suppressed ACTH concentrations consistent with adrenal‐dependent hypercortisolism and 5 dogs were diagnosed with pituitary‐dependent hypercortisolism. Conclusions and Clinical Importance Concurrent pituitary and adrenal lesions were present in 5% of all dogs with hypercortisolism and in 10% of the dexamethasone‐resistant dogs. Diagnostic imaging of both pituitary and adrenal glands should be included in the diagnostic evaluation of every dog with spontaneous hypercortisolism to obtain information needed for estimation of prognosis and choosing the optimal treatment.
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Affiliation(s)
- Kirsten L van Bokhorst
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Evidensia Vets & Pets Veterinary Clinics, Prinsenbeek, The Netherlands
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Susanne A E B Boroffka
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Boroffka Diagnostic Imaging, Utrecht, The Netherlands
| | - Sara Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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22
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Bennaim M, Shiel RE, Forde C, Mooney CT. Evaluation of individual low-dose dexamethasone suppression test patterns in naturally occurring hyperadrenocorticism in dogs. J Vet Intern Med 2018; 32:967-977. [PMID: 29498108 PMCID: PMC5980256 DOI: 10.1111/jvim.15079] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dogs with hyperadrenocorticism (HAC) may be more mildly affected at the time of diagnosis today, which could influence the prevalence of associated clinical and clinicopathological abnormalities and diagnostic test performance. Different low-dose dexamethasone suppression test (LDDST) result patterns have not been evaluated individually. OBJECTIVES To assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ. ANIMALS One hundred and twenty-three dogs undergoing investigation for HAC. METHODS Retrospective evaluation of dogs in which a LDDST was performed and HAC confirmed or excluded by alternative means. Cases with basal cortisol concentrations (t0 ) < 1 μg/dL were excluded. Each LDDST result was classified as (a) complete suppression (t3 and t8 < 1 μg/dL), (b) lack of suppression (t3 and t8 > 1 μg/dL and both > 50% t0 ), (c) partial suppression (t3 and t8 > 1 μg/dL but either < 50% t0 ), (d) escape (t8 > 1 μg/dL and t3 < 1 μg/dL) or (e) inverse (t3 > 1 μg/dL and t8 < 1 μg/dL) pattern. RESULTS Fifty-nine (48%) dogs were diagnosed with HAC and 64 (52%) with non-adrenal illness. Hyperadrenocorticism cases had similar clinicopathological abnormalities compared to previous reports. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (95% confidence interval [CI]) of the LDDST for diagnosing HAC were 96.6 (91.9-100)%, 67.2 (55.7-78.7)%, 73.1 (63.2-82.9)%, and 95.6 (89.5-100)%, respectively. Lack of suppression pattern had the highest PPV (93.9 [85.8-100]%) followed by the partial suppression pattern (67.9 [50.6-85.2]%) and escape or inverse pattern (36.8 [15.1-58.5]%). CONCLUSIONS AND CLINICAL IMPORTANCE A lack of suppression LDDST pattern has the highest PPV for diagnosing HAC followed by a partial suppression pattern. By contrast, the escape or inverse pattern provided limited support of HAC.
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Affiliation(s)
- Michael Bennaim
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Robert E. Shiel
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Christopher Forde
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Carmel T. Mooney
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
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23
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King J, Morton J. Incidence and risk factors for hypoadrenocorticism in dogs treated with trilostane. Vet J 2017; 230:24-29. [DOI: 10.1016/j.tvjl.2017.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022]
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24
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Fowler KM, Frank LA, Morandi F, Whittemore JC. Extended low-dose dexamethasone suppression test for diagnosis of atypical Cushing's syndrome in dogs. Domest Anim Endocrinol 2017; 60:25-30. [PMID: 28371654 DOI: 10.1016/j.domaniend.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to evaluate extension of the low-dose dexamethasone suppression (LDDS) test from 8 h to 12 h to detect possible hypercortisolemia associated with atypical hyperadrenocorticism (AHAC). Twelve client-owned dogs were enrolled in the study: 6 healthy dogs (group 1) and 6 dogs with suspected AHAC (group 2). Baseline EDTA plasma samples were collected for endogenous ACTH determination using an immunoradiometric assay. Serum samples were collected before and at 4, 8, 10, and 12 h post-administration of 0.01 mg/kg dexamethasone IV for cortisol concentration determination via chemiluminescent assay. Mean endogenous ACTH concentration did not differ between groups (group 1: 22.4 pg/mL, group 2: 20.0 pg/mL; P > 0.2). Mean baseline cortisol concentration also did not differ significantly between groups (group 1: 3.03 μg/dL, group 2: 4.95 μg/dL; P > 0.2) nor was there any difference in mean cortisol concentration between the groups at any other time point (P > 0.2). The cortisol concentration from 1 dog in group 2 suppressed to 0.7 μg/dL at 8 h but increased to 1.5 μg/dL at 10 h and 3.7 μg/dL at 12 h post-dexamethasone. Based on results of this study, use of an extended LDDS test could not differentiate between healthy dogs and dogs with AHAC. Diagnosis of AHAC should continue to be based on prior established criteria until new testing has been identified.
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Affiliation(s)
- K M Fowler
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA
| | - L A Frank
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA.
| | - F Morandi
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA
| | - J C Whittemore
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA
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25
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Nagata N, Kojima K, Yuki M. Comparison of Survival Times for Dogs with Pituitary-Dependent Hyperadrenocorticism in a Primary-Care Hospital: Treated with Trilostane versus Untreated. J Vet Intern Med 2016; 31:22-28. [PMID: 27906457 PMCID: PMC5259634 DOI: 10.1111/jvim.14617] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/02/2022] Open
Abstract
Background Although pituitary‐dependent hyperadrenocorticism (PDH) is one of the most common endocrinopathies in dogs, the effects of withholding treatment on survival time in dogs with PDH remain unclear. Hypothesis/Objectives The purpose of this study was to clarify the effects of treatment in dogs with PDH by comparing survival times between dogs treated with trilostane and untreated dogs. Animals Forty‐three dogs diagnosed with PDH at a primary‐care hospital in Japan between June 2009 and January 2014. Methods Retrospective cohort study. The medical records of dogs with PDH treated with trilostane (n = 17) or left untreated (n = 26) were reviewed retrospectively. Survival analysis at 2 years after diagnosis of PDH was performed. Results Median survival time for the trilostane group was not reached (95% confidence interval [CI], 443 days–not applicable) and was significantly longer than the 506 days (95% CI, 292–564 days; P = .016) for the untreated group. Multivariate Cox proportional hazards analysis (including age at diagnosis, basal cortisol concentration at diagnosis, and treatment group) only identified assignment to the untreated group (hazard ratio, 5.01; 95% CI, 1.63–15.44) as associated with increased mortality. Conclusions and Clinical Importance The results of this retrospective cohort study suggest that withholding treatment for dogs with PDH might be associated with a higher risk of death. This represents the largest study to date to report survival times of untreated dogs with PDH.
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Affiliation(s)
- N Nagata
- Yuki Animal Hospital, Nagoya, Aichi, Japan
| | - K Kojima
- Kojima Animal Hospital, Nagoya, Aichi, Japan.,The Asunaro Animal Hospital, Aikougun, Kanagawa, Japan
| | - M Yuki
- Yuki Animal Hospital, Nagoya, Aichi, Japan
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Pagani E, Tursi M, Lorenzi C, Tarducci A, Bruno B, Borgogno Mondino EC, Zanatta R. Ultrasonographic features of adrenal gland lesions in dogs can aid in diagnosis. BMC Vet Res 2016; 12:267. [PMID: 27894345 PMCID: PMC5126813 DOI: 10.1186/s12917-016-0895-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonography to visualize adrenal gland lesions and evaluate incidentally discovered adrenal masses in dogs has become more reliable with advances in imaging techniques. However, correlations between sonographic and histopathological changes have been elusive. The goal of our study was to investigate which ultrasound features of adrenal gland abnormalities could aid in discriminating between benign and malignant lesions. To this end, we compared diagnosis based on ultrasound appearance and histological findings and evaluated ultrasound criteria for predicting malignancy. RESULTS Clinical records of 119 dogs that had undergone ultrasound adrenal gland and histological examination were reviewed. Of these, 50 dogs had normal adrenal glands whereas 69 showed pathological ones. Lesions based on histology were classified as cortical adrenal hyperplasia (n = 67), adenocarcinoma (n = 17), pheochromocytoma (n = 10), metastases (n = 7), adrenal adenoma (n = 4), and adrenalitis (n = 4). Ultrasonographic examination showed high specificity (100%) but low sensitivity (63.7%) for identifying the adrenal lesions, which improved with increasing lesion size. Analysis of ultrasonographic predictive parameters showed a significant association between lesion size and malignant tumors. All adrenal gland lesions >20 mm in diameter were histologically confirmed as malignant neoplasms (pheochromocytoma and adenocarcinoma). Vascular invasion was a specific but not sensitive predictor of malignancy. As nodular shape was associated with benign lesions and irregular enlargement with malignant ones, this parameter could be used as diagnostic tool. Bilaterality of adrenal lesions was a useful ultrasonographic criterion for predicting benign lesions, as cortical hyperplasia. CONCLUSIONS Abnormal appearance of structural features on ultrasound images (e.g., adrenal gland lesion size, shape, laterality, and echotexture) may aid in diagnosis, but these features alone were not pathognomic. Lesion size was the most direct ultrasound predictive criterion. Large and irregular masses seemed to be better predictors of malignant neoplasia and lesions <20 mm in diameter and nodular in shape were often identified as cortical hyperplastic nodules or adenomas.
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Affiliation(s)
- Elena Pagani
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy.
| | - Massimiliano Tursi
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy
| | - Chiara Lorenzi
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy
| | - Alberto Tarducci
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy
| | - Barbara Bruno
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy
| | - Enrico Corrado Borgogno Mondino
- Department of Agriculture, Forest and Food Sciences, University of Turin, L. Paolo Braccini, 2, 10095, Grugliasco, TO, Italy
| | - Renato Zanatta
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco, TO, Italy
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27
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Pagani E, Tarducci A, Borrelli A, Iotti B, Tursi M, Zanatta R. Accuracy of Ultrasonographic Measurements of Adrenal Glands in Dogs: Comparison with Necroscopic Findings. Anat Histol Embryol 2016; 46:187-194. [DOI: 10.1111/ahe.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E. Pagani
- Section of Clinical Sciences; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
| | - A. Tarducci
- Section of Clinical Sciences; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
| | - A. Borrelli
- Section of Clinical Sciences; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
| | - B. Iotti
- Section of Epidemiology; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
| | - M. Tursi
- Section of Anatomic Pathology; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
| | - R. Zanatta
- Section of Clinical Sciences; Department of Veterinary Sciences; University of Turin; L. Paolo Braccini 2 10095 Grugliasco TO Italy
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28
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O'Neill DG, Scudder C, Faire JM, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary-care veterinary practices in the UK from 2009 to 2014. J Small Anim Pract 2016; 57:365-73. [DOI: 10.1111/jsap.12523] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Affiliation(s)
- D. G. O'Neill
- Production and Population Health, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - C. Scudder
- Clinical Sciences and Services, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - J. M. Faire
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - D. B. Church
- Clinical Sciences and Services, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - P. D. McGreevy
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - P. C. Thomson
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - D. C. Brodbelt
- Production and Population Health, The Royal Veterinary College; Hatfield Herts AL9 7TA
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Bargellini P, Orlandi R, Dentini A, Paloni C, Rubini G, Fonti P, Diana A, Peterson ME, Boiti C. Use of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Adrenal Tumors in Dogs. J Am Anim Hosp Assoc 2016; 52:132-43. [DOI: 10.5326/jaaha-ms-6363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
We evaluated the diagnostic accuracy of the contrast-enhanced ultrasonography (CEUS), using a second-generation microbubble contrast agent, in differentiating the different types of adrenal mass lesions in 24 dogs. At B-mode ultrasound, 9 lesions involved the right adrenal gland, 14 the left, and 1 was bilateral. Each dog received a bolus of the contrast agent into the cephalic vein, immediately followed by a 5-mL saline flush. The first contrast enhancement of each adrenal lesion was evaluated qualitatively to assess the degree of enhancement and its distribution during the wash-in and wash-out phases, as well as the presence of non-vascularized areas and specific vascular patterns. Pathological diagnoses were determined in all dogs by histopathology or by cytology. Combining enhancement degree and vascularity resulted in the best predictive model, allowing CEUS to differentiate adrenocortical adenoma (n=10), adenocarcinoma (n=7), and pheochromocytoma (n=7) with an accuracy of 91.7% (P < 0.001). Combining enhancement degree and vascularity, CEUS can discriminate malignant versus benign adrenal lesions with a sensitivity of 100.0%, a specificity of 80.0%, and an accuracy of 91.7% (P < 0.001). In conclusion, results of this study confirm that CEUS is useful for differentiating between the different types of adrenal tumors in dogs.
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Affiliation(s)
- Paolo Bargellini
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Riccardo Orlandi
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Alfredo Dentini
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Chiara Paloni
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Giuseppe Rubini
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Paolo Fonti
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Alessia Diana
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Mark E. Peterson
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
| | - Cristiano Boiti
- From the Tyrus Clinica Veterinaria, Terni, Italy (P.B., R.O., A.D., C.P.); Ultravet Diagnostic, Bologna, Italy (G.R.); Centro Veterinario Specialistico, Roma, Italy (P.F.); Dipartimento di Scienze Mediche Veterinarie, Ozzano Emilia, Italy (A.D.); Animal Endocrine Clinic, New York, NY (M.E.P.); and Laboratorio di Biotecnologie Fisiologiche, Università degli Studi di Perugia, Perugia, Italy (C.B.)
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30
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Bento PL, Center SA, Randolph JF, Yeager AE, Bicalho RC. Associations between sex, body weight, age, and ultrasonographically determined adrenal gland thickness in dogs with non-adrenal gland illness. J Am Vet Med Assoc 2016; 248:652-60. [DOI: 10.2460/javma.248.6.652] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Soulsby SN, Holland M, Hudson JA, Behrend EN. ULTRASONOGRAPHIC EVALUATION OF ADRENAL GLAND SIZE COMPARED TO BODY WEIGHT IN NORMAL DOGS. Vet Radiol Ultrasound 2014; 56:317-26. [DOI: 10.1111/vru.12236] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stacy N. Soulsby
- Department of Clinical Sciences; Auburn University College of Veterinary Medicine; Auburn AL 36849-5540
| | - Merrilee Holland
- Department of Clinical Sciences; Auburn University College of Veterinary Medicine; Auburn AL 36849-5540
| | - Judith A. Hudson
- Department of Clinical Sciences; Auburn University College of Veterinary Medicine; Auburn AL 36849-5540
| | - Ellen N. Behrend
- Department of Clinical Sciences; Auburn University College of Veterinary Medicine; Auburn AL 36849-5540
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Pey P, Rossi F, Vignoli M, Duchateau L, Marescaux L, Saunders JH. Use of contrast-enhanced ultrasonography to characterize adrenal gland tumors in dogs. Am J Vet Res 2014; 75:886-92. [PMID: 25255177 DOI: 10.2460/ajvr.75.10.886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the contrast-enhanced ultrasonographic characteristics and vascular patterns of adrenal gland tumors in dogs and determine whether those features are indicative of malignancy or histologic type of tumor. ANIMALS 14 dogs with 16 adrenal gland lesions (10 carcinomas [8 dogs], 3 adenomas [3 dogs], and 3 pheochromocytomas [3 dogs]). PROCEDURES Unsedated dogs with adrenal gland lesions underwent B-mode ultrasonography and contrast-enhanced ultrasonography ≤ 48 hours before adrenalectomy; contrast-enhanced ultrasonographic examinations were video-recorded. Macroscopic evaluation of the adrenal gland lesions and histologic examination of removed adrenal gland tissues were subsequently performed. Surgical and histopathologic findings and the ultrasonographic and contrast-enhanced ultrasonographic characteristics were recorded for the various tumor types. Time-intensity curves were generated from the contrast-enhanced ultrasonographic recordings and used to calculate regional blood volume (value proportional to area under the curve) and mean transit time (time the lesion began to enhance to the half-peak intensity). RESULTS In adrenal gland carcinomas, tortuous feeding vessels were noticeable during the arterial and venous phases of contrast enhancement. Heterogeneity of contrast enhancement was evident only in malignant tumors. Compared with adenomas, adrenal gland carcinomas and pheochromocytomas had significantly less regional blood volume. Mean transit times were significantly shorter in adrenal gland carcinomas and pheochromocytomas than in adenomas. CONCLUSIONS AND CLINICAL RELEVANCE For dogs, evaluation of the vascular pattern and contrast-enhancement characteristics of adrenal gland tumors by means of contrast-enhanced ultrasonography may be useful in assessment of malignancy and tumor type.
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Affiliation(s)
- Pascaline Pey
- Departments of Medical Imaging of Domestic Animals and Orthopedy of Small Animals, Ghent University, 9820 Merelbeke, Belgium
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Lamb CR, Nelson JR. Diagnostic accuracy of tests based on radiologic measurements of dogs and cats: a systematic review. Vet Radiol Ultrasound 2014; 56:231-44. [PMID: 25339347 DOI: 10.1111/vru.12217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022] Open
Abstract
A systematic review of diagnostic tests based on radiologic measurements of structures in dogs and cats was done in order to reach generalizable conclusions about the value of making such measurements. Literature search was done using the ISI Web of Knowledge(SM) for studies in the subject category Veterinary sciences. Studies were eligible for inclusion that employed length, angle, area or volume measurements from radiographic, ultrasonographic, CT or MR images of dogs or cats as a diagnostic test for a naturally occurring condition, compared the results of imaging with a reference standard, included at least 10 subjects, and sufficient data that a 2 × 2 table of results could be constructed. Quality of studies was assessed using the QUADAS-2 tool. Twenty-six studies were found describing 40 tests that satisfied the inclusion criteria. Tests were radiographic in 22 (55%) instances and ultrasonographic in 18 (45%). Quality of studies was generally low, with a risk of bias in patient selection in 92% studies, performance of the index test in 73% studies, and patient flow in 42% studies. Median (range) number of subjects was 64 (20-305), sensitivity was 77% (38-99%), specificity was 82% (50-99%), positive likelihood ratio was 4.1 (1-103), and negative likelihood ratio was 0.29 (0.01-1). Two studies that compared accuracy of radiographic measurements to subjective image interpretation alone found no difference. Evidence is weak that radiologic measurements of structures in dogs and cats are useful for diagnosis, hence measurements should not be emphasized as a basis for diagnosis in either teaching or clinical imaging reports.
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Affiliation(s)
- Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hertfordshire AL9 7TA, UK
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Arenas C, Melián C, Pérez-Alenza MD. Long-term survival of dogs with adrenal-dependent hyperadrenocorticism: a comparison between mitotane and twice daily trilostane treatment. J Vet Intern Med 2014; 28:473-80. [PMID: 24495125 PMCID: PMC4858016 DOI: 10.1111/jvim.12303] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 11/11/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022] Open
Abstract
Background Treatment of adrenal‐dependent hyperadrenocorticism (ADH) involves either surgical resection of the adrenal tumor or medical therapy. For many years, mitotane has been considered the medical treatment of choice for dogs with ADH. Objectives The aim of this study was to determine survival and prognostic factors for dogs with ADH treated with mitotane and trilostane. Animals Twenty‐six dogs with ADH were included in the study. Methods Fourteen dogs were treated with mitotane and 12 dogs were treated with trilostane. Medical records were reviewed. Epidemiologic factors, signalment, clinicopathologic abnormalities, endocrine test results, and treatment protocols were evaluated to identify potential predictive factors of overall survival time. Results Survival times of dogs treated with mitotane (median, 15.6 months) or trilostane (median, 14.0 months) were not significantly different. Using univariate analysis, age and postadrenocorticotropic hormone cortisol concentrations were inversely correlated with survival time. The multivariate model also identified weakness at presentation as a negative prognostic indicator. Conclusion and Clinical Importance The type of medical treatment (mitotane versus trilostane) does not influence survival time in dogs with ADH; therefore, trilostane, a drug with less frequent and milder adverse effects, might be used as the primary medical treatment when adrenalectomy cannot be performed.
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Affiliation(s)
- C Arenas
- Department of Small Animal Medicine, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
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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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Bugbee AC, Smith JR, Ward CR. Effect of dexamethasone or synthetic ACTH administration on endogenous ACTH concentrations in healthy dogs. Am J Vet Res 2013; 74:1415-20. [PMID: 24168307 DOI: 10.2460/ajvr.74.11.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of dexamethasone or synthetic ACTH administration on endogenous ACTH concentrations in healthy dogs. ANIMALS 10 healthy neutered dogs. PROCEDURES Each dog received dexamethasone (0.01 mg/kg), synthetic ACTH (5 μg/kg), or saline (0.9% NaCl) solution (0.5 mL) IV at intervals of ≥ 30 days. Plasma endogenous ACTH concentrations were measured before (baseline; time 0) and 1, 8, 12, and 24 hours after drug administration; serum cortisol concentrations were measured before and 1 hour after synthetic ACTH and saline solution administration and 8 hours after dexamethasone administration. RESULTS Analysis of serum cortisol concentrations confirmed effects of drug administration. Dexamethasone significantly decreased the endogenous ACTH concentration from the baseline value at both 8 and 12 hours. Synthetic ACTH administration significantly decreased the endogenous ACTH concentration from the baseline value at 8 hours. Saline solution administration had no significant effect on endogenous ACTH concentration. CONCLUSIONS AND CLINICAL RELEVANCE Dexamethasone and synthetic ACTH administered IV at doses used routinely during testing for hyperadrenocorticism caused significant but transient reductions of endogenous ACTH concentrations in healthy dogs. Thus, a 2-hour washout period following ACTH stimulation testing before collection of samples for measurement of the endogenous ACTH concentration may be insufficient. Although this effect has not been verified in dogs with hyperadrenocorticism, these data suggested that samples for measurement of endogenous ACTH concentrations should be obtained before or > 8 hours after initiation of an ACTH stimulation test or before or > 12 hours after the start of a low-dose dexamethasone suppression test.
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Affiliation(s)
- Andrew C Bugbee
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
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Behrend EN, Kooistra HS, Nelson R, Reusch CE, Scott-Moncrieff JC. Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement (small animal). J Vet Intern Med 2013; 27:1292-304. [PMID: 24112317 DOI: 10.1111/jvim.12192] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 07/05/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022] Open
Abstract
This report offers a consensus opinion on the diagnosis of spontaneous canine hyperadrenocorticism. The possibility that a patient has hyperadrenocorticism is based on the history and physical examination. Endocrine tests should be performed only when clinical signs consistent with HAC are present. None of the biochemical screening or differentiating tests for hyperadrenocorticism are perfect. Imaging can also play a role. Awareness of hyperadrenocorticism has heightened over time. Thus, case presentation is more subtle. Due to the changes in manifestations as well as test technology the Panel believes that references ranges should be reestablished. The role of cortisol precursors and sex hormones in causing a syndrome of occult hyperadrenocorticism remains unclear.
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Affiliation(s)
- E N Behrend
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
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Pey P, Daminet S, Smets PMY, Duchateau L, De Fornel-Thibaud P, Rosenberg D, Saunders JCH. Contrast-enhanced ultrasonographic evaluation of adrenal glands in dogs with pituitary-dependent hyperadrenocorticism. Am J Vet Res 2013; 74:417-25. [PMID: 23438117 DOI: 10.2460/ajvr.74.3.417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess vascular changes induced by hyperadrenocorticism of hyperplastic adrenal glands in dogs via contrast-enhanced ultrasonography. ANIMALS 12 dogs with pituitary-dependent hyperadrenocorticism (PDH) and 7 healthy control dogs ≥ 7 years old. PROCEDURES Dogs were assigned to the PDH and control groups and to small-breed (n = 6), medium-breed (4), and large-breed (9) subgroups. Contrast-enhanced ultrasonography of both adrenal glands in each dog was performed with IV injections of contrast agent. Time-intensity curves for the adrenal cortex, adrenal medulla, and ipsilateral renal artery of both adrenal glands were generated. Perfusion variables (time to peak [TTP], upslope of wash-in phase, and downslope of washout phase) were calculated. RESULTS Contrast-enhanced ultrasonography revealed no qualitative difference between PDH and control groups. Quantitatively, TTPs were longer in the adrenal cortex and adrenal medulla of the PDH group, compared with values for the control group, particularly in the adrenal cortex and adrenal medulla of the small-breed subgroup. Washout downslopes were lower for the renal artery, adrenal cortex, and adrenal medulla of the small-breed subgroup between the PDH and control groups. No other perfusion variables differed between groups. CONCLUSIONS AND CLINICAL RELEVANCE Contrast-enhanced ultrasonography of the adrenal glands in dogs with PDH revealed a delayed TTP in the adrenal cortex and adrenal medulla, compared with values for control dogs. Contrast-enhanced ultrasonography was able to detect vascular changes induced by hyperadrenocorticism. Further studies are needed to evaluate whether reference ranges for clinically normal dogs and dogs with PDH can be determined and applied in clinical settings.
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Affiliation(s)
- Pascalline Pey
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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Park F, Blois S, Abrams-Ogg A, Wood R, Allen D, Nykamp S, Downie A. Hypercoagulability and ACTH-Dependent Hyperadrenocorticism in Dogs. J Vet Intern Med 2013; 27:1136-42. [DOI: 10.1111/jvim.12162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/23/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- F.M. Park
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - S.L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - A.C.G. Abrams-Ogg
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - R.D. Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON
| | - D.G. Allen
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - S.G. Nykamp
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - A. Downie
- Health Sciences Center (Downie); Ontario Veterinary College; University of Guelph; Guelph ON
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de Brito Galvao JF, Chew DJ. Metabolic complications of endocrine surgery in companion animals. Vet Clin North Am Small Anim Pract 2011; 41:847-68, v. [PMID: 21889689 DOI: 10.1016/j.cvsm.2011.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metabolic complications of endocrine surgery occur commonly and precautions should be taken to avoid potentially life-threatening situations and to lessen expense associated with a more extended hospital stay. Common complications of endocrine surgery as well as prevention strategies will be reviewed for pancreatic, parathyroid, and adrenal surgery.
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Affiliation(s)
- Joao Felipe de Brito Galvao
- Small Animal Internal Medicine, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA.
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Gilor C, Graves TK. Interpretation of laboratory tests for canine Cushing's syndrome. Top Companion Anim Med 2011; 26:98-108. [PMID: 21596349 DOI: 10.1053/j.tcam.2011.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/08/2011] [Indexed: 11/11/2022]
Abstract
Hypercortisolism (HC) is a common disease in dogs. This article will review the laboratory tests that are available for diagnosis of HC and laboratory tests for differentiating between causes of HC. An emphasis will be made on the clinical process that leads to the decision to perform those tests and common misconceptions and issues that arise when performing them. To choose between the adrenocorticotropic hormone (ACTH)-stimulation test and the low-dose dexamethasone suppression test (LDDST), the advantages and disadvantages of both tests should be considered, as well as the clinical presentation. If the index of suspicion of HC is high and other diseases have been appropriately ruled out, the specificity of the ACTH stimulation test is reasonably high with an expected high positive predictive value. Because of the low sensitivity, a negative result in the ACTH stimulation test should not be used to rule out the diagnosis of HC. The LDDST is more sensitive but also less specific and affected more by stress. A positive result on the urine cortisol:creatinine ratio does not help to differentiate HC from other diseases. A negative result on the urine cortisol:creatinine ratio indicates that the diagnosis of HC is very unlikely. The LDDST is useful in differentiating pituitary-dependent HC from an adrenal tumor in about two thirds of all dogs with HC. Differentiation of HC from diabetes mellitus, liver diseases, and hypothyroidism cannot be based solely on endocrine tests. Clinical signs, imaging studies, histopathology, and response to treatment should all be considered.
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Affiliation(s)
- Chen Gilor
- IDEXX Laboratories LTD., Wetherby, LS22 7DN, United Kingdom.
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Rodríguez Piñeiro MI, de Fornel-Thibaud P, Benchekroun G, Garnier F, Maurey-Guenec C, Delisle F, Rosenberg D. Use of computed tomography adrenal gland measurement for differentiating ACTH dependence from ACTH independence in 64 dogs with hyperadenocorticism. J Vet Intern Med 2011; 25:1066-74. [PMID: 21848965 DOI: 10.1111/j.1939-1676.2011.0773.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The measurement of adrenal gland size on computed tomography (CT) scan has been proposed for the etiological diagnosis of hyperadrenocorticism (HAC) in dogs. Symmetric adrenal glands are considered to provide evidence for ACTH-dependent hyperadrenocorticism (ADHAC), whereas asymmetry suggests ACTH-independent hyperadrenocorticism (AIHAC). However, there are currently no validated criteria for such differentiation. OBJECTIVE The aim of this retrospective study was to compare various adrenal CT scan measurements and the derived ratios in ADHAC and AIHAC cases, and to validate criteria for distinguishing between these conditions in a large cohort of dogs. ANIMALS Sixty-four dogs with HAC (46 ADHAC, 18 AIHAC). METHODS Dogs with confirmed HAC and unequivocal characterization of its origin were included. Linear measurements of adrenal glands were made on both cross-sectional and reformatted images. RESULTS An overlap was systematically observed between the AIHAC and ADHAC groups for all measurements tested. Overlaps also were observed for ratios tested. For the maximum adrenal diameter ratio derived from reformatted images (rADR), only 1/18 AIHAC dogs had a rADR within the range for ADHAC. For a threshold of 2.08, the 95% confidence intervals for estimated sensitivity and specificity extended from 0.815 to 1.000 and from 0.885 to 0.999, respectively, for AIHAC diagnosis. CONCLUSION AND CLINICAL IMPORTANCE Measurements from cross-sectional or reformatted CT scans are of little use for determining the origin of HAC. However, rADR appears to distinguish accurately between ADHAC and AIHAC, with a rADR > 2.08 highly suggestive of AIHAC.
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Affiliation(s)
- M I Rodríguez Piñeiro
- Internal Medicine Unit, National Veterinary School of Alfort, Maisons-Alfort, France
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