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Hall H, Williams T, Florey J, Moreno MP, Black V, Thompson D, Skelly B. Prevalence of hypercalcemia in primary hypoadrenocorticism in dogs: Multicenter, retrospective study. J Vet Intern Med 2023; 37:1685-1693. [PMID: 37382221 PMCID: PMC10472996 DOI: 10.1111/jvim.16786] [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: 10/08/2022] [Accepted: 05/21/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Hypoadrenocorticism is an important differential for hypercalcemia. The etiology of hypercalcemia in hypoadrenocorticism in dogs is unclear. OBJECTIVE To review the prevalence of hypercalcemia and use statistical models to identify clinical, demographic, and biochemical variables associated with hypercalcemia in dogs with primary hypoadrenocorticism. ANIMALS One hundred ten dogs with primary hypoadrenocorticism; 107 with recorded total calcium (TCa), 43 recorded ionized calcium (iCa). METHODS Multicenter retrospective observational study at 4 UK referral hospitals. Univariable logistic regression analyses were performed to assess the association between independent variables of signalment, hypoadrenocorticism type (glucocorticoid only deficient hypoadrenocorticism [GHoC] vs glucocorticoid and mineralocorticoid deficient hypoadrenocorticism [GMHoC]), clinicopathological variables and hypercalcemia. Hypercalcemia was defined as elevated TCa, an elevated iCa, or both elevated TCa and iCa (Model 1) or as elevated iCa (Model 2). RESULTS Overall prevalence of hypercalcemia was 34.5% (38/110). The odds of hypercalcemia (Model 1) were increased (P < .05) in dogs with GMHoC ([vs GHoC], OR [odds ratio] = 3.86, 95% confidence interval [CI] 1.105-13.463), higher serum creatinine (OR = 1.512, 95% CI 1.041-2.197), and higher serum albumin (OR = 4.187, 95% CI 1.744-10.048). The odds of ionized hypercalcemia (Model 2) were increased (P < .05) with reduced serum potassium concentration (OR = 0.401, 95% CI 0.184-0.876) and younger age (OR = 0.737, 95% CI 0.558-0.974). CONCLUSIONS AND CLINICAL IMPORTANCE This study identified several key clinical and biochemical variables associated with hypercalcemia in dogs with primary hypoadrenocorticism. These findings aid understanding of the pathophysiology and etiology of hypercalcemia in dogs with primary hypoadrenocorticism.
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Affiliation(s)
- Harriet Hall
- Department of Veterinary Medicine, Queen's Veterinary School HospitalUniversity of CambridgeCambridgeUnited Kingdom
- Dick White Referrals, Six Mile BottomCambridgeshireUnited Kingdom
| | - Timothy Williams
- Department of Veterinary Medicine, Queen's Veterinary School HospitalUniversity of CambridgeCambridgeUnited Kingdom
| | - Jessica Florey
- Dick White Referrals, Six Mile BottomCambridgeshireUnited Kingdom
| | | | - Victoria Black
- Langford VetsBristol Veterinary School, Langford HouseLangford BS40 5DUUnited Kingdom
| | - Daniel Thompson
- Davies Veterinary Specialists, Manor Farm Business Park, Higham GobionHitchinUnited Kingdom
| | - Barbara Skelly
- Department of Veterinary Medicine, Queen's Veterinary School HospitalUniversity of CambridgeCambridgeUnited Kingdom
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Bugbee A, Rucinsky R, Cazabon S, Kvitko-White H, Lathan P, Nichelason A, Rudolph L. 2023 AAHA Selected Endocrinopathies of Dogs and Cats Guidelines. J Am Anim Hosp Assoc 2023; 59:113-135. [PMID: 37167252 DOI: 10.5326/jaaha-ms-7368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Canine and feline endocrinopathies reflect an endocrine gland disease or dysfunction with resulting hormonal abnormali ties that can variably affect the patient's wellbeing, quality of life, and life expectancy. These guidelines provide consensus recommendations for diagnosis and treatment of four canine and feline endocrinopathies commonly encountered in clini cal practice: canine hypothyroidism, canine hypercortisolism (Cushing's syndrome), canine hypoadrenocorticism (Addi son's disease), and feline hyperthyroidism. To aid the general practitioner in navigating these common diseases, a stepwise diagnosis and treatment algorithm and relevant background information is provided for managing each of these diseases. The guidelines also describe, in lesser detail, the diagnosis and treatment of three relatively less common endo crinopathies of cats: feline hyperaldosteronism, feline hypothyroidism, and feline hyperadrenocorticism. Additionally, the guidelines present tips on effective veterinary team utilization and client communication when discussing endocrine cases.
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Affiliation(s)
- Andrew Bugbee
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Renee Rucinsky
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Sarah Cazabon
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Heather Kvitko-White
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Patty Lathan
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Amy Nichelason
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
| | - Liza Rudolph
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (A.B.); Mid Atlantic Cat Hospital, Mid Atlantic Feline Thyroid Center, Queenstown, Maryland (R.R.); Boston Veterinary Clinic, Boston, Massachusetts (S.C.); KW Veterinary Consulting, LLC, Kansas City, Missouri (H.K.-W.); Mississippi State University, Mississippi State, Mississippi (P.L.); School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin (A.N.); Rowan College of South Jersey, Sewell, New Jersey (L.R.)
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Harper J, Burchell R. Atypical hypoadrenocorticism presenting with hypoglycaemic seizures and bilateral cortical blindness in a dog. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jenna Harper
- Medicine Department North Coast Veterinary Specialists Sunshine Coast Queensland Australia
| | - Richard Burchell
- Medicine Department North Coast Veterinary Specialists Sunshine Coast Queensland Australia
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HATOYA S, KANEGI R, NABETANI T, OJI S, IZAWA T, HIRAI S, SUGIURA K. Atypical hypoadrenocorticism with intact zona glomerulosa of the adrenal cortex after long-term observation: a case report of a dog. J Vet Med Sci 2023; 85:9-13. [PMID: 36372430 PMCID: PMC9887220 DOI: 10.1292/jvms.22-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An 8-year-old intact male pointer presented with lethargy and hypoalbuminemia. On abdominal ultrasonography, both adrenal glands were reduced in thickness. Based on the ACTH stimulation test results and the absence of electrolyte abnormalities, the dog was diagnosed with atypical hypoadrenocorticism. After treatment with low-dose prednisolone, his general condition improved, and blood tests normalized. The dog died 818 days later, and a complete autopsy was performed. Histologically, the architecture of the zonae fasciculata and reticularis was disrupted in both adrenal glands; however, the zona glomerulosa remained relatively normal. In summary, in this study, we detailed the pathological presentation of atypical hypoadrenocorticism without electrolyte abnormalities.
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Affiliation(s)
- Shingo HATOYA
- Laboratory of Cell Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Cell Pathobiology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan,Correspondence to: Hatoya S: , Laboratory of Cell Pathobiology, Graduate School of Veterinary
Sciences, Osaka Metropolitan University, 1-58 Rinku-oraikita, Izumisano, Osaka 598-8531, Japan
| | - Ryoji KANEGI
- Veterinary Medical Center, Osaka Prefecture University, Osaka, Japan,Present address: Veterinary Medical Center, Osaka Metropolitan University, Osaka, Japan
| | - Tomoyo NABETANI
- Veterinary Medical Center, Osaka Prefecture University, Osaka, Japan,Present address: Veterinary Medical Center, Osaka Metropolitan University, Osaka, Japan
| | - Shoko OJI
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Takeshi IZAWA
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Veterinary Pathology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan
| | | | - Kikuya SUGIURA
- Laboratory of Cell Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan,Present address: Laboratory of Cell Pathobiology, Graduate School of Veterinary Sciences, Osaka Metropolitan University, Osaka, Japan
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Reagan KL, McLarty E, Marks SL, Sebastian J, McGill J, Gilor C. Characterization of clinicopathologic and abdominal ultrasound findings in dogs with glucocorticoid deficient hypoadrenocorticism. Vet Med (Auckl) 2022; 36:1947-1957. [DOI: 10.1111/jvim.16564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Krystle L. Reagan
- Department of Medicine and Epidemiology, School of Veterinary Medicine University of California—Davis Davis California USA
| | - Ehren McLarty
- Department of Veterinary Surgery and Radiologic Sciences, School of Veterinary Medicine University of California—Davis Davis California USA
| | - Stanley L. Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine University of California—Davis Davis California USA
| | - Jamie Sebastian
- William R. Prichard Veterinary Medical Teaching Hospital University of California‐Davis Davis USA
| | - Jennifer McGill
- William R. Prichard Veterinary Medical Teaching Hospital University of California‐Davis Davis USA
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine University of Florida Gainesville Florida USA
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Bacon J, Graham PA, Hrovat A, Kilpatrick S, Mann NO, Swales H. Successful use of a benchtop fluorescent enzyme immunoassay analyzer to measure serum cortisol concentration as a screening test for hypoadrenocorticism in dogs. J Am Vet Med Assoc 2022; 261:111-117. [PMID: 36288206 DOI: 10.2460/javma.22.08.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of a benchtop fluorescent enzyme immunoassay analyzer (AIA-360; Tosoh Bioscience Inc) for the measurement of serum cortisol concentration as a screening test for hypoadrenocorticism in dogs. ANIMALS 173 client-owned dogs (20 with hypoadrenocorticism and 153 with nonadrenal illness). PROCEDURES Medical records of all dogs that underwent an ACTH stimulation test between June 2015 and October 2019 were reviewed retrospectively. Dogs were excluded if the ACTH stimulation test was performed on the basis of a suspicion of hypercortisolism, serum cortisol concentrations were measured using an analyzer other than the one assessed in the present study, or dogs had received medication known to affect the pituitary-adrenal axis in the 4 weeks1,2 preceding ACTH stimulation testing. The diagnostic performance of the benchtop analyzer was evaluated by calculating sensitivity, specificity, and likelihood ratios at various cutoff points. RESULTS Serum resting cortisol cutoff point concentrations of 0.8 μg/dL (22 nmol/L), 1 μg/dL (28 nmol/L), and 2 μg/dL (55 nmol/L) had a sensitivity of 100%. An optimal serum resting cortisol cutoff point of 0.58 μg/dL (16 nmol/L) had a sensitivity, specificity, and positive and negative likelihood ratios of 100%, 97%, and 30.6 and 0.0, respectively. CLINICAL RELEVANCE Findings indicated that previously derived cutoff points could be used with excellent sensitivity to exclude hypoadrenocorticism in this population of dogs when serum cortisol concentration was measured with the evaluated benchtop analyzer. An ACTH stimulation test may need to only be performed to diagnose hypoadrenocorticism if resting serum cortisol concentration is ≤ 0.58 μg/dL when measured with the evaluated benchtop analyzer.
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Affiliation(s)
- Jessica Bacon
- Wear Referrals Veterinary Hospital, Bradbury, Stockton-on-Tees, UK
| | - Peter A Graham
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | | | | | - Nicholas O Mann
- Wear Referrals Veterinary Hospital, Bradbury, Stockton-on-Tees, UK
| | - Harry Swales
- Moorview Referrals, Cramlington, Northumberland, UK
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Reagan KL, Pires J, Quach N, Gilor C. Evaluation of a machine learning tool to screen for hypoadrenocorticism in dogs presenting to a teaching hospital. J Vet Intern Med 2022; 36:1942-1946. [PMID: 36259689 DOI: 10.1111/jvim.16566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Dogs with hypoadrenocorticism (HA) have clinical signs and clinicopathologic abnormalities that can be mistaken as other diseases. In dogs with a differential diagnosis of HA, a machine learning model (MLM) has been validated to discriminate between HA and other diseases. This MLM has not been evaluated as a screening tool for a broader group of dogs. HYPOTHESIS An MLM can accurately screen dogs for HA. ANIMALS Dogs (n = 1025) examined at a veterinary hospital. METHODS Dogs that presented to a tertiary referral hospital that had a CBC and serum chemistry panel were enrolled. A trained MLM was applied to clinicopathologic data and in dogs that were MLM positive for HA, diagnosis was confirmed by measurement of serum cortisol. RESULTS Twelve dogs were MLM positive for HA and had further cortisol testing. Five had HA confirmed (true positive), 4 of which were treated for mineralocorticoid and glucocorticoid deficiency, and 1 was treated for glucocorticoid deficiency alone. Three MLM positive dogs had baseline cortisol ≤2 μg/dL but were euthanized or administered glucocorticoid treatment without confirming the diagnosis with an ACTH-stimulation test (classified as "undetermined"), and in 4, HA was ruled out (false positives). The positive likelihood ratio of the MLM was 145 to 254. All dogs diagnosed with HA by attending clinicians tested positive by the MLM. CONCLUSIONS AND CLINICAL IMPORTANCE This MLM can robustly predict HA status when indiscriminately screening all dogs with blood work. In this group of dogs with a low prevalence of HA, the false positive rates were clinically acceptable.
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Affiliation(s)
- Krystle L Reagan
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Jully Pires
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Nina Quach
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Chen Gilor
- Department of Small Animal Clinical sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Guzmán Ramos PJ, Bennaim M, Shiel RE, Mooney CT. Diagnosis of canine spontaneous hypoadrenocorticism. Canine Med Genet 2022; 9:6. [PMID: 35505424 PMCID: PMC9066729 DOI: 10.1186/s40575-022-00119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Hypoadrenocorticism is characterized by a reduction in mineralocorticoid and/or glucocorticoid production by the adrenal glands. Several subtypes have been described with different clinical and clinicopathological consequences. Most affected dogs have vague and non-specific signs that precede an eventual life-threatening crisis. This review aims to appraise classification, the available data on epidemiology and the clinical and laboratory features of naturally occurring canine hypoadrenocorticism. Canine hypoadrenocorticism is a relatively uncommon endocrine disease that can present with a wide variety of clinical signs resulting from cortisol or aldosterone deficiency or both. Hypoadrenocorticism should be considered in all dogs with severe illness and typical electrolyte abnormalities but also in those with waxing and waning clinical signs. Multiple clinical and laboratory features are suggestive of the disease and should prompt evaluation of adrenal function. The ACTH stimulation test is the best test for diagnosing hypoadrenocorticism but, in those cases without the typical presentation, evaluation of aldosterone secretory capacity and endogenous ACTH concentrations should be performed to distinguish primary from secondary disease. In this review we discuss the pathophysiology of the disease, the clinical signs and laboratory features that should raise suspicion of hypoadrenocorticism and the performance of the different diagnostic tests.
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Affiliation(s)
- Pedro J Guzmán Ramos
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland.
| | - Michael Bennaim
- Centre Hospitalier Vétérinaire Anicura Aquivet, Eysines, France
| | - Robert E Shiel
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland
| | - Carmel T Mooney
- University College Dublin Veterinary Hospital, University College Dublin, Dublin, Ireland
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Gallego AF, Gow AG, Boag AM. Evaluation of resting cortisol concentration testing in dogs with chronic gastrointestinal signs. J Vet Intern Med 2022; 36:525-531. [PMID: 35118742 PMCID: PMC8965248 DOI: 10.1111/jvim.16365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
Background Resting cortisol concentrations are routinely measured in dogs with chronic gastrointestinal signs to rule out hypoadrenocorticism based on a concentration >2 μg/dL (>55 nmol/L). Hypothesis/Objectives To assess the cross‐sectional prevalence of hypoadrenocorticism in a group of dogs with chronic gastrointestinal signs presented to a referral internal medicine service. Animals Two‐hundred and eighty‐two client‐owned dogs with chronic gastrointestinal signs and with resting cortisol concentration testing performed. Methods Retrospective review of medical records (final diagnosis, resting cortisol concentration, and adenocorticotropic hormone [ACTH] stimulation test results) of a referral population of dogs between May 2013 and September 2017. Results Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 79 patients (28%). Repeated resting cortisol concentration measurements were performed in 28 dogs, and in 8, resting cortisol concentrations remained <2 μg/dL (<55 nmol/L). Post‐ACTH cortisol concentration was <2 μg/dL (<55 nmol/L) in 1 dog, consistent with a diagnosis of hypoadrenocorticism and giving a prevalence estimate of hypoadrenocorticism in this population of dogs of 0.3% (95% confidence interval [95CI], 0.03‐1.5%). In 19 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). Overall, the most common diagnosis was chronic primary inflammatory enteropathy (176/282, 62.4%), followed by extragastrointestinal neoplasia (17/282, 6%), protein‐losing enteropathy, pancreatitis and megaesophagus (10/282, 3.5% each). Conclusions and Clinical Importance Although dogs with hypoadrenocorticism can present with chronic gastrointestinal signs, it was the final diagnosis in only 1 of 282 dogs presenting to a referral internal medicine service for signs of chronic enteropathy. Repeated resting cortisol concentration may be considered as a test to try and exclude hypoadrenocorticism.
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Affiliation(s)
- Ana Fernandez Gallego
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Midlothian, United Kingdom
| | - Adam G Gow
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Midlothian, United Kingdom
| | - Alisdair M Boag
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Midlothian, United Kingdom
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Raj J, Sanchez Lara A, Bell R, Tappin S. Canine isolated hypoaldosteronism. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jennifer Raj
- Small Animal Internal Medicine Dick White Referrals Ltd Six Mile Bottom Cambridgeshire UK
| | | | - Rory Bell
- Small Animal Internal Medicine Dick White Referrals Ltd Six Mile Bottom Cambridgeshire UK
| | - Simon Tappin
- Small Animal Internal Medicine Dick White Referrals Ltd Six Mile Bottom Cambridgeshire UK
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Schofield I, Woolhead V, Johnson A, Brodbelt DC, Church DB, O'Neill DG. Hypoadrenocorticism in dogs under UK primary veterinary care: frequency, clinical approaches and risk factors. J Small Anim Pract 2021; 62:343-350. [PMID: 33555046 PMCID: PMC8248152 DOI: 10.1111/jsap.13285] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 01/06/2023]
Abstract
Objectives To estimate the frequency, clinical approaches and risk factors of hypoadrenocorticism in dogs under UK primary veterinary care. Materials and Methods Dogs diagnosed with hypoadrenocorticism were identified from the UK VetCompass™ programme by searching anonymised electronic patient records. Pre‐existing and newly diagnosed cases of disease during 2016 were included. Cases were further sub‐categorised as having a laboratory‐confirmed or presumed diagnosis of hypoadrenocorticism based on the information recorded in the electronic patient records. Descriptive data were manually extracted. Multivariable logistic regression methods were used to identify demographic risk factors. Results There were 177 hypoadrenocorticism cases identified from 905,543 dogs in 2016; 72 laboratory‐confirmed and 105 presumed. The 1‐year period prevalence for hypoadrenocorticism in all dogs was 0.06% (95% confidence interval: 0.05‐0.07%). The most common presenting clinical signs in laboratory‐confirmed dogs were lethargy (51/66, 77.3%), anorexia (48/66, 66.7%) and vomiting (48/66, 66.7%). Hyperkalaemia was reported in 47 of 53 (88.7%), hyponatraemia in 46 of 53 (86.8%). Median sodium: potassium ratio was 19.00 (interquartile range: 16.20‐20.60). Breed, age, neuter status and insurance status were associated with a laboratory‐confirmed diagnosis of hypoadrenocorticism. No sex association with hypoadrenocorticism was observed in the multivariable model. The standard poodle had 51.38 times the odds (95% CI: 14.49‐182.18) of hypoadrenocorticism compared with crossbreeds. The labradoodle and West Highland white terrier also had increased odds. Clinical Significance This is the first epidemiological study to report on hypoadrenocorticism in dogs within the UK primary‐care population. These results provide benchmark data of current veterinary activity relating to hypoadrenocorticism in primary‐care practices.
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Affiliation(s)
- I Schofield
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - V Woolhead
- Eastcott Referrals, Edison Park, Dorcan Way, Swindon, SN3 3RB, UK
| | - A Johnson
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
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12
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Tan AWK, Epstein SE, Hopper K. Period prevalence and mortality rates associated with hypocholesterolaemia in dogs and cats: 1,375 cases. J Small Anim Pract 2020; 61:669-675. [PMID: 32767372 DOI: 10.1111/jsap.13204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/09/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022]
Abstract
To determine the period prevalence of hypocholesterolaemia and the associated mortality rates in dogs and cats at a university teaching hospital. The secondary aim was to identify disease processes associated with hypocholesterolaemia. MATERIALS AND METHODS Medical records over a 5-year period were reviewed to determine the severity of hypocholesterolaemia and its associated mortality rate. Medical records of animals with moderate to severe hypocholesterolaemia (<2.59 mmol/L in dogs, <1.81 mmol/L in cats) were analysed further. Animals with hospital-acquired hypocholesterolaemia were identified. RESULTS Among 16,977 dogs and 3,788 cats that had at least one cholesterol measurement, the period prevalence of hypocholesterolaemia was 7.0% in dogs and 4.7% in cats. The mortality rate of hypocholesteraemic dogs and cats was 12% in both species which was significantly higher than that of animals with normal serum cholesterol. The degree of hypocholesterolaemia was significantly associated with mortality. Dogs, but not cats, with hospital-acquired hypocholesterolaemia had a higher mortality rate than those presenting with hypocholesterolaemia. Disease of hepatic, gastrointestinal and lymphoreticular systems were most commonly associated with hypocholesterolaemia, and infectious and neoplastic disease were the most commonly associated pathophysiologic processes in both species. Lymphoma was over-represented in dogs with neoplasia. CLINICAL SIGNIFICANCE Hypocholesterolaemia is not a frequent abnormality but was associated with mortality in this study and may be a negative prognostic indicator. It is not known if hypocholesterolaemia is simply a marker for disease severity, or if it is has active physiologic effects contributing to poor outcomes.
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Affiliation(s)
- A W K Tan
- William R. Pritchard, Veterinary Medical Teaching Hospital, University of California, Davis, 1 Garrod Dr, Davis, CA, 95616, USA
| | - S E Epstein
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 2112 Tupper Hall, Davis, CA, 95616, USA
| | - K Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 2112 Tupper Hall, Davis, CA, 95616, USA
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Sullivant AM, Lathan P. Ketoconazole-induced transient hypoadrenocorticism in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:407-410. [PMID: 32255827 PMCID: PMC7074211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 6-year-old, spayed female, mixed breed boxer dog was presented for decreased appetite, polyuria and polydipsia, and lethargy 9 days after treatment with ketoconazole for Malassezia pododermatitis. Ketoconazoleinduced hypoadrenocorticism was confirmed with an adrenocorticotropic hormone (ACTH) stimulation test, and ketoconazole was discontinued. Clinical signs resolved 48 hours after initiation of prednisone, and resolution of glucocorticoid insufficiency was confirmed with a repeat ACTH stimulation test 48 hours after a 10-day course of prednisone. Glucocorticoid insufficiency after administration of a commonly used dermatological dose of ketoconazole has not been previously reported in veterinary medicine but should be considered in patients with adverse effects while receiving ketoconazole. Key clinical message: Iatrogenic hypoadrenocorticism may occur in dogs treated with commonly used dermatological doses of ketoconazole. The disease is likely transient, but steroid supplementation may be required in some patients to resolve clinical signs, especially in the presence of concurrent illness or stress.
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Affiliation(s)
- Alyssa M Sullivant
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, 240 Wise Center Drive, Mississippi State, Mississippi 39762, USA
| | - Patty Lathan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, 240 Wise Center Drive, Mississippi State, Mississippi 39762, USA
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Kimura Y, Iwaki S, Kameshima S, Itoh N. A case of canine hypoadrenocorticism needing blood transfusion for severe acute anemia due to gastrointestinal hemorrhage. J Vet Med Sci 2019; 82:31-34. [PMID: 31748437 PMCID: PMC6983671 DOI: 10.1292/jvms.19-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 3-year-old male Rottweiler presented with the chief complaint of recurrent vomiting, diarrhea, hypothermia, and lethargy. Hypovolemic shock was noted with abnormal electrolytes (Na/K ratio, 27.9) and anemia (hematocrit, 17.3%). Since the hematocrit was 49.2% four days earlier when the primary veterinarian examined the dog, acute anemia was diagnosed. Melena was observed on the next day. The general condition and hydration improved with treatment, and an adrenocorticotropic hormone stimulation test identified hypoadrenocorticism. However, the hematocrit decreased further to 9%, necessitating blood transfusion. The cause of severe acute anemia was thought to be gastrointestinal hemorrhage. It should be noted that hypoadrenocorticism can lead to potentially fatal anemia with gastrointestinal tract bleeding, and blood transfusion may be required.
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Affiliation(s)
- Yuya Kimura
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Higashi 23-35-1, Towada, Aomori 034-8628, Japan
| | - Sayuri Iwaki
- Misawa Veterinary Treatment Facility, Public Health Activity-Japan, Bldg. 1370 Misawa AB, Misawa, Aomori 033-0022, Japan
| | - Satoshi Kameshima
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Higashi 23-35-1, Towada, Aomori 034-8628, Japan
| | - Naoyuki Itoh
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Higashi 23-35-1, Towada, Aomori 034-8628, Japan
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Craven MD, Washabau RJ. Comparative pathophysiology and management of protein-losing enteropathy. J Vet Intern Med 2019; 33:383-402. [PMID: 30762910 PMCID: PMC6430879 DOI: 10.1111/jvim.15406] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Abstract
Protein‐losing enteropathy, or PLE, is not a disease but a syndrome that develops in numerous disease states of differing etiologies and often involving the lymphatic system, such as lymphangiectasia and lymphangitis in dogs. The pathophysiology of lymphatic disease is incompletely understood, and the disease is challenging to manage. Understanding of PLE mechanisms requires knowledge of lymphatic system structure and function, which are reviewed here. The mechanisms of enteric protein loss in PLE are identical in dogs and people, irrespective of the underlying cause. In people, PLE is usually associated with primary intestinal lymphangiectasia, suspected to arise from genetic susceptibility, or “idiopathic” lymphatic vascular obstruction. In dogs, PLE is most often a feature of inflammatory bowel disease (IBD), and less frequently intestinal lymphangiectasia, although it is not proven which process is the true driving defect. In cats, PLE is relatively rare. Review of the veterinary literature (1977‐2018) reveals that PLE was life‐ending in 54.2% of dogs compared to published disease‐associated deaths in IBD of <20%, implying that PLE is not merely a continuum of IBD spectrum pathophysiology. In people, diet is the cornerstone of management, whereas dogs are often treated with immunosuppression for causes of PLE including lymphangiectasia, lymphangitis, and crypt disease. Currently, however, there is no scientific, extrapolated, or evidence‐based support for an autoimmune or immune‐mediated mechanism. Moreover, people with PLE have disease‐associated loss of immune function, including lymphopenia, severe CD4+ T‐cell depletion, and negative vaccinal titers. Comparison of PLE in people and dogs is undertaken here, and theories in treatment of PLE are presented.
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Affiliation(s)
- Melanie D Craven
- Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Robert J Washabau
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
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Santifort KM, Kooistra HS, Mandigers PJJ. Neurological signs due to hypoadrenocorticism in two dogs. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Koen M Santifort
- Veterinair Verwijscentrum de Pietersberg ‐ part of Evidensia GroupOosterbeekThe Netherlands
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion AnimalsUtrecht UniversityUtrechtThe Netherlands
| | - Paul JJ Mandigers
- Department of Clinical Sciences of Companion AnimalsUniversiteit UtrechtUtrechtThe Netherlands
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Botsford A, Behrend EN, Kemppainen RJ, Gaillard PR, Oprandy F, Lee HP. Low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism. J Vet Intern Med 2018; 32:1886-1890. [PMID: 30230611 PMCID: PMC6272038 DOI: 10.1111/jvim.15256] [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: 01/31/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Low-dose ACTH stimulation testing would lower cost and may increase sensitivity for identification of partial ACTH deficiency. HYPOTHESIS (1) The low-dose ACTH stimulation test will provide comparable results to the standard-dose ACTH stimulation test in dogs suspected of hypoadrenocorticism and (2) partial ACTH deficiency exists in dogs and can result in chronic, intermittent gastrointestinal signs. ANIMALS Thirty-one client-owned dogs suspected of having hypoadrenocorticism. METHODS Prospective study. Dogs suspected of having hypoadrenocorticism received 1 μg/kg cosyntropin IV for the first ACTH stimulation test; the second test was performed 4 h later and dogs received 5 μg/kg cosyntropin IV. Blood samples were obtained pre-ACTH and 1 hour post-ACTH for each dose (4 measurements total). Samples for endogenous ACTH measurement were obtained at the time of initial blood collection. RESULTS No significant difference was observed in the basal cortisol concentration before administration of a 1 μg/kg versus before a 5 μg/kg dose of cosyntropin (P = .544). For dogs suspected of having hypoadrenocorticism, the ACTH-stimulated cortisol concentrations in response to both doses of ACTH were equivalent (90% confidence interval [CI], 80.5-97.2%; P = .04). No cases with partial ACTH deficiency were identified conclusively. CONCLUSIONS AND CLINICAL IMPORTANCE A 1 μg/kg dose of cosyntropin is equivalent to a 5 μg/kg dose of cosyntropin for screening dogs suspected of hypoadrenocorticism. The existence of partial ACTH deficiency was not identified in this small group of dogs.
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Affiliation(s)
- Annabel Botsford
- Department of Clinical Sciences, Auburn University, Auburn, Alabama.,Atlantic Veterinary Internal Medicine and Oncology, Columbia, Maryland
| | - Ellen N Behrend
- Department of Clinical Sciences, Auburn University, Auburn, Alabama
| | - Robert J Kemppainen
- Department of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama
| | - Philippe R Gaillard
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama
| | - Frank Oprandy
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama
| | - Hollie P Lee
- Department of Clinical Sciences, Auburn University, Auburn, Alabama
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Lathan P, Thompson AL. Management of hypoadrenocorticism (Addison's disease) in dogs. VETERINARY MEDICINE-RESEARCH AND REPORTS 2018; 9:1-10. [PMID: 30050862 PMCID: PMC6055912 DOI: 10.2147/vmrr.s125617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hypoadrenocorticism (HOAC; Addison’s disease) is an endocrine condition seen in small animal practice. Dogs with this disease can present in a variety of ways from acute hypovolemic collapse to vague, chronic, waxing, and waning clinical signs. In the most common form of this disease, animals have both mineralocorticoid and glucocorticoid deficiency, resulting in hyponatremia and hyperkalemia, and signs of cortisol deficiency. The etiology may be immune-mediated destruction of the adrenal cortex, drug-induced adrenocortical necrosis (mitotane), enzyme inhibition (trilostane), or infiltrative processes such as neoplastic or fungal disease. Much less commonly, dogs have signs of cortisol deficiency, but no electrolyte changes. This is referred to as atypical HOAC. The veterinarian needs to have a clinical suspicion for HOAC to make a diagnosis in a timely manner. Treatment of dogs with an acute presentation prioritizes correcting the hypovolemia, hyperkalemia, acidosis, and hypoglycemia. Fluid therapy addresses most of these issues, but other directed therapies may be required in the most severe cases. For chronic management, all patients with Addison’s disease will require replacement of glucocorticoids (usually prednisone), and most patients require replacement of mineralocorticoids with either desoxycorticosterone pivalate or fludrocortisone. Atypical Addisonians do not require mineralocorticoid supplementation, but electrolytes should be monitored in case the need arises in the future. The prognosis for dogs treated for HOAC promptly and appropriately is excellent; most patients die from other diseases. However, if the diagnosis is missed, patients may die as a consequence of HOAC. Thus, knowledge of the hallmarks of Addison’s disease is imperative.
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Affiliation(s)
- Patty Lathan
- College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA,
| | - Ann L Thompson
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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Affiliation(s)
- U Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A & M University, College Station, Texas 77843, USA
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