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Lopes DJ, De Jesus L, Rivas BB, De Oliveira MC, Furtado PV, Cattaruzzi D, Poppl ÁG. Safety and efficacy assessment of a synthetic porcine recombinant corticotrophin for the ACTH stimulation test in healthy cats. Domest Anim Endocrinol 2024; 89:106880. [PMID: 39163657 DOI: 10.1016/j.domaniend.2024.106880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 08/22/2024]
Abstract
Porcine adrenocorticotrophic hormone (ACTH) has been considered valid for the ACTH stimulation test (ACTHST) in humans and dogs; however, its safety and efficacy for use in cats are unknown. Also, the equivalence between 5 µg/kg and 125 µg/cat dose of synthetic corticotropin (1-24 ACTH - cosyntropin/tetracosactide) is assumed for ACTHST in cats. This study evaluated the safety and effectiveness of different porcine recombinant ACTH doses for the ACTHST in healthy cats and its equivalence with tetracosactide. The study was divided into two arms. The first evaluated safety and equivalence of intravenous 1 µg/kg, 5 µg/kg, or 125 µg/cat porcine ACTH in seven healthy cats for the ACTHST evaluating basal and post-ACTH androstenedione, aldosterone, cortisol, and progesterone concentrations. In the second arm, the equivalence of the 125 µg/cat porcine ACTH dose was evaluated compared to results obtained using 125 µg/cat of tetracosactide in ten healthy cats regarding cortisol responses. In all tests, several cat-friendly strategies were adopted, and the ACTHST protocol involved basal and 60-minute post-ACTH blood sampling and intravenous ACTH injection. No adverse reactions were documented, and no tested cat showed any complications during the study. No porcine ACTH tested dose significantly increased androstenedione secretion. In contrast, all tested doses were able to increase progesterone concentration significantly (P < 0.05), and Δ-progesterone in response to 5 µg/kg or 125 µg/cat was considered equivalent (P > 0.99). The 125 µg/cat dose promoted greater responses for both cortisol and aldosterone, characterized by Δ-cortisol (P = 0.009) and Δ-aldosterone (P = 0.004). Despite equivalent Δ-cortisol results in response to 5 µg/kg or 125 µg/cat (P = 0.18); post-ACTH results of cortisol in response to 5 µg/kg only approximate statistical significance when compared with basal (P = 0.07). Porcine ACTH and tetracosactide significantly increased post-ACTH cortisol concentration (P < 0.0001) while the Δ-cortisol was slightly greater in response to the porcine ACTH (P = 0.006). These results suggest porcine ACTH could be an alternative source of corticotropin for the ACTHST in cats; however, maximum corticoadrenal stimulation seemed more reliable in response to a 125 µg/cat regarding cortisol and aldosterone.
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Affiliation(s)
- Daniela J Lopes
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana De Jesus
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Barbara B Rivas
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Milena C De Oliveira
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Priscila V Furtado
- Hormone Laboratory, Provet - Medicina Veterinária Diagnóstica, São Paulo, Brazil
| | - Debora Cattaruzzi
- Hormone Laboratory, Provet - Medicina Veterinária Diagnóstica, São Paulo, Brazil
| | - Álan G Poppl
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Animal Medicine Departament, Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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2
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Nappo D, Massarenti C, Andreis ME, Zini E, Lacava G, Rabba S, Auriemma E. Computed tomographic anatomic variations of the phrenicoabdominal veins in cats. Vet Radiol Ultrasound 2024. [PMID: 38979844 DOI: 10.1111/vru.13408] [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: 02/08/2024] [Revised: 06/16/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024] Open
Abstract
There are no published reports describing the anatomic variations of the phrenicoabdominal (PhAbd) veins in cats. The aim of this study was to evaluate the anatomic variations of the PhAbd veins in cats without adrenal disease. This is an anatomic study. Abdominal CT images of cats acquired from January 2021 to February 2023 were retrospectively reviewed. Inclusion criteria were the presence of pre- and postcontrast CT images of the abdomen and the absence of any abdominal diseases that compromise the left and right PhAbd veins visualization. A total of 128 cats were included. Three different vascular anatomic variations were found in the distal pericaval segment of the left phrenicoabdominal (LPhAbd) vein. In the first type, found in 65 cases (50.8%), the LPhAbd vein drained directly into the caudal vena cava. In the second type defined IIa, found in 25 cases (19.5%), the LPhAbd vein drained into the distal third of the left renal vein, less than 5 mm from its opening into the caudal vena cava. In the third type defined IIb, found in 38 cases (29.7%), the LPhAbd vein drained into the distal third of the left renal vein, more than 5 mm from its opening into the caudal vena cava. The right phrenicoabdominal vein had a consistent path and drained into the caudal vena cava in all cases. The knowledge of these vascular variations is expected to help the surgeon during adrenalectomy due to masses with vascular invasion in cats.
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Affiliation(s)
- Dario Nappo
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
| | - Chiara Massarenti
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
| | | | - Eric Zini
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse, Zurich, Switzerland
| | - Giuseppe Lacava
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
| | - Silvia Rabba
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
| | - Edoardo Auriemma
- AniCura Istituto Veterinario Novara, Granozzo con Monticello, Novara, Italy
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3
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Erger CG, Gerras AL, Conley AJ, Gilor C, Burns DeMarle K, Refsal KR, Fleming JM, Sledge DG, Langlois DK. Case report: Androgen-secreting adrenocortical tumors in eight cats. Front Vet Sci 2023; 10:1158142. [PMID: 37383353 PMCID: PMC10293747 DOI: 10.3389/fvets.2023.1158142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
Urine marking, aggression, and other behavioral concerns are common reasons for cat owners to seek veterinary care. Empiric treatment for lower urinary tract disease or primary behavior disorders are commonly pursued, especially in those cases with normal routine laboratory evaluations. Herein, we report the clinicopathologic findings in eight sexually altered cats that were diagnosed with androgen-secreting adrenocortical tumors. Nearly all cats (n = 7) initially were evaluated for inappropriate urination and pungent urine, with additional behavioral concerns including aggression (n = 3) and excess vocalization (n = 4) commonly reported. Penile barbs (n = 5) were identified in all five male cats, and an enlarged clitoris was observed in one female cat. Testing of serum androgen concentrations revealed abnormally high androstenedione (n = 1) or testosterone (n = 7) concentrations. In the five cases with available adrenal tissue, histopathologic evaluation identified either an adrenocortical adenoma (n = 3) or adrenocortical carcinoma (n = 2). Hormonal abnormalities resolved and clinical signs improved in the four cats that underwent surgical adrenalectomy, with each of these cats surviving >1 year. However, clinical signs were minimally impacted with medical treatments, including one cat in which trilostane treatment failed to improve clinical signs or testosterone concentrations. This collection of cases underscores the importance of a detailed physical examination as well as the consideration of endocrine disturbances in cats undergoing evaluation for inappropriate urination or aggression. Furthermore, this report adds to the growing body of evidence that sex-hormone secreting adrenal tumors in cats may be an under-recognized syndrome.
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Affiliation(s)
- Caylen G. Erger
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Allison L. Gerras
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Alan J. Conley
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Karah Burns DeMarle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Kent R. Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | | | - Dodd G. Sledge
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | - Daniel K. Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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4
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Prego MT, Dias MJ, Mestrinho L, Englar R, Grinwis G, Galac S, Leal RO. Diagnosis, treatment and outcome of pheochromocytoma in a cat. J Small Anim Pract 2023; 64:415-420. [PMID: 36977649 DOI: 10.1111/jsap.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 03/30/2023]
Abstract
Pheochromocytoma in cats is a rare clinical condition characterised by the development of a secretory endocrine tumour that arises from the adrenal medulla. An 8-year-old castrated male, domestic shorthair cat was referred for further investigation of a 4-month history of progressive weight loss with normal appetite, polyuria/polydipsia, generalised weakness, and severe hypertension. Sonography and computed tomography of the abdomen disclosed a mass arising from the left adrenal gland. The contralateral adrenal gland was normal in size and shape. Results from a low dose dexamethasone suppression test and measurements of plasma aldosterone concentration and plasma renin activity ruled out a cortisol-secreting tumour and aldosteronoma. The clinical presentation made a sex-steroid secreting tumour unlikely. Increased plasma metanephrine and normetanephrine concentrations prioritised the differential diagnosis of pheochromocytoma. The cat underwent adrenalectomy of the left gland and histopathological diagnosis with immunohistochemical markers confirmed the diagnosis.
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Affiliation(s)
- M T Prego
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
| | - M J Dias
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - L Mestrinho
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - R Englar
- College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd, Oro Valley, Arizona, 85737, USA
| | - G Grinwis
- Veterinair Pathologisch Diagnostisch Centrum - Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R O Leal
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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5
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Zhang RM, Case JB. Use of a Harmonic scalpel for laparoscopic adrenalectomy in two
cats. JFMS Open Rep 2023; 9:20551169231159635. [PMID: 36969148 PMCID: PMC10034285 DOI: 10.1177/20551169231159635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Case series summary Adrenal tumors are rare in cats and reports of laparoscopic adrenalectomy in
cats are limited. This case series describes two cats that underwent
laparoscopic adrenalectomy using a Harmonic scalpel for dissection and
coagulation. Both surgeries were successful, with minimal hemorrhage, smoke
production and lateral thermal damage. Vessels were appropriately sealed and
surgical times were appropriate. Both cats recovered without complications
postoperatively. Relevance and novel information To our knowledge, this is the first veterinary report to describe the use of
the Harmonic scalpel for laparoscopic adrenalectomy as the sole device in
cats. Owing to the absence of hemorrhage, there was no indication for
irrigation, suction or hemostatics. The Harmonic scalpel is an ultrasonic
vessel-sealing device with benefits over conventional electrosurgery,
including less lateral thermal damage, less smoke production and improved
safety due to the lack of an electrical current. This case report aims to
highlight the usefulness of ultrasonic vessel-sealing devices for
laparoscopic adrenalectomy in cats.
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Affiliation(s)
| | - J Brad Case
- J Brad Case DVM, MS, DACVS-SA, University
of Florida, 2015 SW 16th Avenue, Gainesville, FL 32608, USA
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6
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Niessen SJM. Hypersomatotropism and Other Causes of Insulin Resistance in Cats. Vet Clin North Am Small Anim Pract 2023; 53:691-710. [PMID: 36906467 DOI: 10.1016/j.cvsm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
True insulin resistance should be differentiated from management-related difficulties (eg, short insulin duration, inappropriate insulin injection, inappropriate storage). Hypersomatotropism (HST) is the number one cause of insulin resistance in cats, with hypercortisolism (HC) occupying a more distant second place. Serum insulinlike growth factor-1 is adequate for screening for HST, and screening at the time of diagnosis, regardless of presence of insulin resistance, is advocated. Treatment of either disease centers on removal of the overactive endocrine gland (hypophysectomy, adrenalectomy) or inhibition of the pituitary or adrenal glands by using drugs such as trilostane (HC), pasireotide (HST, HC) or cabergoline (HST, HC).
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Affiliation(s)
- Stijn J M Niessen
- Royal Veterinary College London, UK; Veterinary Specialist Consultations and VIN Europe, Loosdrechtseweg 56, Hilversum 1215 JX, the Netherlands.
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7
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Del Magno S, Foglia A, Rossanese M, Montinaro V, Cola V, Pisoni L, Rossetti D, Cantatore M, De La Puerta B, Nicoli S, Pisani G, Collivignarelli F, Romanelli G, Cinti F, Olimpo M, Fracassi F. Surgical findings and outcomes after unilateral adrenalectomy for primary hyperaldosteronism in cats: a multi-institutional retrospective study. J Feline Med Surg 2023; 25:1098612X221135124. [PMID: 36706013 PMCID: PMC10812040 DOI: 10.1177/1098612x221135124] [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] [Indexed: 01/28/2023]
Abstract
CASE SERIES SUMMARY Twenty-nine cats from different institutions with confirmed or highly suspected primary hyperaldosteronism treated by unilateral adrenalectomy were retrospectively included in this study. The most frequent clinical signs were lethargy (n = 20; 69%) and neck ventroflexion (n = 17; 59%). Hypokalaemia was present in all cats, creatinine kinase was elevated in 15 and hyperaldosteronism was documented in 24. Hypertension was frequently encountered (n = 24; 89%). Preoperative treatment included potassium supplementation (n = 19; 66%), spironolactone (n = 16; 55%) and amlodipine (n = 11; 38%). There were 13 adrenal masses on the right side, 15 on the left and, in one cat, no side was reported. The median adrenal mass size was 2 × 1.5 cm (range 1-4.6 × 0.4-3.8); vascular invasion was present in five cats, involving the caudal vena cava in four cats and the renal vein in one. Median duration of surgery was 57 mins. One major intraoperative complication (3%) was reported and consisted of haemorrhage during the removal of a neoplastic thrombus from the caudal vena cava. In 4/29 cats (14%), minor postoperative complications occurred and were treated medically. One fatal complication (3%) was observed, likely due to disseminated intravascular coagulation. The median duration of hospitalisation was 4 days; 97% of cats survived to discharge. The potassium level normalised in 24 cats within 3 months of surgery; hypertension resolved in 21/23 cats. Follow-up was available for 25 cats with a median survival of 1082 days. Death in the long-term follow-up was mainly related to worsening of comorbidities. RELEVANCE AND NOVEL INFORMATION Adrenalectomy appears to be a safe and effective treatment with a high rate of survival and a low rate of major complications. Long-term medical treatment was not required.
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Affiliation(s)
- Sara Del Magno
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
| | - Armando Foglia
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
| | - Matteo Rossanese
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Vincenzo Montinaro
- Soft Tissue Department, Clinica Veterinaria Malpensa, AniCura, Samarate, Italy
| | - Veronica Cola
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
| | - Luciano Pisoni
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
| | - Diego Rossetti
- ADVETIA, Centre Hospitalier Vètèrinaire, Vèlizy-Villacoublay, France
| | | | | | | | | | - Francesco Collivignarelli
- University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | | | - Filippo Cinti
- Veterinary Hospital of Portoni Rossi – Anicura, Bologna, Italy
| | - Matteo Olimpo
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Italy
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8
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Moretto L, Herzig R, Beckmann K, Wolfer N, Dennler M, Glaus TM. Reversible facial nerve paralysis in a cat suspected to be associated with systemic hypertension. JFMS Open Rep 2021; 7:20551169211063454. [PMID: 34925872 PMCID: PMC8679037 DOI: 10.1177/20551169211063454] [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: 11/16/2022] Open
Abstract
Case summary This report describes the appearance of facial nerve paralysis in a 16-year-old hypertensive cat. MRI was helpful in visualising and characterising mesencephalic and facial nerve lesions thought to be induced by hypertension. Neurological signs rapidly resolved under antihypertensive therapy. Relevance and novel information Systemic hypertension is an important medical condition in geriatric cats causing damage in various target organs, including the brain. Hypertensive encephalopathy is an umbrella term for a multitude of different clinical manifestations of cerebral target organ damage. Facial nerve paralysis secondary to hypertension is recognised in human medicine, particularly in children, but so far has not been reported in veterinary medicine.
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Affiliation(s)
- Laura Moretto
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Robert Herzig
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Katrin Beckmann
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Wolfer
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Tony M Glaus
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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9
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Domenegato BM, Côté E, Agarwal D, O'Sullivan ML, Reveler ED, Dobbin E, McMahon E. Effects of handling and storage on potassium concentration in plasma and serum samples obtained from cats. J Am Vet Med Assoc 2021; 260:187-193. [PMID: 34890359 DOI: 10.2460/javma.20.09.0530] [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 compare potassium concentrations in feline plasma and serum samples analyzed promptly after collection or after 20 to 28 hours of refrigerated storage. ANIMALS 41 cats. PROCEDURES A venous blood sample was obtained from each cat. Aliquots were placed in 2 tubes without anticoagulant (blood was allowed to clot to derive serum) and 2 tubes with heparin (to derive plasma). One serum and 1 plasma sample were kept at room temperature and analyzed within 60 minutes after collection (baseline); the other serum and plasma samples were analyzed after 20 to 28 hours of refrigerated storage. At both time points, serum and plasma potassium concentrations were measured. RESULTS Median baseline serum potassium concentration (4.3 mmol/L) was significantly higher than median baseline plasma potassium concentration (4.1 mmol/L). The median difference between those values was 0.4 mmol/L (95% CI, 0.2 to 0.5 mmol/L). Compared with their respective baseline measurements, the median serum plasma concentration (4.8 mmol/L) and median plasma potassium concentration (4.6 mmol/L) were higher after 20 to 28 hours of refrigeration. CLINICAL RELEVANCE Results indicated that with regard to potassium concentration in feline blood samples, clotting or refrigerated storage for 20 to 28 hours results in a significant artifactual increase. Detection of an unexpectedly high potassium concentration in a cat may represent pseudohyperkalemia, especially if the blood sample was placed in a no-additive tube, was stored for 20 to 28 hours prior to analysis, or both.
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Affiliation(s)
- Briana M Domenegato
- Veterinary Teaching Hospital, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Deepmala Agarwal
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - M Lynne O'Sullivan
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Elaine D Reveler
- Veterinary Teaching Hospital, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Elizabeth Dobbin
- Diagnostic Services, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Ellen McMahon
- Diagnostic Services, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
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10
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Yu J, Lenord J, Lau M, Brunel L, Gray R, Donahoe SL, Boland L. Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism. JFMS Open Rep 2021; 7:20551169211045640. [PMID: 34616560 PMCID: PMC8488528 DOI: 10.1177/20551169211045640] [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: 11/30/2022] Open
Abstract
Case summary A 7-year-old male neutered domestic longhair cat was presented with chronic progressive gynaecomastia, polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behavioural changes were not reported and virilisation was not present on physical examination. Pertinent haematology, biochemistry and urinalysis findings at the time of referral included mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation of adrenal hormones with a low-dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hyperaldosteronism and hypercortisolism. Adrenalectomy was performed and histopathology was consistent with an adrenocortical tumour. Clinical signs and hormone elevations resolved postoperatively. Relevance and novel information To our knowledge, this is the second report of gynaecomastia secondary to an adrenal tumour in a male neutered cat and the first associated with hyperprogesteronism.
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Affiliation(s)
- Jane Yu
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Jason Lenord
- Balmain Veterinary Hospital, Rozelle, NSW, Australia
| | - Michelle Lau
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Rachael Gray
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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11
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Harro CC, Refsal KR, Shaw N, Alston SM, Folger W, Gross C, Cousins WM, Monahan CF, Mazaki-Tovi M, Langlois DK. Retrospective study of aldosterone and progesterone secreting adrenal tumors in 10 cats. J Vet Intern Med 2021; 35:2159-2166. [PMID: 34473866 PMCID: PMC8478046 DOI: 10.1111/jvim.16256] [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: 05/12/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Primary hyperaldosteronism caused by adrenal neoplasia has been well described in cats. Multiple corticosteroid abnormalities occur in a subset of affected cats, but characterizations of this syndrome are limited to several case reports. Objectives To describe a series of cats with adrenal tumors secreting aldosterone and additional corticosteroids. Animals Ten cats with multiple corticosteroid secreting adrenocortical tumors. Methods Retrospective case series. Medical records of cats with adrenal tumors secreting both aldosterone and progesterone were identified. Data concerning historical findings, clinicopathologic features, treatments, and outcomes were retrieved from medical records. Results All 10 cats had diabetes mellitus in addition to biochemical features of hyperaldosteronism such as hypokalemia. High corticosterone concentrations were observed in all 3 cats in which this corticosteroid was measured. Ultrasound examinations revealed unilateral adrenal tumors in all 10 cases, and the contralateral adrenal gland was either atrophied or not identified in 5 cats. Three of 4 cats developed hypoadrenocorticism after surgical adrenalectomy. Three cats achieved diabetic remission after adrenalectomy. Two cats treated with adrenalectomy survived >1 year, 1 cat survived 6.5 months, and 1 cat was alive 5.5 months after diagnosis. Survival >1 year occurred in 2 of 4 cats treated with medical management alone. Two cats were not treated. Conclusions and Clinical Importance The presence of multiple corticosteroid abnormalities should be considered in cats with aldosterone secreting adrenal tumors, especially those with concurrent diabetes mellitus. Both surgical and medical management can result in long‐term survival, although diabetic remission was documented only in cats undergoing adrenalectomy.
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Affiliation(s)
- Cailin C Harro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kent R Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nicole Shaw
- Veterinary Emergency and Referral Group, Brooklyn, New York, USA
| | | | | | - Carolyn Gross
- Central Hospital for Veterinary Medicine, Guilford, Connecticut, USA
| | - W Mark Cousins
- The Cat Practice Veterinary Hospital, New Orleans, Louisiana, USA
| | - Colleen F Monahan
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Michal Mazaki-Tovi
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Daniel K Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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Pérez-López L, Wägner AM, Saavedra P, Jaber JR, Melián C. Ultrasonographic evaluation of adrenal gland size in two body weight categories of healthy adult cats. J Feline Med Surg 2021; 23:804-808. [PMID: 33236660 PMCID: PMC10812194 DOI: 10.1177/1098612x20974962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adrenal gland size and its association with body weight have been rarely evaluated in cats. This study was undertaken to assess the association between feline body weight and adrenal gland thickness, and to propose reference intervals (RIs) for adrenal gland thickness in healthy cats. METHODS This was a cross-sectional study in which 39 healthy cats were included. The cats were divided into two weight categories, classified as ⩽4.0 kg and >4-8 kg of ideal body weight (with 13 and 26 cats in each group, respectively), which took into consideration the body condition score of the cats. All cats underwent an ultrasound examination that was taken from a subcostal position. Maximum dorsoventral thicknesses of the left (MTL) and right (MTR) adrenal glands were measured in a sagittal plane. RIs were obtained for the maximum thickness (MT), which included the MTLs and MTRs of each cat. RIs with the 90% confidence intervals were calculated according to American Society for Veterinary Clinical Pathology guidelines on RIs. RESULTS No statistical differences for adrenal gland thickness were observed between the left and right (P = 0.543) adrenal glands or between male and female cats (P = 0.943). Mean MT was significantly greater in the group of cats weighing >4-8 kg compared with the group of cats weighing ⩽4 kg (3.7 ± 0.6 vs 3.2 ± 0.4 mm; P <0.005). The lower limit of the RI for MT was 2.4 mm (range 2.2-2.6 mm) in the group weighing ⩽4 kg and 2.6 mm (range 2.4-2.8 mm) in the group weighing >4-8 kg. The upper limit of the RI for MT was 3.9 mm (range 3.7-4.1 mm) in the group of cats weighing ⩽4 kg and 4.8 mm (range 4.6-5.1 mm) in the group of cats weighing >4-8 kg. CONCLUSIONS AND RELEVANCE The use of RIs based on two group sizes allows for a more accurate ultrasonographic evaluation of adrenal gland thickness in cats. The maximum normal adrenal gland thickness is lower in smaller cats (3.9 mm for those weighing ⩽4 kg and 4.8 mm for those weighing >4-8 kg).
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Affiliation(s)
- Laura Pérez-López
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
| | - Ana María Wägner
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Arucas, Spain
| | - Jose Raduan Jaber
- Department of Morphology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - Carlos Melián
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas, Las Palmas, Spain
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Langlois DK, Mazaki-Tovi M, Harro CC, Refsal KR. Multiple corticosteroid abnormalities in cats with hyperaldosteronism. J Vet Intern Med 2021; 35:2152-2158. [PMID: 34331479 PMCID: PMC8478033 DOI: 10.1111/jvim.16224] [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: 05/12/2021] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background The frequency with which multiple corticosteroid abnormalities occur in cats with aldosterone secreting adrenocortical tumors is unknown. Objectives To evaluate adrenal‐derived corticosteroids in cats in which blood samples were submitted for measure of aldosterone. Animals Two hundred ninety‐seven cats. Methods Retrospective study. Analysis of a convenience sample of previously submitted serum or plasma. Progesterone, corticosterone, and cortisol were measured in feline serum or plasma samples submitted to an endocrinology laboratory for aldosterone measurements. Demographics and clinical history were retrieved from submittal forms when provided. Statistical testing was performed to investigate associations among the adrenal corticosteroids. Results Progesterone and corticosterone concentrations were strongly correlated (ρ = 0.74; P < .001). Progesterone (median, 5 nmol/L; interquartile range, 3‐10 nmol/L) and corticosterone (113 nmol/L, 38‐250 nmol/L) in cats with markedly increased aldosterone concentrations (≥3000 pmol/L) were higher than progesterone (1 nmol/L, 1‐2 nmol/L) and corticosterone (12 nmol/L, 3‐25 nmol/L) in cats with normal aldosterone concentrations (P < .001 for both comparisons). Progesterone concentrations ≥10 nmol/L (normal, ≤2 nmol//L) occurred in 24 of 76 (32%) cats with aldosterone concentrations ≥3000 pmol/L. Cortisol was lower in cats with aldosterone concentrations ≥3000 pmol/L as compared to those with aldosterone concentrations <500 pmol/L (59 nmol/L, 27‐103 nmol/L vs 103 nmol/L, 49‐182 nmol/L; P = .002). Conclusions and Clinical Importance Multiple corticosteroid abnormalities occur in a subset of cats with hyperaldosteronism. The magnitude of increases in progesterone and corticosterone in some cats with hyperaldosteronism is likely to be clinically relevant.
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Affiliation(s)
- Daniel K Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Michal Mazaki-Tovi
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Cailin C Harro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Kent R Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Reche Junior A, Ramos D, Ferreira M, da Silva LAG, Hirai Y, Horta PV. A case of behavioral changes in a castrated male cat due to a functional adrenocortical adenoma producing testosterone and androstenedione. JFMS Open Rep 2021; 7:2055116920981247. [PMID: 33489305 PMCID: PMC7809526 DOI: 10.1177/2055116920981247] [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: 11/17/2022] Open
Abstract
Case summary This case report describes a 9-year-old neutered male cat with a functional adrenal tumor showing aggression toward other cats in the household, excessive meowing and urine spraying. The diagnosis was made based on the clinical signs, an enlarged right adrenal gland on ultrasound, penile spines and elevated sex hormones on an adrenocorticotropic hormone stimulation test. The cat was submitted to celiotomy and adrenalectomy. Histopathological examination confirmed the adrenocortical adenoma. Three months after surgery the penile spines disappeared and urine spraying, as well as excessive meowing, had greatly decreased; however, aggressive behavior took much longer to stop and required behavior therapy. Relevance and novel information Functional adrenal tumors producing only sex hormones and behavioral changes are uncommon. The cat reported herein started showing behavioral changes before spines appeared on the penis, and structural alterations in the adrenal gland at the abdominal ultrasonography were detected. Considering all the possible implications resulting from severe behavior problems such as cat-cat aggression, from a permanent separation of the cats to relinquishment, a detailed investigation of underlying medical mechanisms in these animals is crucial from the start. Examinations may need to be repeated later in the course.
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Affiliation(s)
- Archivaldo Reche Junior
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil.,Vetmasters and 4 Cats Hospital, São Paulo, Brazil
| | | | | | | | - Yumi Hirai
- Vetmasters and 4 Cats Hospital, São Paulo, Brazil
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- BVSc, Ce666rtAVP, DipECVDI, Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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16
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Toleson LE, Tamulevicus A, Rahilly L. Diabetes mellitus and anterior uveitis secondary to the systemic effects of a functional adrenal tumour in a cat. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001080] [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)
- Lauren E Toleson
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
| | - Amy Tamulevicus
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
| | - Louisa Rahilly
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
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Kirkwood N, Boland L, Brunel L, Wardman A, Barrs VR. Acute adrenal haemorrhage in two cats with aldosterone-secreting adenocarcinomas. JFMS Open Rep 2019; 5:2055116919840828. [PMID: 30992996 PMCID: PMC6449812 DOI: 10.1177/2055116919840828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary Two 13-year-old domestic shorthair cats were diagnosed with unilateral right
adrenocortical carcinomas (ACCs) and primary hyperaldosteronism (PHA). Both
had polyuria, polydipsia and weight loss, and developed severe anaemia from
an episode of acute adrenal haemorrhage. In one case, this occurred during
hospitalisation and treatment of severe muscle weakness with cervical
ventroflexion, while the other cat had acute collapse at home. A diagnosis
of PHA was confirmed in both cases based on measurement of plasma
aldosterone and renin activity. In one case, basal progesterone was also
measured and was elevated. On ultrasonography and CT in one case,
haemorrhage into the right retroperitoneal space was identified. Unilateral
adrenalectomy was performed in both cases and there was no evidence of
venous tumoral invasion in either. On histopathology of the excised adrenal
glands both were ACCs with tumour necrosis, and one had extensive
intratumoral haemorrhage. Both cats were diagnosed with International Renal
Interest Society stage 2 or 3 chronic kidney disease postoperatively; one
survived for 18 months and the other was well 8 months postoperatively. Relevance and novel information Acute adrenal haemorrhage secondary to adrenal neoplasia has been reported in
only one other cat, in which tumour type and function were not specified.
Acute adrenal haemorrhage can occur as a consequence of tumour necrosis and
rupture and can cause severe hypovolaemia and anaemia in cats with primary
hyperaldosteronism.
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Affiliation(s)
- Nicolle Kirkwood
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Alison Wardman
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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Carter J. Hypertensive ocular disease in cats: A guide to fundic lesions to facilitate early diagnosis. J Feline Med Surg 2019; 21:35-45. [PMID: 30763152 PMCID: PMC10814178 DOI: 10.1177/1098612x18818668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PRACTICAL RELEVANCE Systemic hypertension is common in older cats and can result in damage to organs with a rich arteriolar supply such as the eyes, kidneys, myocardium and brain. Hypertensive disease in these organs is known as target organ damage (TOD). Disease in the eye resulting from hypertension is the most easily identifiable form of TOD and can often be the reason the cat is presented to the veterinarian. Routine blood pressure measurement and fundic examination allows cats with hypertensive ocular lesions to be detected early in the course of the disease, when the lesions have the best chance of responding to treatment. CLINICAL CHALLENGES Detecting early evidence of TOD in the fundus requires a veterinarian to be competent in recognising lesions associated with mild hypertensive disease, as well as the more easily recognised advanced lesions that frequently result in impaired vision and blindness. AUDIENCE This review is written for all veterinarians who treat cats. It provides information and images to facilitate and guide veterinarians performing fundoscopy in cats, in particular in those over 7 years of age, with the aim of diagnosing hypertensive ocular lesions when they are present. EQUIPMENT The clinical manifestations of hypertensive ocular disease can be detected non-invasively with inexpensive equipment. A summary of the equipment available for general practitioners to perform fundoscopy is provided. EVIDENCE BASE This is a comprehensive review of the literature on hypertensive ocular disease in cats. The author has also included images of hypertensive ocular lesions taken in general practice to highlight the variety of lesions that can be detected.
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Lopez KE, Sutherland-Smith J, Caudal V, Aarsvold S. What Is Your Diagnosis? J Am Vet Med Assoc 2018; 253:1247-1249. [PMID: 30398421 DOI: 10.2460/javma.253.10.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Di Girolamo N, Fecteau K, Carnimeo A, Bongiovanni L, Fracassi F, Isani G, Selleri P. Variability of serum aldosterone concentrations in pet ferrets (Mustela putorius furo). J Am Vet Med Assoc 2018; 252:1372-1376. [DOI: 10.2460/javma.252.11.1372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bijsmans ES, Doig M, Jepson RE, Syme HM, Elliott J, Pelligand L. Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats. J Vet Intern Med 2018; 30:1630-1636. [PMID: 27717190 PMCID: PMC5032874 DOI: 10.1111/jvim.14562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/02/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background Hypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored. Aims To determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations. Methods Fifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response. Results Cats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration. Conclusions and Clinical Importance Cats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK.
| | - M Doig
- ABS Laboratories Ltd, Welwyn Garden City, Hertfordshire, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - L Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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Boland LA, Barrs VR. Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment. J Feline Med Surg 2017; 19:933-947. [PMID: 28838299 PMCID: PMC11128894 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).
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Affiliation(s)
- Lara A Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, 2006, Australia
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Abstract
CASE SUMMARY Herein a drug-resistant IgG-lambda-type multiple myeloma associated with probable phaeochromocytoma in a cat is described. A 12-year-old cat presented with weakness, weight loss, progressive blindness and open-mouth breathing, in addition to polyuria and polydipsia of 2 months' duration. Abdominal ultrasonography revealed a left adrenal mass. Phaeochromocytoma was suspected on the basis of cytology and was associated with systemic hypertension. Biochemistry showed hyperproteinaemia. Serum protein electrophoresis revealed a narrow spike in the gamma region, identified as IgG lambda type at immunoelectrophoresis. Bone marrow cytology revealed an infiltrate with numerous mature plasma cells. The cat was resistant to two different drugs for multiple myeloma and was euthanased 6 months later because of anorexia and persistent poor general condition. RELEVANCE AND NOVEL INFORMATION This is the first clinical description of multiple myeloma associated with a suspected phaeochromocytoma in a cat.
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Mitchell JW, Mayhew PD, Culp WTN, Brad Case J, Singh A, Fuller MC, Della Maggiore A. Outcome of laparoscopic adrenalectomy for resection of unilateral noninvasive adrenocortical tumors in 11 cats. Vet Surg 2017; 46:714-721. [DOI: 10.1111/vsu.12655] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jeffrey W. Mitchell
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - J. Brad Case
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville Florida
| | - Ameet Singh
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Mark C. Fuller
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis California
| | - Ann Della Maggiore
- Department of Medicine and Epidemiology, School of Veterinary Medicine; University of California-Davis; Davis California
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Romine JF, Kozicki AR, Elie MS. Primary adrenal lymphoma causing hypoaldosteronism in a cat. JFMS Open Rep 2016; 2:2055116916684409. [PMID: 28491445 PMCID: PMC5415298 DOI: 10.1177/2055116916684409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Case summary A 10-year-old, 5.1 kg (11.2 lb), male castrated cat was presented with signs of lethargy and decreased appetite at home after being previously healthy. Serum biochemical analysis identified normokalemia (5.1 mmol/l; reference interval [RI] 3.4–5.6 mmol/l) and severe hyponatremia (123 mmol/l; RI 145–158 mmol/l), with an Na/K ratio of 24 (RI 32–41). Baseline serum cortisol was low to normal, but serum aldosterone was markedly decreased with a pre-adrenocorticotropic hormone stimulation concentration of 13 pmol/l (RI 194–388 pmol/l) and post-adrenocorticotropic hormone stimulation concentration of 21 pmol/l (RI 277–721 pmol/l). Hematologic and biochemical analyses were otherwise unremarkable. Abdominal ultrasound revealed bilaterally enlarged adrenal glands with no other abnormalities noted; thoracic radiographs also did not identify any signs of metastasis. Fine-needle aspiration was strongly suggestive of lymphoma of the adrenal glands, and PCR for antigen receptor rearrangement was positive for B-cell clonal expansion; based on these findings, a diagnosis of primary adrenal B-cell lymphoma was made. Stable disease was achieved for a short period of time following vincristine, cyclophosphamide, prednisolone and fludrocortisone therapy, followed by progressive adrenal enlargement and electrolyte derangements that responded to neither doxorubicin nor adjustments in fludrocortisone dosage. Ultrasonographic metastasis was not identified at any time, and other organ derangements were not noted on hematologic or biochemical analyses. The cat was euthanized 55 days after initial presentation. Relevance and novel information This is the first report of primary adrenal lymphoma in a cat, with presenting signs compatible with hypoaldosteronism. Lymphoma should be a differential for cats presenting with adrenal enlargement or clinical signs and biochemical changes consistent with hypoaldosteronism or hypoadrenocorticism.
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Affiliation(s)
- Jessica F Romine
- Department of Internal Medicine, BluePearl Veterinary Partners, Southfield, MI, USA
| | - Angela R Kozicki
- Department of Oncology, BluePearl Veterinary Partners, Southfield, MI, USA
| | - Marc S Elie
- Department of Internal Medicine, BluePearl Veterinary Partners, Southfield, MI, USA
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Folger WR, Mahony O, Barton BA. Adrenalectomy: postoperative survival data. J Feline Med Surg 2016; 18:683. [PMID: 27250741 PMCID: PMC10816381 DOI: 10.1177/1098612x16652186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Leshinsky J, Beatty JA, Fawcett A, Voss K, Makara M, Krockenberger MB, Barrs VR. Aldosterone and progesterone-secreting adrenocortical adenocarcinoma in a cat with a concurrent meningioma. JFMS Open Rep 2016; 2:2055116915624448. [PMID: 28491405 PMCID: PMC5359794 DOI: 10.1177/2055116915624448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/22/2022] Open
Abstract
CASE SUMMARY A 12-year-old, male neutered domestic shorthair cat was referred for investigation of suspected hyperaldosteronism due to persistent hypokalaemia, hindlimb ataxia, weakness of 1 month's duration and a left adrenal mass that was detected on abdominal ultrasound. Neurological examination findings at referral were suggestive of a concurrent left forebrain lesion. Hyperaldosteronism and concurrent hyperprogesteronism were confirmed on endocrine testing. On computed tomography (CT) of the abdomen and thorax there was no evidence of local vascular invasion by the adrenal mass or of metastatic disease. CT and magnetic resonance imaging featured a large, focal rim-enhancing extra-axial left forebrain lesion consistent with a meningioma. Surgical excision of the forebrain mass was followed by adrenalectomy 2 weeks later. The tumours were classified on histopathology as a psammomatous meningioma and an adrenocortical adenocarcinoma, respectively. Immunohistochemical staining of the meningioma confirmed the presence of progesterone receptors. The cat remains well 2 years later. RELEVANCE AND NOVEL INFORMATION In humans, elevated serum progesterone levels have been associated with rapid growth of meningiomas due to the presence of progesterone receptors on the tumour. This is the first report of a cat with a progesterone and aldosterone-secreting adrenocortical adenocarcinoma and a concurrent meningioma. Clinicians should be aware of the potential effect of elevated progesterone on meningiomas in cats.
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Affiliation(s)
- Jana Leshinsky
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Julia A Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Anne Fawcett
- Sydney Animal Hospitals – Inner West, Stanmore, NSW, Australia
| | - Katja Voss
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Mariano Makara
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Mark B Krockenberger
- Veterinary Pathology Diagnostic Services, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
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