Applying children's enuresis treatment with amitriptyline for canine post-spaying urinary incontinence: A pilot estriol-controlled randomized clinical trial

Urinary incontinence due to urethral sphincter mechanism incompetence (USMI) affects up to 20% of bitches that undergo spaying surgery. Amitriptyline is a tricyclic antidepressant whose urinary retention is a reported side effect. This study aimed to assess the efficacy and safety of amitriptyline when compared to estriol orally. Fifteen bitches with a clinical diagnosis of post-spaying UI were evaluated during 60 days in a non-blinded randomized clinical trial. All patients were enrolled after clinical evaluation consisting of anamnesis, physical examination, and complementary exams (complete blood count, biochemical parameters, urinalysis, and abdominal ultrasound). The amitriptyline (AMT) group consisted of 8 bitches, which received the initial dose of 1 mg/kg every 12 h, whereas the estriol (EST) group consisted of 7 bitches which were initially treated with 1 mg/animal every 24 h. Patients underwent clinical evaluation at 7 days, and then at 21 and 60 days of treatment to assess safety and efficacy, as well as adjustments of dose when necessary. A urinary incontinence scale was used to assess the level of incontinence and therapeutic response to treatment. During the period of the study, estriol was fully effective in 71% of cases and amitriptyline in 62%. Both drugs proved safe in the medical treatment of USMI, with adverse effects such as somnolence (AMT, n = 5/8) and male attraction (EST, n = 1/7). The results support the amitriptyline recommendation as a substitute for estriol in USMI treatment.

Clinical features of muscle stiffness in 37 dogs with concurrent naturally occurring hypercortisolism

BACKGROUND

Severe muscle stiffness (SMS) in dogs with hypercortisolism (HC) is uncommon.

OBJECTIVES

To evaluate signalment, presentation, treatments, and long-term outcomes of dogs with concurrent HC and SMS.

ANIMALS

Thirty-seven dogs.

METHODS

Medical records of dogs with HC and concurrent SMS were recruited from 10 institutions. Clinical information, test results, therapeutic responses, and survival times were reviewed.

RESULTS

All 37 dogs with HC and SMS had pituitary-dependent hypercortisolism (PDH); 36/37 weighed <20 kg. Signs and test results were typical of PDH aside from SMS, initially diagnosed in all 4 limbs in 9, pelvic limbs of 22, and thoracic limbs of 6 dogs. Hypercortisolism and SMS were diagnosed together in 3 dogs; HC 1-36 months before SMS in 23; SMS 1-12 months before HC in 11. Mitotane or trilostane, given to control HC in 36/37 dogs, improved or resolved HC signs in 28; SMS did not resolve, remaining static or worsening in 31/36 dogs, mildly improving in 5/19 dogs given additional therapies. Progression of SMS included additional limbs in 10 dogs and the masticatory muscles of 2. The median survival time from diagnosis of SMS was 965 days (range, 8-1188).

CONCLUSIONS AND CLINICAL IMPORTANCE

Concurrent SMS and HC is uncommon, possibly affecting only dogs with PDH. Development of SMS might occur before or after diagnosis of HC. Apart from SMS, the clinical picture and survival time of these dogs seem indistinguishable from those of dogs with HC in general. However, while muscle weakness usually resolves with HC treatment SMS does not.

Is methylprednisolone acetate-related insulin resistance preventable in cats?

Methylprednisolone acetate (MPA) is often prescribed to cats despite being recognized eventually as diabetogenic. To assess MPA-related insulin resistance and evaluate the efficacy of metformin or an obesity and diabetes mellitus (O&D) adjuvant diet as protective factors, a randomized clinical trial was conducted with 28 owned cats undergoing glucocorticoid therapy. A single MPA dose of 20 mg intramuscularly was administered to each cat. Controls (n=10) received only MPA. In the diet group (n=9), replacement of their habitual diet by ad-libitum feeding of a feline commercial O&D diet (Equilíbrio O&D, Total Alimentos ADM) was made. In the metformin group (n=9), metformin chlorhydrate 25mg/cat PO/q24h was administered for 30 days. All patients were clinically evaluated at baseline (T0), day 15 (T15), and day 30 (T30) and blood draw for complete blood count, serum biochemistry, and determination of insulin concentrations. Fasting Insulin Sensitivity Index (SI), Amended Insulin to Glucose Ratio (AIGR), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and Homeostatic Model Assessment of beta-cell function (HOMA-B) were calculated based on fasting glycemia and insulinemia. All groups showed significantly higher levels (p < 0.05) of neutrophils, albumin, glucose, cholesterol, triglycerides, and serum insulin at T15. Patients in the metformin group showed also higher SI, AIGR, and HOMA-IR results at T15. Also, at T15, reduced levels (p < 0.05) of eosinophils, lymphocytes, and creatinine were documented in all groups. An MPA single dose induced changes in insulin sensitivity in cats; however, neither metformin nor O&D feeding used in this study was effective as protective factors against MPA-related insulin resistance.

Pyometra-associated insulin resistance assessment by insulin binding assay and tyrosine kinase activity evaluation in canine muscle tissue

Diestrus is associated with insulin resistance in bitches and pyometra can further impair insulin sensitivity. This study aimed to compare insulin sensitivity, insulin binding, and tyrosine kinase activity in bitches in anestrus, diestrus, or with pyometra. Patients submitted to elective ovariohysterectomy were divided into anestrus (n = 11) or diestrus (n = 13) according to reproductive history, vaginal cytology, and uterine histology. The group pyometra (n = 8) included bitches diagnosed with the disease based on clinical presentation and abdominal ultrasound findings and further confirmed by uterine histopathology. All patients were submitted to an intravenous glucose tolerance test (IVGTT) before ovariohysterectomy, and rectus abdominis muscle samples were collected during surgery for plasmatic membrane suspension preparation. Muscle-membranes were submitted to cold saturation insulin binding assay for dissociation constant (Kd) and maximum binding capacity (Bmax) determination, as well as exogenous substrate Poly (Glu: Tyr 4:1) phosphorylation assay for basal tyrosine kinase evaluation. Bitches with pyometra showed higher basal insulin (P < 0.001) and higher area under the curve (AUC) for insulin (P = 0.01) and glucose (P < 0.001) response during the IVGTT in comparison with bitches in anestrus or diestrus. Diestrus (P < 0.0001) and pyometra (P = 0.001) were associated with reduced tyrosine kinase activity in comparison with anestrus. No differences were documented in Kd and Bmax results for the low-affinity/high-capacity insulin receptors; however, high-affinity/low-capacity insulin receptors showed higher Kd and Bmax results in bitches in diestrus or with pyometra (P < 0.05) in comparison with anestrus. Despite the pyometra group showed the highest Kd values (P < 0.01), its Bmax results did not differ from the diestrus group (P > 0.05). Diestrus' higher Kd values and reduced tyrosine kinase activity in muscle tissue were compensated by increased total insulin binding capacity. Absent differences in IVGTT results between diestrus and anestrus bitches corroborate this finding. However, in bitches with pyometra, the highest Kd values were not compensated by increased total insulin binding capacity. This finding was associated with insulin resistance and glucose intolerance in IVGTT results. Moreover, pyometra resolution restored insulin sensitivity and glucose tolerance. These features can play a key role in pyometra-associated CDM, as well as in diabetic remission after pyometra resolution.

Non-lactose-fermenting uropathogenic Escherichia coli from dogs: virulence profile characterization

Non-lactose-fermenting Escherichia coli (NLFEC) has a few descriptive studies restricted to human infections. In the present study, isolates of NLFEC obtained from urine samples of dogs with hyperadrenocorticism were characterized regarding their virulence ability, biofilm formation capacity and antimicrobial susceptibility profile. Escherichia coli lactose-fermenting strains from urinary infection in dogs with the same conditions were analysed to provide comparisons. The non-lactose-fermenting E. coli strains were classified as belonging to clade I E. coli, whereas the lactose-fermenting strains were classified in phylogroup B2. All strains presented virulence markers to adhesion, iron acquisition, toxins, colicin and cytotoxin production, and biofilm regulation. Components of the extracellular matrix in addition to the in vitro biofilm formation ability were observed in the strains. Multidrug resistance (MDR) profiles were observed by in vitro susceptibility tests to all NLFEC strains. In summary, non-lactose-fermenting uropathogenic E. coli from dogs behaves similar to lactose-fermenting E. coli, exhibiting MDR profile, and pathogenic potential of promote animal infections.

Clinical and microbiological characterization of subclinical bacteriuria and sporadic bacterial cystitis in dogs with spontaneous hypercortisolism

Study's aims were to characterize subclinical bacteriuria (SB) and sporadic bacterial cystitis (SBC) in dogs with spontaneous hypercortisolism (HC). Prospective cross-sectional design divided patients as newly diagnosed (n = 27), poorly controlled (n  = 21), well controlled (n  = 34), and controls (n  = 19). Urine culture positive results were identified by MALDI-TOF and submitted to antibiogram. Escherichia coli was the most common microorganism (36%). The majority of positive cultures in HC were SB (12.2%). All 4.1% SBC cases were in well controlled HC cases. Bacteriuria correlated with low urine specific gravity and low lymphocyte count. HC degree of control correlated with leukocyturia. SB/SBC cases were treated based in antimicrobial susceptibility leading to microbiological cure in 75% of HC cases. Persistent infections occurred only in SB cases, all by E. coli which became more resistant. SB/SBC prevalence in canine HC is actually lower. Further evidence for current ISCAID guideline contraindication for SB treatment due to HC were provided.

Osmotic Demyelination Syndrome after Primary Hypoadrenocorticism Crisis Management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient's life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms "osmotic myelinolysis" or “osmotic demyelination syndrome" are considered more suitable when compared to the term "central pontine myelinolysis" since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hippocampus and cerebellum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis.Keywords: Addison Syndrome, hyponatremia, osmotic myelinolysis, magnetic resonance imaging.

Evidence of Pituitary Hypoplasia Associated with Partial Central Diabetes Insipidus in a Young Persian Cat

Background: Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat.Case: A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, a reduced serum concentration of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), thyroid hormones, and testosterone was documented, confirming the diagnosis of hyposomatotropism, hypogonadism, and secondary hypothyroidism. Furthermore, therapeutic diagnosis with desmopressin revealed partial central diabetes insipidus (CDI). As the sibling showed normal development aging 13-months, a radiographic examination of the forelimb (carpus) was performed on both cats. There was lack of growth plate fusion in the patient, without any other evidence of dysgenesis, whereas complete epiphyseal closure was observed in the sibling. Despite desmopressin and levothyroxine therapeutic prescription the owners refuse further follow-up to the case.Discussion: Notwhistanding neuroimaging was not available for investigation of pituitary aspect in this particular case, the clinical symptoms added to the results of the complementary tests were consistent with pituitary hypoplasia, associated with hyposomatotropism, secondary hypothyroidism, hypogonadism, and partial CDI. Hyposomatotropism was presumably diagnosed based on the patient’s clinical characteristics, which included proportional growth delay, delayed tooth eruption, delayed growth plate fusion, associated with serum reduced IGF-1 results in comparison with its sibling. The report of low free T4 by equilibrium dialysis and of low total T4 levels, associated with low TSH levels, was considered compatible with secondary hypothyroidism. TRH stimulation test is considered the gold standard for secondary hypothyroidism diagnosis since low TSH could be secondary to assay´s low sensibility. However, normal TSH and thyroid hormone results in the sibling results ruled out this possible dismissed diagnose. The patient’s lack of sexual interest, associated with hypotestosteronemia and underdeveloped genitals (absence of penile spines and testicular hypoplasia), indicates hypogonadism. Finally, partial CDI diagnosis was demonstrated by cat´s partial ability to increase urinary specific gravity under water deprivation often made by the owners, as well as the response pattern to desmopressin therapy. Owing the lack of neurological signs expected to be associated with neoplastic or traumatic hypopituitarism etiology, hypoplasia hypothesis was raised. Quite often, patients with pituitary hypoplasia develop Rathke cleft cysts that might expand over time. In the present case, partial CDI is likely to be caused by the compression of the neurohypophysis by cyst formation secondary to adenohypophyseal hypoplasia since this kind of pituitary congenital anomaly does not justify per se neurohypophysis implications.

Müller´s Duct Persistence Syndrome Associated with Cryptorchidism, Sertoli Cell Tumor and Pyometra in a Miniature Schnauzer

Background: Sexual development disturbances (SDD) are divided in SDD with XX genotype (SDD XX) and SDD with XY genotype (SDD XY). Among SDD XY, the Müller´s duct persistence syndrome (MDPS) is characterized by XY karyotype individuals with male external genitals; however, with internal female reproductive organs such as uterine horns, uterus, and cranial vagina portion. The MDPS cases and their related complications are considered very rare in veterinary medicine. The aim of the present case report is to describe the clinical and pathological aspects of a MDPS case associated with cryptorchidism, Sertoli cell tumor, and pyometra in a Miniature Schnauzer dog.Case: A 7-year-old male Miniature Schnauzer weighting 7 kg was brought to veterinary consultation due to owner´s complain of frequent vomiting, apathy, abdominal algia and progressive scrotal enlargement in the last two months. Physical exam reveals hyperthermia (39.7°C), discrete dehydration, enlarged popliteal lymph nodes as well as scrotum enlargement with only one palpable testicle. A blood sample collected for complete blood count showed regenerative anemia, thrombocytopenia, and neutrophilia with left shift in the leukogram. Abdominal ultrasound examination indicated the presence of a tubular structure filled by anechoic content extending from the scrotum to caudal abdomen. Moreover, a 6.39 x 8.54 cm heterogeneous mass in the medial mesogastric region became evident. The patient was hospitalized and submitted to exploratory laparotomy after 24 h due to rectal temperature increase (41°C), worsened abdominal pain and intense apathy. There was free purulent liquid in abdominal cavity and two uterine horns were documented. The left uterine horn passes through inguinal ring and both horns were filled by purulent material. At the right uterine horn extremity there was the mass previously document at ultrasound. The structures were removed and sent to histopathological examination. The microscopic exam confirmed testicular and uterine tissue; furthermore, a Sertoli cell tumor and pyometra were also characterized. The dog was kept at the hospital receiving fluid, antibiotics, analgesics, and anti-inflammatory therapy. After five days the animal was discharged with clear clinical recover. A sample for karyotyping was collected from the oral mucosa which reveals a XY karyotype in the dog. By this way it was concluded that the dog suffers from a SDD XY with MDPS associated to cryptorchidism, Sertoli cell tumor and pyometra.  Discussion: The MDPS cases are often associated with cryptorchidism and testicular tumors. Miniature Schnauzers is one of the most affected dog breeds with this condition, and the heritability pattern is already described. Most cases are identified in adult to old-aged dogs after vague clinical signs investigation such as apathy, anorexia and abdominal or inguinal enlargement, as observed in the present report. When Sertoli cell tumor are present, the hormone secretion pattern of this neoplasia may influence complications occurrence. Once higher estrogen levels may induce endometrial gland proliferation, hydrometra and pyometra are among these complications, as well as reduced hematopoiesis. Moreover, progesterone levels could be also increased favoring pyometra pathophysiology. By conclusion, despite very rare, MDPS should be investigated in Miniature Schnauzers with vague clinical signs, especially cryptorchidic ones. Karyotyping and histopathology were crucial to confirm the diagnosis. Moreover, no other case with MDPS, cryptorchidism, Sertoli cell tumor, and pyometra was found in the published literature consulted. 

Granulosa Cell Tumor Associated with Occult Hyperadrenocorticism in a Yorkshire Terrier Bitch

Background: Hyperadrenocorticism (HAC), is considered a set of symptoms due to excessive exposure to cortisol. Naturally occurring HAC is most often related to pituitary tumors (pituitary-dependent HAC - PDH). Occult HAC, is referred as a clinical picture highly consistent with HAC; however, routine screening tests are negative. In addition, one or more steroids are elevated following administration of adrenocorticotrophic hormone (ACTH). Ovarian granulosa cell tumors, can produce steroids leading to paraneoplastic syndromes. The objective of this study was to report an unpublished case of ovarian granulosa cell tumor associated with occult hyperadrenocorticism in a Yorkshire Terrier.Case: A 13-year-old intact female dog, Yorkshire Terrier, was brought for consultation with slight weight loss, polyuria, polydipsia, irregular estrous cycles, increased abdominal volume and thin coat. On physical examination the animal was gasping and presented severe periodontal disease, bulging abdomen, alopecia and skin hyperpigmentation. Complete blood count presented no changes; however, serum biochemistry evaluation highlighted hyperalbuminemia, hypertriglyceridemia, alkaline phosphatase increased activity, and urinary specific gravity and creatinine below reference values. On abdominal ultrasonography left adrenal gland measured 2.08 cm x 1.08 cm and the right adrenal gland measured 2.11 cm x 0.84 cm, indicating bilateral adrenomegaly compatible with PDH. In the hypogastric abdomen, a large heterogeneous hypoechogenic mass was also observed, with areas of cystic cavities, measuring 5.80 cm x 7.30 cm. A low dose dexamethasone suppression test (LDDST) was performed, due to PDH suspicion. The test did not confirm HAC, suspecting, then, to be a case of occult/atypical HAC. Due to the strong clinical suspicion, and owner financial problems for further investigated occult HAC, trilostane treatment was initiated. Approximately one month after starting treatment, an ACTH stimulation test (AST) for cortisol and 17-hydroxyprogesterone (17-OHP) determination was performed, revealing high values for both hormones. Exploratory laparotomy was indicated due to the tumor image on hypogastric region visualized on abdominal ultrasonography. A cranial pole mass of the left ovary measuring 8.5 x 7.0 x 4.5 cm, of friable consistency and brownish color, was removed through ovariohysterectomy. A granulosa cell tumor on left ovary, as well as leiomyoma and cystic endometrial hyperplasia in the uterus, became clear through histopathological examination. Trilostane treatment was sustained after surgery. Few weeks later, the patient presented a clinical picture suggestive of hypoadrenocorticism, associated with a low sodium:potassium ratio (25:1), and AST results (basal and post-ACTH cortisol) below reference range, confirming Addisonian´ crises. The patient deceives within two days.Discussion: Granulosa cell tumors can produce estrogen and progesterone, as well as other steroids, leading to paraneoplastic syndromes with peculiar clinical presentations. Steroids transport in plasma occurs via specific carrier proteins. Increased production of other steroid hormones may result in higher concentration of free cortisol, thus leading to clinical manifestations of hypercortisolism. As 17-OHP is one of the precursors in cortisol synthesis and has been shown elevated on AST, it can be assumed that altered steroid hormone levels due to the granulosa cell tumor interfered on cortisol biodisponibility, leading to HAC signs. Dexamethasone suppression test results indicated that pituitary-adrenal axis was responsive to negative feedback. The Addisonian crises after tumor removal indicate that the main source for systemic excessive cortisol effects was the eminent steroid secretion by the granulosa cell tumor.

Diabetes mellitus remission in a cat with pituitary-dependent hyperadrenocorticism after trilostane treatment

Case summary

An 8-year-old male neutered Persian cat was presented with polyuria, polydipsia, polyphagia and muscle weakness associated with a 7 month history of diabetes mellitus (DM). The cat had initially been treated with neutral protamine Hagedorn (NPH) insulin 2 U q12h, followed by porcine lente insulin 2 U q12h and, most recently, 3 U glargine insulin q12h, without improvement of clinical signs. The cat also suffered from concurrent symmetrical bilateral alopecia of thorax and forelimbs, abdominal distension and lethargy. Hyperadrenocorticism (HAC), specifically pituitary-dependent HAC, was suspected and confirmed through abdominal ultrasonography demonstrating bilateral adrenal enlargement, and a low-dose dexamethasone suppression test using 0.1 mg/kg dexamethasone intravenously. Trilostane treatment (initially 10 mg/cat PO q24h then increased to 10 mg/cat PO q12h) was started and insulin sensitivity gradually improved, ultimately leading to diabetic remission after an increased in trilostane dose to 13mg/cat PO q12h, 14 months after the DM diagnosis and 7 months after the initiation of trilostane therapy.

Relevance and novel information

DM in cats with HAC is a difficult combination of diseases to treat. To our knowledge this is the first reported case of diabetic remission in a feline patient with HAC as a result of treatment with trilostane. Further work should focus on whether fine-tuning of trilostane-treatment protocols in cats with concurrent DM and HAC could lead to a higher proportion of diabetic remissions in this patient group.

Mixossarcoma esplênico em cão

Background: Myxosarcomas (MXS) are malignant mesenchymal neoplasms originated from mainly mucin producing fibroblasts than collagen. Despite malignant neoplasms, MXS is believed to have low metastase generation ability. Myxosarcomas reports in dogs are widespread, usually involving trunk and limbs subcutaneous tissue. The aim of this report is to describe clinical, pathological, and immunohistochemistry aspects of a rare case of splenic myxosarcoma in a dog.Case: A 10-year-old, intact male Basset Hound, weiging 25 kg, showing signals such apathy, dark soft-stooled stools, progressive thinning, and increasing abdominal enlargement, perceived three months ago was brought to clinical consultation. Physical examination showed extremely pale oral and ocular mucosas, in addition to mild dehydration (6%), 35.4°C rectal temperature, and a very bulging abdomen, with no fluids or gases, evidence at abdominal percussion. A complete blood count (CBC) revealed neutrophilic leukocytosis and anemia. Patient´s abdominal cavity ultrasound examination showed an heterogeneous mass, occupying large part of cavity, and apparently from spleen origin. A spleenic multilobulated mass measuring 25 x 12 x 20 cm was obtained after exploratory laparotomy. The mass showed predominantly soft consistency with some firm areas, and no visible mesentery or other abdominal organs adhesions. Mass and spleen histopathological examination were routinely processed for histological analysis with haematoxylin and eosin and alcian blue staining. In addition, fragments of the neoplasm were submitted to immunohistochemistry (IHC) which confirmed myxosarcoma diagnosis. The owner returned to hospital two months after, complaining for apathy, prostration, anorexia, and abdominal pain. A new ultrasound examination were suggestive of liver and kidneys neoplasms. The tutor opted for patient´s euthanasia. However, dog´s necropsy was not authorized.Discussion: Myxosarcomas are malignant tumors considered rare in small animals, affecting mainly middle age or advanced age patients. Corroborating with the present case, the main clinical signs identified in cases of splenic neoplasias, in general, are abdominal distention and algia, emaciation, prostration, anemia, hypothermia, and inappetence. Regarding neutrophilic leukocytosis and anemia in CBC, those alterations are atributable to paraneoplastic syndromes commonly observed in small animals. The diagnosis of myxosarcoma was based on the pathological and IHC findings. The mesenchymal origin of the neoplastic cells was confirmed by the expression of vimentin and by the absence of cytokeratin labeling in the immunohistochemical examination. It was possible to confirm the diagnosis due to the presence of large amount of mucopolysaccharides between the neoplastic cells, demonstrated through Alcian Blue staining. Although rare, there have been reports of metastasis from cardiac myxosarcoma in humans and splenic myxosarcomas in dogs. The patient’s resubmission in two months with a new nonspecific clinical picture and documentation of hepatic and renal masses supports the possibility of agressive metastatic disease in the present case, despite the non-authorization of the autopsy examination. It was concluded by the present case report that MXS, although uncommon in small animals, should be included as a differential diagnosis in cases of abdominal neoplasias. The histopathological analysis and the immunohistochemical examination of neoplasms are important and should be considered in order to establish diagnosis and prognosis in dogs. Despite not confirmed by post-morten examination, agressive metastic disease seems likely in the present report, and emphasize MXS´malignat nature.

Congenital Secondary Hypothyroidism Evidences in a Dog

Background: Deficiency of thyroid hormones thyroxine (T4) and triiodothyronine (T3) results in multisystemic disease described as hypothyroidism (HpoT). Secondary HpoT is defined by TSH decreased production and, therefore, thyroid hormones. This condition is rare in dogs, accounting for less than 5% of cases. The objective of this report is to describe evidence of congenital secondary hypothyroidism in a mongrel dog and therapeutic response obtained.Case: A 3-year-old neutered male mongrel dog was brought to the veterinarian with a history of overweight without polyphagia, associated with discrete alopecia, poor quality skin and hair coat, lethargy and evident exercise intolerance. Physical examination revealed a body condition score of seven (1 to 9 scale), disqueratosis, pyoderma, ventral cervical alopecia, hair thinning on the posterior surface of the pelvic limbs and nonpalpable thyroid. A body conformation characterized by disproportionate dwarfism was observed. Owners provided a former patient´s X-ray (18 months of age), showing growth plate non-closure in vertebral bodies. Results of a complete blood count (CBC) and serum biochemical profile were within normal limits except for elevated fructosamine (459 µmol/L; reference range: 170-338 µmol/L) and total cholesterol (558 mg/dL; reference range: 135-270 mg/dL). Analyses of the hormone profile showed decreased levels of canine thyroid-stimulating hormone (cTSH) 0.03 ng/mL (reference range: 0.05-0.5 ng/mL), free thyroxine by equilibrium dialysis (fdT4) 0.57 ng/dL (reference range: 0.8-3.0 ng/dL), and total thyroxine (tT4) 5.1 ng/mL (reference range: 15-30 ng/mL). A distal forelimb X-ray was performed and showed opened epiphyseal growth plates from radius and ulnar bones. The patient was discharged with sodium levothyroxine (20 µg/kg PO q 24 hr) until re-evaluation. The patient was re-evaluated 2 months later and clinical symptoms observed at the first admission were still persistent. CBC and serum biochemical profile were within normal range. The values of T4t and cTSH were 21.3 ng/mL (reference range for treated dogs 25-45 ng/mL post-thyroxine) and 0.03 ng/mL respectively. Owners were administering a generic levothyroxine, and then a commercial sodium levothyroxine was prescribed at the same dose for treatment. Clinical improvement was reported by the owner 4 weeks later. A new forelimb and vertebral radiographic examination performed 6 months later revealed complete epiphyseal ossification.Discussion: The patient was diagnosed with central hypothyroidism based on the clinical presentation in conjunction with the laboratory tests results. The main hypothesis argues for a congenital pituitary malformation, leading to a defective hypothalamic-pituitary-thyroid axis function. This decreased hormonal TSH secretion culminated in a chronic mild state of hypothyroidism associated with reduction in the thyroid hormones secretion. Metabolic consequences of mild hypothyroidism affect bone development directly and lead to delayed epiphyseal ossification and epiphyseal growth, reduced long bone growth, and disproportionate dwarfism. Studies have suggested a genetic relation with the development of congenital hypothyroidism, although no disease-causing mutations were found in the genes previously investigated. The prognosis for dogs with secondary hypothyroidism due to malformation or destruction of the pituitary ranges from poor to reserved, with shorter life expectancy in dogs with congenital pituitary malformation due to cysts expansion. Although cost is limiting for some owners, advanced imaging such as computed tomography or magnetic resonance may be useful in the macroscopic evaluation of the pituitary gland and are recommended in central hypothyroidism cases.

Frequency of Endocrinopathies and Characteristics of Affected Dogs and Cats in Southern Brazil (2004-2014)

Background: The increase in the life expectancy of dogs and cats in recent decades has heightened the incidence of aging-associated diseases. Among such diseases, endocrinopathies, such as obesity, stand out. In addition, there exists a lack of professionals with expertise in this area. Therefore, proper knowledge of the characteristics of patients affected by endocrinopathies as well as the frequency of these diseases aid in the recognition of endocrine syndromes in the general population. Thus, the aim of this study was to conduct a retrospective analysis of medical charts of dogs and cats compiled by a Division of Endocrinology in southern Brazil during a 10-year period.Materials, Methods & Results: An epidemiological survey of the medical charts of 1,400 dogs and cats compiled by a Division of Endocrinology between 2004 and 2014 was performed. The diagnostic data based on laboratory and hormone tests and on ultrasound scans were used as gold standard. The data were tabulated using Excel for Windows for the stratified analysis of the diagnoses. The major diseases (93.4% of the cases) detected in dogs were hyperadrenocorticism (37%), diabetes mellitus (22%), hypothyroidism (11%), and overweight/obesity (8%), whereas the main diseases (6.6% of the cases) detected in cats were diabetes mellitus (42%) and hyperthyroidism (23%). Some rare and uncommon diseases were diagnosed, such as hypoparathyroidism, pheochromocytoma, pituitary dwarfism, and diabetes insipidus, but they were present in less than 1% of the patients. Multiple endocrinopathies accounted for 8% of the cases, and the most frequent association was that between diabetes mellitus and hyperadrenocorticism in dogs and cats. The mean age of dogs was 9.11 ± 3.43 years, and 69% of the patients were female. The mean age of cats was 10.97 ± 4.29 years, and 58% of the patients were male.Discussion: The high prevalence of endocrinopathies among female dogs is closely related to the higher prevalence of diabetes mellitus and hyperadrenocorticism in female patients, and these two diseases together accounted for 59% of the cases. Among cats, the high prevalence of endocrinopathies among male cats was influenced by the large number of cases of diabetes mellitus, a disease that is typically more prevalent among tomcats. Some findings were alarming as they indicate probable lack of early diagnoses of some conditions (e.g., the prevalence of dogs with hyperadrenocorticism and diabetes three times greater than that reported by other countries), absence of patients younger than 10 years with hyperthyroidism, or failure to seek veterinary care for obese cats with initial presentation of overweight. Raising the awareness of tutors about the consequences of overweight can drastically reduce the incidence of diabetes mellitus in cats. Finally, knowledge about the characteristics of patients with the most common types of endocrinopathies is useful to clinicians as it can increase the predictive values of clinical and laboratory findings and help them include certain endocrinopathies as differential diagnoses for patients with some risk factors (age or sex). Anyway, the endocrinopathies, as well as the characteristics of the affected population in southern Brazil, are in line with similar studies on the most frequent diseases in other regions, taking into account small differences in breed and age distribution.