Use of endogenous ACTH concentration and adrenal ultrasonography to distinguish the cause of canine hyperadrenocorticism (original) (raw)
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Veterinary Radiology & Ultrasound, 2008
We conducted a retrospective study to determine whether multidetector computed tomography (CT) could be of value for adrenal gland assessment in dogs with pituitary-dependent hyperadrenocorticism. Adrenal gland attenuation and volume values of 49 dogs with hyperadrenocorticism were recorded and age, body weight, and gender were examined to determine if a relationship existed between these variables and adrenal gland morphology. There was not a statistically significant difference in mean X-ray attenuation of the left vs. right adrenal gland in normal dogs (35.3 AE 6.1 HU), or in dogs with hyperadrenocorticism. The mean adrenal X-ray attenuation (AE standard deviation [SD]) in dogs with microadenoma was 33.1 AE 6.8 vs. 31.8 AE 12.7 HU for dogs with macroadenoma, and these values were not statistically different. The mean volume of the left adrenal gland in normal dogs (0.59 AE 0.17 cm 3) was greater than that of the right adrenal gland (0.54 AE 0.19 cm 3) (Po0.05). The mean CT volume (AE SD) of the adrenal glands in dogs with microadenoma vs. macroadenoma were 1.60 AE 1.25 vs. 2.88 AE 1.60 cm 3 , respectively. There was no effect of age or gender on adrenal gland morphology or X-ray attenuation. The weight effect was the most important source of variation for the volume measurement in dogs with hyperadrenocorticism.
Citation: Remo Lobetti (2016) Retrospective Studyof Adrenal Gland Ultrasonography in Dogs with Normal and Abnormal ACTH Stimulation Test. J Vet Clin Pract petCare 1: 1-6. Abstract Objective: To identify adrenal ultrasonography parameters that can be used to identify dogs with hypoadrenocorticism. Design: Retrospective review of adrenal gland measurements and morphology in 56 client-owned dogs presented for a variety of medical reasons suspicious for possible hypoadreno-corticism. Setting : Private veterinary practice. Animals: 81 client-owned dogs. Interventions: Based on adrenal gland measurements and morphology and an ACTH stimulation test, dogs were divided into two groups: hypoadrenocorticism (Group 1,37 dogs) and a non-hypoadrenocorticism (Group 2, 19 dogs). In addition there was a control group of healthy dogs (Group 3, 25 dogs). Measurements and Main Results: The median right adrenal length in Group 1-3 was 1.75 cm, 1.8 cm, and 2.03 cm, respectively. Median left adrenal length in Group 1-3 was 1.77 cm, 2.08 cm, and 2.1 cm, respectively. There was no statistically difference between the right and left adrenal gland and within groups. Median right adrenal thickness in Group 1-3 was 0.34 cm, 0.37 cm, and 0.6 cm, respectively. Median left adrenal thickness in Group 1-3 was 0.31 cm, 0.4 cm, and 0.6 cm, respectively. In both right and left measurements, groups 1 and 2 were statistically different from group 3 but there was no statistical difference between groups 1 and 2. Conclusion and Clinical Relevance: Although not a specific finding, the ultrasound detection of small, flattened, isoec-hoic adrenal glands should be an alert for possible hypoad-renocorticism, prompting further testingand therapeutic intervention .
Journal of veterinary internal medicine, 2016
Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical. To compare the cortisol response to 1 and 5 μg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC. Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15). In this prospective study, healthy dogs had consecutive ACTH stimulation tests to ensure 2 tests could be performed in sequence. For the first test, cosyntropin (1 μg/kg IV) was administered; the second test was initiated 4 hours after the start of the first (5 μg/kg cosyntropin IV). Dogs suspected of having HAC or being treated with mitotane were tested as the healthy dogs. Dogs receiving trilostane treatment were tested on consecutive days at the same time post pill using the low dose on day 1. In dogs being treated with mitotane or tr...
Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited prior to publication. The authors are solely responsible for the content of the statements.
Plasma ACTH Precursors in Cats with Pituitary-Dependent Hyperadrenocorticism
Journal of Veterinary Internal Medicine, 2012
serum cortisol concentration 8 hours after low-dose dexamethasone 39 administration 40 DM diabetes mellitus 41 DSH domestic shorthair 42 HAC hyperadrenocorticism 43 IRMA immunoradiometrical assay 44 LDDST low-dose dexamethasone suppression test 45 MRI magnetic resonance imaging 46 PC1 prohormone convertase 1 47 PDH pituitary-dependent hyperadrenocorticism 48 RIA radioimmunoassay 49 UCCR urine cortisol:creatinine ratio 50 51 Diagnosis of pituitary-dependent hyperadrenocorticism (PDH) in cats is 53 challenging because there is no specific diagnostic test. 54 Hypothesis/Objective: The determination of plasma ACTH precursor (POMC and pro-ACTH) 55 concentration might facilitate the diagnosis of PDH in cats. The aim of the study was to evaluate 56 prospectively the plasma concentrations of ACTH precursors in a small cohort of cats with PDH 57 and to estimate the value of this approach for diagnosis. 58 Animals: Four groups of cats were included: group 1 (cats with PDH), group 2 (cats with 59 diabetes mellitus but not hyperadrenocorticism (HAC)), group 3 (cats with diabetes mellitus and 60 confirmed acromegaly but not HAC) and group 4 (healthy cats). 61 Methods: PDH diagnosis was based on clinical data, low-dose dexamethasone suppression 62 test (LDDST) and adrenal and pituitary gland computed tomography (CT) scan. For groups 2, 3 63 and 4, hyperadrenocorticism was excluded by LDDST or urine cortisol:creatinine ratio (UCCR). 64 An immunoluminometric assay was used to determine plasma concentrations of ACTH 65 precursors in the 4 groups of cats. 66 Results: Group 1 contained 9 cats (enlarged pituitary gland in 7/9). Plasma ACTH precursor 67 concentrations ranged from <53 to >1010 pmol/L with 8/9 concentrations ≥229 pmol/L. Groups 68 2, 3 and 4 included 13, 7 and 13 cats, respectively. Plasma ACTH precursor concentrations 69 ranged from <53 to 96 pmol/L in group 2, <53 to 72 pmol/L in group 3 and <53 to 99 pmol/L in 70 group 4. 71 Conclusion and clinical importance: High plasma concentration of ACTH precursors in cats 72 increase specificity. 24 94 Deregulated secretion of adrenocorticotropic hormone (ACTH) by corticotroph tumor causes 95 PDH. ACTH is derived from pro-opiomelanocortin (POMC) a high molecular weight polypeptide 96
Diagnosis of hyperadrenocorticism in dogs: a survey of internists and dermatologists
Javma-journal of The American Veterinary Medical Association, 2002
Objective-To determine testing protocols used by board-certified internists and dermatologists for diagnosis of hyperadrenocorticism (HAC) in dogs. Design-Survey. Study Population-Board-certified internists and dermatologists. Procedure-A questionnaire was mailed to 501 specialists to gather information pertaining to diagnosis of HAC. Results-206 surveys were returned. Only 26% of respondents indicated they would screen a dog for HAC if the dog had only a few laboratory abnormalities consistent with HAC and no clinical signs consistent with the disease; 31% indicated they would not, and 43% indicated they would sometimes. Overall, 55% of respondents indicated they preferred to use the lowdose dexamethasone suppression test for routine screening of dogs suspected to have HAC. However, many respondents indicated they would use a different screening test than usual in particular circumstances. Sixty-eight percent of respondents indicated they would perform a second screening test for confirmation if results of an initial screening test were positive but there were few clinical or laboratory abnormalities consistent with HAC. Most respondents used some sort of test to differentiate pituitary-dependent HAC from HAC secondary to an adrenal tumor (AT), but no 1 test was clearly preferred. Ultrasonography was commonly used, whereas computed tomography and magnetic resonance imaging were not, even if available. Conclusions and Clinical Relevance-Results suggest that the low-dose dexamethasone suppression test is the test most commonly used to screen dogs for HAC but that other tests may be used in certain circumstances. A variety of tests were used to differentiate pituitary-dependent HAC from HAC secondary to an AT.
Hyperadrenocorticism in a dog due to ectopic secretion of adrenocorticotropic hormone
2005
Spontaneous hyperadrenocorticism in dogs is known to be the result of excessive secretion of adrenocorticotropic hormone (ACTH) by the pituitary gland or excessive autonomous glucocorticoid secretion by an adrenocortical tumor. Here, we report on an 8-year-old German shepherd dog in which ACTH-dependent hyperadrenocorticism was a result of ectopic ACTH secretion and could be related to an abdominal neuroendocrine tumor.
Veterinary Radiology <html_ent glyph="@amp;" ascii="&"/> Ultrasound, 2003
Trilostane, a 3p-hydroxysteroid dehydrogenase inhibitor, has been used successfully over the last few years for the treatment of canine pituitary-dependent hyperadrenocorticism. In a prospective study of 19 dogs with pituitary-dependent hyperadrenocorticism, the adrenal glands were measured before and at least 6 months after initiation of trilostane therapy. Right adrenal gland length and caudal pole thickness and left adrenal gland caudal pole thickness increased significantly (p 5 0.05); there was no significant change in left adrenal gland length. Enlargement of adrenal glands during trilostane therapy may occur as a result of suppression of the negative feedback mechanism affecting cortisol production.
Canine atypical hyperadrenocorticism associated with hypothyroidism
Journal MVZ Cordoba , 2019
License (https://creativecommons.org/licenses/by-sa/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source. How to cite (Vancouver) Quishpe-Contreras y Gomes-Pöppl. Canine atypical hyperadrenocorticism associated with hypothyroidism. Rev MVZ Cordoba. 2019; 24(2):7262-7267. ABSTRACT Hyperadrenocorticism (HAC) is one of the most common endocrinopathies in dogs, caused by excessive synthesis of cortisol. Atypical or occult HAC is a syndrome characterized by the presentation of clinical, biochemical, and imaging alterations compatible with hypercortisolism, but normal results in endocrine tests that are conventionally used for HAC diagnosis. However, these patients present high serum concentrations of precursors or other corticoadrenal hormones. The present study describes the case of an 8 years old female canine, Bichón Frisé, epileptic and treated with phenobarbital, presenting clinical signs associated with HAC, in which the low-dose dexamethasone suppression test and stimulation with ACTH resulted within normal values. The measurement of adrenal steroids, after ACTH stimulation, showed abnormal elevation of estrogen and progesterone, the latter persisting after the patient was spayed. Treatment with trilostane allowed the reduction of progesterone levels and the partial resolution of clinical signs. However, full clinical recovery was only achieved after the diagnosis and treatment of concomitant hypothyroidism. The challenge that represent the diagnosis of atypical HAC highlights the importance of performing and having availability of panels that include measurement of adrenal steroid hormones other than cortisol, as well as considering the occurrence of other concomitant endocrine metabolic diseases. RESUMEN El hiperadrenocorticismo (HAC) es una de las endocrinopatías más frecuentes en caninos, producida por la síntesis excesiva de cortisol. El HAC atípico u oculto es un síndrome caracterizado por la presentación de alteraciones clínicas, bioquímicas e imagenológicas compatibles con hipercortisolismo, pero con resultados normales en las pruebas endo-crinológicas utilizadas convencionalmente para diagnóstico de HAC. Sin embargo, estos pacientes presentan elevada concentración sérica de precursores u otras hormonas corticoadrenales. El presente estudio describe el caso de una canina hembra, Bichón Frisé de 8 años de edad, epiléptica y tratada con fenobarbital, presentando signos clínicos asociados a HAC, en la que el test de supresión con dexametasona a dosis bajas y de estimulación con ACTH arrojaron valores normales. La medición de esteroides adrenales, post estimulación con ACTH, mostró elevación anormal de estrógenos y progesterona, persistiendo esta última después de que la paciente fuera esterilizada. El tratamiento con trilostano permitió la disminución de los niveles de progesterona y la resolución parcial de los signos clínicos. Sin embargo , la recuperación clínica en su totalidad sólo se obtuvo después del diagnóstico y tratamiento del hipotiroidismo concomıtante. El desafío que representa el diagnóstico del HAC atípico resalta la importancia de realizar y disponer de paneles que incluyan medición de hormonas esteroideas adrenales diferentes al cortisol, además de considerar la ocurrencia de otras enfermedades endocrinas metabólicas concomitantes.