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      Clinical Findings, Diagnostic Test Results, and Treatment Outcome in Cats with Spontaneous Hyperadrenocorticism: 30 Cases

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          Abstract

          Background

          Spontaneous hyperadrenocorticism ( HAC) is rare in cats. Clinical findings, diagnostic test results, and response to various treatment options must be better characterized.

          Objectives

          To report the clinical presentation, clinicopathologic findings, diagnostic imaging results, and response to treatment of cats with HAC.

          Animals

          Cats with spontaneous HAC.

          Methods

          Retrospective descriptive case series.

          Results

          Thirty cats (15 neutered males, 15 spayed females; age, 4.0–17.6 years [median, 13.0 years]) were identified from 10 veterinary referral institutions. The most common reason for referral was unregulated diabetes mellitus; dermatologic abnormalities were the most frequent physical examination finding. Low‐dose dexamethasone suppression test results were consistent with HAC in 27 of 28 cats (96%), whereas ACTH stimulation testing was suggestive of HAC in only 9 of 16 cats (56%). Ultrasonographic appearance of the adrenal glands was consistent with the final clinical diagnosis of PDH or ADH in 28 of 30 cats (93%). Of the 17 cats available for follow‐up at least 1 month beyond initial diagnosis of HAC, improved quality of life was reported most commonly in cats with PDH treated with trilostane.

          Conclusions and Clinical Importance

          Dermatologic abnormalities or unregulated diabetes mellitus are the most likely reasons for initial referral of cats with HAC. The dexamethasone suppression test is recommended over ACTH stimulation for initial screening of cats with suspected HAC. Diagnostic imaging of the adrenal glands may allow rapid and accurate differentiation of PDH from ADH in cats with confirmed disease, but additional prospective studies are needed.

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          Most cited references31

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          Canine hyperadrenocorticism: pretreatment clinical and laboratory evaluation of 117 cases.

          G H Stabenfeldt, Diane Comer, Karleen D Gribble … (1979)
          The physical findings, clinical signs, age, breed and sex distributions, and laboratory data of 117 dogs with untreated Cushing's syndrome were reviewed. Poodles, Dachshunds, and Boxers of all ages were found to be at increased risk, as were dogs of all breeds greater than or equal to 6 years old. Polydipsia, polyuria, progressive bilaterally symmetric alopecia, and abdominal distention were the most frequently observed clinical signs and physical findings. Lymphopenia, eosinopenia, above normal values of serum alkaline phosphatase, serum cholesterol, and sulfobromphthalein dye retention, and below normal urine specific gravity were the most frequent abnormalities found in the laboratory data. About 50% of the dogs had urinary tract infections. Final diagnosis was established on the basis of abnormally high plasma corticosteroid values in response to an intramuscular injection of adrenocorticotropic hormone.
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            Systemic arterial blood pressure and urine protein/creatinine ratio in dogs with hyperadrenocorticism.

            Kristyn Feldman, L Cowgill, Amy R. Nelson … (1996)
            To determine prevalence and severity of systemic arterial hypertension and proteinuria in dogs with naturally developing hyperadrenocorticism and to determine whether these abnormalities resolve with adequate management of the disease. Case series and cohort study. 77 dogs with naturally developing hyper-adrenocorticism examined once; 15 dogs examined before and after treatment. Among dogs examined only once, hypertension was diagnosed in 21 of 26 dogs with untreated pituitary-dependent hyperadrenocorticism (PDH), 17 of 21 with inadequately controlled PDH, 8 of 16 with well-controlled PDH, 10 of 10 with an untreated adrenocortical tumor, and 0 of 4 that had undergone adrenalectomy because of an adrenocortical tumor. Untreated dogs and dogs with inadequately controlled PDH had significantly higher blood pressures than did other dogs. Proteinuria was documented in 12 of 26 dogs with untreated PDH, 5 of 16 with inadequately controlled PDH, 3 of 14 with well-controlled PDH, 5 of 8 with an untreated adrenocortical tumor, and 1 of 3 that had undergone adrenalectomy. Dogs with untreated PDH and dogs with an untreated adrenocortical tumor had higher urine protein/creatinine ratios than did dogs with well-controlled PDH. Among dogs evaluated before and after treatment, blood pressure and urine protein/creatinine ratio did not change in 8 dogs with inadequately controlled hyperadrenocorticism, but decreased in 7 dogs with well-controlled disease. Results suggest that systemic hypertension and proteinuria are common in dogs with untreated hyperadrenocorticism and that successful treatment of hyperadrenocorticism will result in resolution of these abnormalities in many, but not all, dogs.
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              Effects of disease on the results of diagnostic tests for use in detecting hyperadrenocorticism in dogs.

              A J Kaplan, M Peterson, R J Kemppainen (1995)
              The purpose of the study reported here was to assess 3 commonly used screening tests for hyperadrenocorticism (low-dose dexamethasone suppression test, ACTH stimulation test, and urinary cortisol:creatinine ratio) in dogs with various diseases other than those of the adrenal glands (nonadrenal diseases). A group of 100 dogs was studied: 59 dogs with nonadrenal disease, 21 clinically normal dogs, and 20 dogs with pituitary-dependent hyperadrenocorticism. Of 59 dogs with nonadrenal disease, 20 (34%) had high baseline cortisol concentration (greater than reference range limits), and 22 (38%) and 33 (56%) had inadequate serum cortisol suppression at 4 and 8 hours, respectively, after administration of a low dose of dexamethasone. Compared with clinically normal dogs, dogs with nonadrenal disease had significantly (P < 0.05) higher mean serum cortisol concentration at 4 and 8 hours after administration of a low dose of dexamethasone; however, significant differences were not detected between the mean cortisol concentration at 8 hours after administration for dogs with nonadrenal disease and for dogs with hyperadrenocorticism. After ACTH stimulation, only 8 of 59 (14%) dogs with nonadrenal disease had high serum cortisol concentrations. Significant differences did not exist after ACTH stimulation between mean cortisol concentration of clinically normal dogs and that of dogs with nonadrenal disease. Of 59 dogs with nonadrenal disease, 45 (76%) had a high urinary cortisol:creatinine ratio. When compared with clinically normal dogs, dogs with nonadrenal disease had a significantly higher mean urinary cortisol:creatinine ratio, but significant differences did not exist between the mean urinary cortisol:creatinine ratio of dogs with nonadrenal disease and that of dogs with hyperadrenocorticism.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Vet Intern Med
                Journal ID (iso-abbrev): J. Vet. Intern. Med
                Journal ID (doi): 10.1111/(ISSN)1939-1676
                Journal ID (publisher-id): JVIM
                Title: Journal of Veterinary Internal Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0891-6640
                ISSN (Electronic): 1939-1676
                Publication date (Electronic): 16 January 2014
                Publication date (Print): Mar-Apr 2014
                Volume: 28
                Issue: 2 ( doiID: 10.1111/jvim.2014.28.issue-2 )
                Pages: 481-487
                Affiliations
                [ 1 ] Department of Veterinary Clinical SciencesCollege of Veterinary Medicine Purdue University West Lafayette IN
                [ 2 ] Department of Medicine and EpidemiologySchool of Veterinary Medicine University of California Davis CA
                [ 3 ] Department of Veterinary Clinical SciencesThe Ohio State University Columbus OH
                [ 4 ]Unité de Médecine Interne Ecole Nationale Vétérinaire d'Alfort AlfortFrance
                [ 5 ] Department of Comparative PathobiologyCollege of Veterinary Medicine Purdue University West LafayetteIN
                Author notes
                [*] [* ]Corresponding author: J.C. Scott‐Moncrieff, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907‐2026; e‐mail: scottmon@ 123456purdue.edu .
                Article
                Publisher ID: JVIM12298
                DOI: 10.1111/jvim.12298
                PMC ID: 4858028
                PubMed ID: 24433386
                SO-VID: 5ff65b51-df6f-494c-a5c2-eb14114ead54
                Copyright © Copyright © 2014 by the American College of Veterinary Internal Medicine
                History
                Date received : 03 July 2013
                Date revision received : 07 October 2013
                Date accepted : 05 December 2013
                Page count
                Pages: 7
                Categories
                Subject: Original Article
                Subject: Standard Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id jvim12298
                cover-date March/April 2014
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:4.8.8 mode:remove_FC converted:25.04.2016

                ScienceOpen disciplines: Veterinary medicine
                Keywords: adrenal gland,diabetes mellitus,pituitary gland,skin fragility
                Data availability:
                ScienceOpen disciplines: Veterinary medicine
                Keywords: adrenal gland, diabetes mellitus, pituitary gland, skin fragility

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