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Pérez-López L, Mendoza P, Melián C. Effects of concurrent canine Cushing's syndrome and diabetes Mellitus on insulin requirements, trilostane dose, and survival time. Res Vet Sci 2023; 161:62-68. [PMID: 37321012 DOI: 10.1016/j.rvsc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
Trilostane and insulin requirements and survival time of dogs with concurrent naturally-occurring Cushing's syndrome (CS) and diabetes mellitus (DM) has not been fully investigated. This retrospective study evaluated trilostane and insulin doses in dogs with concurrent CS and DM compared to dogs with only CS or DM. Additionally, a survival analysis was performed using a Kaplan-Meier survival curve. Survival time was compared through Log-rank test. Cox proportional regression method was used to screen predictor factors of death in dogs with CS, DM or concurrent CS and DM. A total of 95 dogs were included, 47 dogs had CS, 31 dogs had DM and 17 dogs had concurrent CS and DM. After long-term follow-up, dogs with concurrent CS and DM required higher final median doses of insulin than dogs with DM [0.90 (0.73-1.1) vs 0.67 (0.55-0.73) u/kg/12 h; P = 0,002]. Conversely, the median trilostane requirements in dogs with concurrent CS and DM did not differ from the median trilostane requirements of dogs with CS [1.52 (0.76-2.80) vs 1.64 (1.19-4.95) mg/kg/day; P = 0.283]. No statistical difference was found for the median survival time between dogs with CS and dogs with concurrent CS and DM (1245 vs 892 days; p = 0.152). Although, median survival time of dogs with DM was not reached, it was longer than median survival time of dogs with CS and DM (892 days; P = 0.002). In conclusion, diabetic dogs with concurrent CS need higher insulin doses and have a shorter survival time compared to diabetic dogs without CS.
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Affiliation(s)
- L Pérez-López
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Spain
| | - P Mendoza
- Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413, Arucas, Las Palmas, Spain
| | - C Melián
- Institute of Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Spain; Department of Animal Pathology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413, Arucas, Las Palmas, Spain; Clínica Veterinaria Atlántico - VetPartners, Pi y Margall, 42, 35006 Las Palmas de Gran Canaria, Spain.
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2
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Schofield I, Brodbelt DC, Niessen SJM, Church DB, Geddes RF, O'Neill DG. Frequency and risk factors for naturally occurring Cushing's syndrome in dogs attending UK primary-care practices. J Small Anim Pract 2021; 63:265-274. [PMID: 34881823 PMCID: PMC9299886 DOI: 10.1111/jsap.13450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 01/03/2023]
Abstract
Objectives To estimate the frequency and risk factors for Cushing's syndrome in dogs under UK primary veterinary care. Materials and Methods Dogs with Cushing's syndrome were identified by searching electronic patient records of primary‐care veterinary practices. Pre‐existing and incident cases of Cushing's syndrome during 2016 were included to estimate the 1‐year period prevalence. Incident cases were used to estimate the annual incidence and to identify demographic risk factors for the diagnosis of Cushing's syndrome in dogs, through multivariable logistic regression. Results Analysis included 970 pre‐existing and 557 incident cases of Cushing's syndrome from a population of 905,544 dogs. The estimated 1‐year period prevalence for Cushing's syndrome in dogs under veterinary care was 0.17% (95% confidence interval 0.16 to 0.18) and incidence was 0.06% (95% confidence interval 0.05 to 0.07). In multivariable logistic regression modelling, the Bichon frise (odds ratio=6.17, 95% confidence interval 4.22 to 9.00), Border terrier (5.40, 95% confidence interval 3.66 to 7.97) and Miniature schnauzer (3.05, 95% confidence interval 1.67 to 5.57) had the highest odds of Cushing's syndrome. The Golden retriever (0.24, 95% confidence interval 0.06 to 0.98) and Labrador retriever (0.30, 95% confidence interval 0.17 to 0.54) were the most protected breeds. Increasing age, bodyweight greater than the breed‐sex mean and being insured also showed increased odds of Cushing's syndrome. Clinical Significance As Cushing's syndrome is predominately diagnosed and managed in primary‐care practice, this study provides valuable new information of its epidemiology in this setting. Demographics reported are supportive of previous work and additional novel associations identified, such as the Border terrier, could enhance the index of suspicion for veterinarians.
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Affiliation(s)
- I Schofield
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - D C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - S J M Niessen
- Clinical Science and Services, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK.,Veterinary Specialist Consultations, Hilversum, The Netherlands
| | - D B Church
- Clinical Science and Services, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - R F Geddes
- Clinical Science and Services, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - D G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
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3
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Schofield I, Brodbelt DC, Niessen SJM, Church DB, Geddes RF, Kennedy N, O'Neill DG. Development and internal validation of a prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary-care practice. J Vet Intern Med 2020; 34:2306-2318. [PMID: 32935905 PMCID: PMC7694798 DOI: 10.1111/jvim.15851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Novel methods to aid identification of dogs with spontaneous Cushing's syndrome are warranted to optimize case selection for diagnostics, avoid unnecessary testing, and ultimately aid decision-making for veterinarians. HYPOTHESIS/OBJECTIVES To develop and internally validate a prediction tool for dogs receiving a diagnosis of Cushing's syndrome using primary-care electronic health records. ANIMALS Three hundred and ninety-eight dogs diagnosed with Cushing's syndrome and 541 noncase dogs, tested for but not diagnosed with Cushing's syndrome, from a cohort of 905 544 dogs attending VetCompass participating practices. METHODS A cross-sectional study design was performed. A prediction model was developed using multivariable binary logistic regression taking the demography, presenting clinical signs and some routine laboratory results into consideration. Predictive performance of each model was assessed and internally validated through bootstrap resampling. A novel clinical prediction tool was developed from the final model. RESULTS The final model included predictor variables sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritus, alkaline phosphatase, and urine specific gravity. The model demonstrated good discrimination (area under the receiver operating curve [AUROC] = 0.78 [95% CI = 0.75-0.81]; optimism-adjusted AUROC = 0.76) and calibration (C-slope = 0.86). A tool was developed from the model which calculates the predicted likelihood of a dog having Cushing's syndrome from 0% (score = -13) to 96% (score = 10). CONCLUSIONS AND CLINICAL IMPORTANCE A tool to predict a diagnosis of Cushing's syndrome at the point of first suspicion in dogs was developed, with good predictive performance. This tool can be used in practice to support decision-making and increase confidence in diagnosis.
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Affiliation(s)
- Imogen Schofield
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - David C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Stijn J M Niessen
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK.,The VetCT Telemedicine Hospital, St John's Innovation Centre, Cambridge, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Rebecca F Geddes
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Noel Kennedy
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
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Schofield I, Brodbelt DC, Wilson ARL, Niessen S, Church D, O'Neill D. Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England. Vet Rec 2019; 186:348. [PMID: 31542726 PMCID: PMC7146928 DOI: 10.1136/vr.105159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 07/11/2019] [Accepted: 08/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hyperadrenocorticism is an endocrine disease routinely encountered within primary care practice; however, few studies evaluating survival beyond diagnosis have studied this population. METHODS This retrospective cohort study analysed the electronic patient records of 219 cases of hyperadrenocorticism from a sample of dogs attending primary care practices in England. Kaplan-Meier plots examined the cumulative survival and Cox proportional hazard regression modelling identified factors associated with the hazard of all-cause mortality. RESULTS In the analysis, 179/219 (81.7 per cent) hyperadrenocorticism cases died during the study period with a median survival time from first diagnosis of 510 days (95% CI 412 to 618 days). Trilostane was used in 94.1 per cent of cases and differentiation between pituitary-dependent and adrenal-dependent disease was made in 20.1 per cent of cases. In the multivariable analysis, dogs weighing greater than or equal to 15 kg (HR 1.51, 95% CI 1.06 to 2.15, P=0.023) and those diagnosed greater than or equal to 13 years of age (HR 3.74, 95% CI 2.29 to 6.09, P<0.001) had increased hazards of all-cause mortality. Dogs that had their initial trilostane dose increased had a favourable prognosis (HR 0.49, 95% CI 0.32 to 0.76, P=0.015). CONCLUSION This study shows that survival from diagnosis of hyperadrenocorticism appears fair for many dogs and provides primary care practitioners with relatable benchmark prognostic figures.
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Affiliation(s)
- Imogen Schofield
- Pathobiology and Population Science, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - David C Brodbelt
- Pathobiology and Population Science, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Anna R L Wilson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Stijn Niessen
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - David Church
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Dan O'Neill
- Pathobiology and Population Science, Royal Veterinary College, Hatfield, Hertfordshire, UK
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5
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Bennaim M, Shiel RE, Mooney CT. Diagnosis of spontaneous hyperadrenocorticism in dogs. Part 2: Adrenal function testing and differentiating tests. Vet J 2019; 252:105343. [PMID: 31554584 DOI: 10.1016/j.tvjl.2019.105343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/07/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
Hyperadrenocorticism is a relatively common endocrine disorder in dogs that has been extensively described. However, its diagnosis remains challenging because there is no true reference standard test, and a myriad factors can affect the diagnostic performance of the commonly used adrenal function tests. Ultimately, the diagnosis is based on a combination of signalment, history and clinical findings, and a variety of diagnostic test results. The second part of this review aims to appraise available data on diagnostic performance of adrenal function tests in naturally occurring canine hyperadrenocorticism.
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Affiliation(s)
- Michael Bennaim
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland.
| | - Robert E Shiel
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
| | - Carmel T Mooney
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Ireland
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Carotenuto G, Malerba E, Dolfini C, Brugnoli F, Giannuzzi P, Semprini G, Tosolini P, Fracassi F. Cushing's syndrome-an epidemiological study based on a canine population of 21,281 dogs. Open Vet J 2019; 9:27-32. [PMID: 31086762 PMCID: PMC6500859 DOI: 10.4314/ovj.v9i1.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/23/2019] [Indexed: 11/24/2022] Open
Abstract
The epidemiological characteristics of spontaneous hypercortisolism (HC) were derived from 21,281 client-owned dogs selected from four private veterinary clinics and one university reference center for endocrinology. The odds ratio (OR) method was employed to investigate the risk of developing HC related to breed, gender, and sexual status. The estimated prevalence of HC in the four private clinics was 0.20% [95% confidence interval (CI), 0.13–0.27] and was significantly different compared to the university reference center (1.46%; 95% CI, 1.12–1.80). Sex, breed, and age resulted in risk factors for HC. Mean (± SD) age for dogs with HC was 9.8 (± 2.5) yr. Females had higher risk for HC compared to males (OR 1.85; 95% CI, 1.24–2.75); all neutered dogs (both males and females) had higher risk than intact dogs (OR 2.54; 95% CI, 1.72–3.73); and neutered females had higher risk compared to intact females (OR 2.61; 95% CI, 1.54–4.42). Using the mixed breed dogs as a control population (OR = 1), the risk of developing HC was significantly higher in the Standard Schnauzer (OR 58.1; p < 0.0001) and Fox Terrier (OR 20.33; p < 0.0001). With regard to HC, this study identified an overall prevalence of 0.20%. The data support the existence of sex predisposition, with the highest risk for neutered females.
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Affiliation(s)
- Gaia Carotenuto
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Eleonora Malerba
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Costanza Dolfini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Francesca Brugnoli
- Ospedale Veterinario I Portoni Rossi, Zola Predosa, Bologna 40069, Italy
| | | | | | | | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
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7
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Hoffman JM, Lourenço BN, Promislow DEL, Creevy KE. Canine hyperadrenocorticism associations with signalment, selected comorbidities and mortality within North American veterinary teaching hospitals. J Small Anim Pract 2018; 59:681-690. [PMID: 30039567 PMCID: PMC6559942 DOI: 10.1111/jsap.12904] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/01/2018] [Accepted: 05/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a large population of dogs with a diagnosis of hyperadrenocorticism at the time of death in North American veterinary teaching hospitals, and to identify comorbid conditions associated with hyperadrenocorticism. MATERIALS AND METHODS Retrospective cohort study of 1519 dogs with hyperadrenocorticism from a population of 70,574 dogs reported to the Veterinary Medical Database. Signalment, presence or absence of hyperadrenocorticism, aetiology of hyperadrenocorticism (if described), frequency of select comorbidities and causes of death were evaluated in dogs with and without hyperadrenocorticism. RESULTS Hyperadrenocorticism was more frequent in females. Neutering was associated with a minor, but significant, increase in the odds of hyperadrenocorticism. Hyperadrenocorticism was the presumed cause of death of 393 (25∙9%) of affected dogs. When aetiology was specified (527 dogs, corresponding to 34∙7% of the cases), pituitary-dependent hyperadrenocorticism [387 (73∙4%) out of 527 dogs] was more common than functional adrenocortical tumour [136 (25∙8%) out of 527 dogs). Hyperadrenocorticism was over-represented in certain expected (miniature poodle, dachshund) and unexpected (Irish setter, bassett hound) breeds compared with the population at large. Of the select comorbidities investigated, dogs with hyperadrenocorticism were at increased risk for concurrent diabetes mellitus, urinary tract infection, urolithiasis, hypertension, gall bladder mucocoele and thromboembolic disease compared with dogs without hyperadrenocorticism. CLINICAL SIGNIFICANCE Hyperadrenocorticism is significantly associated with certain comorbid conditions but is not a major cause of mortality in affected dogs. Documented patterns now provide targets for prospective clinical research.
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Affiliation(s)
- J. M. Hoffman
- Department of Genetics, University of Georgia, Athens, Georgia 30602, USA
| | - B. N. Lourenço
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
| | - D. E. L. Promislow
- Department of Pathology & Department of Biology, University of Washington, Seattle, Washington 98195, USA
| | - K. E. Creevy
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
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8
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Langlois DK, Fritz MC, Schall WD, Bari Olivier N, Smedley RC, Pearson PG, Bailie MB, Hunt SW. ATR-101, a selective ACAT1 inhibitor, decreases ACTH-stimulated cortisol concentrations in dogs with naturally occurring Cushing's syndrome. BMC Endocr Disord 2018; 18:24. [PMID: 29720169 PMCID: PMC5932779 DOI: 10.1186/s12902-018-0251-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cushing's syndrome in humans shares many similarities with its counterpart in dogs in terms of etiology (pituitary versus adrenal causes), clinical signs, and pathophysiologic sequelae. In both species, treatment of pituitary- and adrenal-dependent disease is met with limitations. ATR-101, a selective inhibitor of ACAT1 (acyl coenzyme A:cholesterol acyltransferase 1), is a novel small molecule therapeutic currently in clinical development for the treatment of adrenocortical carcinoma, congenital adrenal hyperplasia, and Cushing's syndrome in humans. Previous studies in healthy dogs have shown that ATR-101 treatment led to rapid, dose-dependent decreases in adrenocorticotropic hormone (ACTH) stimulated cortisol levels. The purpose of this clinical study was to investigate the effects of ATR-101 in dogs with Cushing's syndrome. METHODS ATR-101 pharmacokinetics and activity were assessed in 10 dogs with naturally-occurring Cushing's syndrome, including 7 dogs with pituitary-dependent disease and 3 dogs with adrenal-dependent disease. ATR-101 was administered at 3 mg/kg PO once daily for one week, followed by 30 mg/kg PO once daily for one (n = 4) or three (n = 6) weeks. Clinical, biochemical, adrenal hormonal, and pharmacokinetic data were obtained weekly for study duration. RESULTS ATR-101 exposure increased with increasing dose. ACTH-stimulated cortisol concentrations, the primary endpoint for the study, were significantly decreased with responders (9 of 10 dogs) experiencing a mean ± standard deviation reduction in cortisol levels of 50 ± 17% at study completion. Decreases in pre-ACTH-stimulated cortisol concentrations were observed in some dogs although overall changes in pre-ACTH cortisol concentrations were not significant. The compound was well-tolerated and no serious drug-related adverse effects were reported. CONCLUSIONS This study highlights the potential utility of naturally occurring canine Cushing's syndrome as a model for human disease and provides proof of concept for ATR-101 as a novel agent for the treatment of endocrine disorders like Cushing's syndrome in humans.
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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, 48824, USA.
| | - Michele C Fritz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
- Present address: College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - William D Schall
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - N Bari Olivier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Rebecca C Smedley
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Paul G Pearson
- Pearson Pharma Partners, Inc., Los Angeles, California, 91362, USA
| | - Marc B Bailie
- Integrated Non-Clinical Development Solutions, Inc., Ann Arbor, MI, 48103, USA
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10
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Bennaim M, Shiel RE, Forde C, Mooney CT. Evaluation of individual low-dose dexamethasone suppression test patterns in naturally occurring hyperadrenocorticism in dogs. J Vet Intern Med 2018; 32:967-977. [PMID: 29498108 PMCID: PMC5980256 DOI: 10.1111/jvim.15079] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dogs with hyperadrenocorticism (HAC) may be more mildly affected at the time of diagnosis today, which could influence the prevalence of associated clinical and clinicopathological abnormalities and diagnostic test performance. Different low-dose dexamethasone suppression test (LDDST) result patterns have not been evaluated individually. OBJECTIVES To assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ. ANIMALS One hundred and twenty-three dogs undergoing investigation for HAC. METHODS Retrospective evaluation of dogs in which a LDDST was performed and HAC confirmed or excluded by alternative means. Cases with basal cortisol concentrations (t0 ) < 1 μg/dL were excluded. Each LDDST result was classified as (a) complete suppression (t3 and t8 < 1 μg/dL), (b) lack of suppression (t3 and t8 > 1 μg/dL and both > 50% t0 ), (c) partial suppression (t3 and t8 > 1 μg/dL but either < 50% t0 ), (d) escape (t8 > 1 μg/dL and t3 < 1 μg/dL) or (e) inverse (t3 > 1 μg/dL and t8 < 1 μg/dL) pattern. RESULTS Fifty-nine (48%) dogs were diagnosed with HAC and 64 (52%) with non-adrenal illness. Hyperadrenocorticism cases had similar clinicopathological abnormalities compared to previous reports. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (95% confidence interval [CI]) of the LDDST for diagnosing HAC were 96.6 (91.9-100)%, 67.2 (55.7-78.7)%, 73.1 (63.2-82.9)%, and 95.6 (89.5-100)%, respectively. Lack of suppression pattern had the highest PPV (93.9 [85.8-100]%) followed by the partial suppression pattern (67.9 [50.6-85.2]%) and escape or inverse pattern (36.8 [15.1-58.5]%). CONCLUSIONS AND CLINICAL IMPORTANCE A lack of suppression LDDST pattern has the highest PPV for diagnosing HAC followed by a partial suppression pattern. By contrast, the escape or inverse pattern provided limited support of HAC.
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Affiliation(s)
- Michael Bennaim
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Robert E. Shiel
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Christopher Forde
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
| | - Carmel T. Mooney
- University College Dublin Veterinary Hospital, University College DublinBelfieldDublinIreland
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11
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Oblak ML, Bacon NJ, Covey JL. Perioperative Management and Outcome of Bilateral Adrenalectomy in 9 Dogs. Vet Surg 2016; 45:790-7. [DOI: 10.1111/vsu.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 04/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle L. Oblak
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Canada
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12
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O'Neill DG, Scudder C, Faire JM, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary-care veterinary practices in the UK from 2009 to 2014. J Small Anim Pract 2016; 57:365-73. [DOI: 10.1111/jsap.12523] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Affiliation(s)
- D. G. O'Neill
- Production and Population Health, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - C. Scudder
- Clinical Sciences and Services, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - J. M. Faire
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - D. B. Church
- Clinical Sciences and Services, The Royal Veterinary College; Hatfield Herts AL9 7TA
| | - P. D. McGreevy
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - P. C. Thomson
- Faculty of Veterinary Science, The University of Sydney; Sydney New South Wales 2006 Australia
| | - D. C. Brodbelt
- Production and Population Health, The Royal Veterinary College; Hatfield Herts AL9 7TA
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Fracassi F, Corradini S, Floriano D, Boari A, Aste G, Pietra M, Bergamini PF, Dondi F. Prognostic factors for survival in dogs with pituitary-dependent hypercortisolism treated with trilostane. Vet Rec 2014; 176:49. [PMID: 25170036 DOI: 10.1136/vr.102546] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pituitary-dependent hypercortisolism (PDH) is one of the most frequent endocrinopathies in dogs, but prognostic factors are largely unknown. The aim of this retrospective case series study was to determine the prognostic value of different clinical and clinicopathological variables evaluated in dogs newly diagnosed with PDH that were subsequently treated with trilostane. Medical records from one referral centre were evaluated. Eighty-five dogs with PDH were included. The median survival time was 852 days (range 2-3210 days); 60/85 (70 per cent) and 25/85 (29 per cent) dogs survived more than one and three years, respectively. In multivariable model analysis the length of survival of older dogs (HR 1.24, 95% CI 1.09 to 1.40) and dogs with higher serum phosphate concentrations (HR 1.35, 95% CI 1.01 to 1.81) was shorter. Serum phosphate concentrations were above the reference range in 37/85 (44 per cent) of animals. Clinical signs, liver enzymes, serum cortisol concentrations of the endocrine tests, proteinuria, systolic hypertension, the presence of concomitant disorders, and the frequency of trilostane administration were not associated with survival time. Hyperphosphataemia is a common finding in dogs with newly diagnosed PDH and represents a negative prognostic factor.
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Affiliation(s)
- F Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
| | - S Corradini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
| | - D Floriano
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
| | - A Boari
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - G Aste
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - M Pietra
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
| | - P F Bergamini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
| | - F Dondi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dellEmilia, Italy
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Mawby DI, Whittemore JC, Fecteau KA. Canine pancreatic-specific lipase concentrations in clinically healthy dogs and dogs with naturally occurring hyperadrenocorticism. J Vet Intern Med 2014; 28:1244-50. [PMID: 24903625 PMCID: PMC4857952 DOI: 10.1111/jvim.12376] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/26/2014] [Accepted: 04/22/2014] [Indexed: 12/23/2022] Open
Abstract
Background Specificity of canine pancreatic lipase immunoreactivity (cPLI) assays in dogs with hyperadrenocorticism (HAC) is unknown. Hypothesis Results of cPLI assays differ for clinically healthy dogs and dogs with HAC. Animals Seventeen healthy dogs and 20 dogs with HAC diagnosed by ACTH stimulation test results without evidence of clinical pancreatitis. Methods Dogs were enrolled between December 2009 and November 2010. Serum cPLI concentrations were determined by quantitative (Spec cPL test, SPEC) and semiquantitative (SNAP cPL test, SNAP) assays. Results were categorized as normal, equivocal, or abnormal (SPEC) or negative or positive (SNAP). Associations between group and cPLI were assessed using Fisher's exact test or the Mann–Whitney U‐test. Spearman rank correlation coefficients (ρ) were determined for SNAP and SPEC results. Significance was set at P < .05. Results Spec cPL test concentrations were significantly (P < .001) higher in dogs with HAC (491.1 μg/L) than in healthy dogs (75.2 μg/L), with more abnormal SPEC results in HAC dogs (P < .001). There were more (P = .002) positive SNAP results in dogs with HAC (55%) than in healthy dogs (6%). SNAP and SPEC results were highly correlated (ρ = 0.85; P < .001). Conclusions and Clinical Importance Dogs with HAC had higher SPEC concentrations and more positive SNAP results than clinically healthy dogs with normal ACTH stimulation test results. Specificity of SPEC and SNAP assays in HAC dogs without clinical pancreatitis were 65 and 45%, respectively. Pending further study, SNAP and SPEC results should be interpreted cautiously in dogs with HAC to avoid false diagnosis of concurrent pancreatitis.
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Affiliation(s)
- D I Mawby
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
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15
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Bonadio CM, Feldman EC, Cohen TA, Kass PH. Comparison of adrenocorticotropic hormone stimulation test results started 2 versus 4 hours after trilostane administration in dogs with naturally occurring hyperadrenocorticism. J Vet Intern Med 2014; 28:1239-43. [PMID: 24863172 PMCID: PMC4857938 DOI: 10.1111/jvim.12357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/09/2014] [Accepted: 03/11/2014] [Indexed: 11/26/2022] Open
Abstract
Background Trilostane medical treatment of naturally occurring hyperadrenocorticism (NOH) in dogs is common, as is use of the adrenocorticotropic hormone (ACTH) stimulation test (ACTHst) in monitoring response to treatment. There is uncertainty regarding when the ACTHst should be started relative to time of trilostane administration. Objective To compare ACTHst results in dogs being treated for NOH with trilostane when the test is begun 2 versus 4 hours after trilostane administration. Animals Twenty‐one privately owned dogs with NOH, each treated with trilostane for at least 30 days. Methods Each dog had 2 ACTHst completed, 1 started 2 hours and the other 4 hours after trilostane administration. The second test was started no sooner than 46 hours and no later than 74 hours after the first. Results For all 21 dogs, the mean post‐ACTH serum cortisol concentration from tests started 2 hours after trilostane administration (5.4 ± 3.7 μg/dL) was significantly lower (P = .03) as compared with results from the tests started 4 hours after administration (6.5 ± 4.5 μg/dL). Conclusions Results of ACTHst started at different times yield significantly different results. Dogs with NOH, treated with trilostane, and monitored with ACTHst results should have all of their subsequent ACTHst tests begun at or about the same time after trilostane administration.
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Affiliation(s)
- C M Bonadio
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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16
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Arenas C, Melián C, Pérez-Alenza MD. Long-term survival of dogs with adrenal-dependent hyperadrenocorticism: a comparison between mitotane and twice daily trilostane treatment. J Vet Intern Med 2014; 28:473-80. [PMID: 24495125 PMCID: PMC4858016 DOI: 10.1111/jvim.12303] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 11/11/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022] Open
Abstract
Background Treatment of adrenal‐dependent hyperadrenocorticism (ADH) involves either surgical resection of the adrenal tumor or medical therapy. For many years, mitotane has been considered the medical treatment of choice for dogs with ADH. Objectives The aim of this study was to determine survival and prognostic factors for dogs with ADH treated with mitotane and trilostane. Animals Twenty‐six dogs with ADH were included in the study. Methods Fourteen dogs were treated with mitotane and 12 dogs were treated with trilostane. Medical records were reviewed. Epidemiologic factors, signalment, clinicopathologic abnormalities, endocrine test results, and treatment protocols were evaluated to identify potential predictive factors of overall survival time. Results Survival times of dogs treated with mitotane (median, 15.6 months) or trilostane (median, 14.0 months) were not significantly different. Using univariate analysis, age and postadrenocorticotropic hormone cortisol concentrations were inversely correlated with survival time. The multivariate model also identified weakness at presentation as a negative prognostic indicator. Conclusion and Clinical Importance The type of medical treatment (mitotane versus trilostane) does not influence survival time in dogs with ADH; therefore, trilostane, a drug with less frequent and milder adverse effects, might be used as the primary medical treatment when adrenalectomy cannot be performed.
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Affiliation(s)
- C Arenas
- Department of Small Animal Medicine, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
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