Evaluation of Basal Serum or Plasma Cortisol Concentrations for the Diagnosis of Hypoadrenocorticism in Dogs

Comparison of prednisolone and alternative glucocorticoid dosing protocols for canine hypoadrenocorticism: insights from a survey-based study

Objectives

The aim of the study was to analyze glucocorticoid (GC) dosing protocols in dogs with hypoadrenocorticism (HA), and to identify predictors for optimal clinical outcomes during both the acute and chronic phases of the disease, as well as during long-term therapy.

Methods

This observational cross-sectional study utilized a case-based online questionnaire. Practicing veterinarians across Germany were invited to participate. The survey collected data in the disease course and follow-ups. Responses were analyzed using descriptive statistics, single and multiple comparisons, and a multivariable logistic regression model.

Results

For 103 dogs the questionnaire was fully completed and analyzed. Of these, 85 dogs (82.5%) were hospitalized, and they received either prednisolone (52.9%), dexamethasone (31.8%) or hydrocortisone (11.8%). Hydrocortisone therapy was associated with a shorter hospitalization time and faster normalization of electrolytes compared to prednisolone. Follow-up data were available for 85 dogs, with 82.35% (n = 70/85) achieving an optimal or well-adjusted clinical outcome. Multivariable logistic regression analysis indicated that the eukalemic and eunatremic form was significantly less associated with the presence of azotemia and the occurrence of an acute adrenal crisis. Dividing the daily GC dosage was associated with poorer clinical outcomes and a reduced likelihood of achieving optimal medication adjustment.

Conclusion

Our findings provide new, relevant recommendations for the therapeutic management of HA in dogs. Hydrocortisone appears to be a promising treatment for managing HA during hospitalization, highlighting its potential use in clinical practice. Once-daily administration of prednisolone is advisable for long-term therapy. To achieve the best possible outcome, implementing an optimal treatment protocol is essential, which veterinarians should tailor based on the needs of both owners and animals. The main limitations of the study include its retrospective nature and the limited number of participants. Future studies, particularly prospective ones, could further validate the beneficial effects of hydrocortisone and evaluate long-term therapy in comparison to prednisolone.

Prednisolone pharmacokinetics in dogs with protein-losing enteropathy

BACKGROUND

It is unknown if glucocorticoid malabsorption contributes to the approximate 50% treatment failure rate in dogs with protein-losing enteropathy (PLE).

OBJECTIVE

To compare pharmacokinetics (PK) of orally administered prednisolone in dogs with PLE vs healthy controls.

ANIMALS

Fourteen dogs with well-characterized PLE and 7 control dogs.

METHODS

Prospective case-controlled study. Dogs were treated with 1 mg/kg prednisolone PO once daily for approximately 3 weeks. Venous blood samples were collected at set timepoints before and after prednisolone administration on the first (T1) and final (T2) study days. Total and non-protein bound serum prednisolone concentrations were determined using liquid chromatography tandem-mass spectrometry, and pharmacokinetics variables were derived from the drug concentration data. Pharmacokinetics variables were compared between PLE and control dogs and between PLE short-term responders and non-responders.

RESULTS

The PLE dogs had a shorter half-life of the terminal slope than control dogs (harmonic mean of 1.3 vs 1.8 hours; P = .05) whereas the percentage of serum prednisolone that was non-protein bound was higher in PLE dogs than in control dogs (median of 15.7% vs 6.7%; P = .02) at T1. Total prednisolone drug exposures and maximum total serum drug concentrations did not differ between PLE and control dogs at T1 or T2, nor did they differ between short-term responders and non-responders within the PLE population (P > .05 for all comparisons).

CONCLUSIONS AND CLINICAL IMPORTANCE

Overall drug exposures are similar between PLE dogs and healthy controls. Glucocorticoid malabsorption is unlikely to be a common cause of treatment failure in dogs with PLE.

DO HEALTHY COQUEREL'S SIFAKAS IN CAPTIVITY HAVE UNUSUALLY LOW CIRCULATING CORTISOL?

Cortisol, and other glucocorticoids, are routinely used as markers of physiological stress in wildlife. Typically, stress activates the hypothalamic-pituitary-adrenal (HPA) axis, with adrenocorticotropic hormone (ACTH) signaling the adrenal glands to release cortisol. Nevertheless, recent anecdotes in captive Coquerel's sifakas (Propithecus coquereli), strepsirrhine primates that are difficult to maintain under human care, may challenge the assumption that physiological stress universally increases circulating cortisol. Here, the authors ask if low circulating cortisol and minimal response to adrenal stimulation might be hallmarks of outwardly healthy sifakas in captivity. Comparative ACTH stimulation or control tests were performed in 10 Coquerel's sifakas and six ring-tailed lemurs (Lemur catta) at the Duke Lemur Center (DLC). At baseline, sifakas had average cortisol concentrations of just 0.67 µg/dl, whereas those of ring-tailed lemurs averaged 12.53 µg/dl. Stressful pre-experiment procedures, including kenneling and handling, activated the HPA axis in ring-tailed lemurs, masking further cortisol release from ACTH administration; however, neither these procedures nor exogenous ACTH raised cortisol concentrations in sifakas. Additionally, cortisol in dozens of serum samples from DLC sifakas banked over 17 yr was assayed. Across samples, cortisol concentrations averaged just 0.49 µg/dl and did not vary by animal sex, age, or housing condition. Comparable samples from two individual sifakas in sepsis at the end of life (4.28 and 21.88 µg/dl) indicate that the assay does capture meaningful variation in cortisol in captive sifakas, although robust biological validation is needed. Currently there is a lack of comparative data from wild Coquerel's sifakas that might determine if these unusual endocrine patterns are characteristic of the species or a function of captivity. If the latter, chronic stress in captivity could lead to a downregulated HPA axis, with persistent hypocortisolism perhaps contributing to the Coquerel's sifaka's susceptibility to infection under human management.

Resting cortisol concentrations in dogs presenting to a university teaching hospital with collapse

BACKGROUND

The relationship between collapse and a diagnosis of hypoadrenocorticism is not well understood in dogs.

HYPOTHESIS

To assess the prevalence of episodes of collapse in dogs screened for hypoadrenocorticism, and to assess the prevalence of confirmed hypoadrenocorticism in dogs presenting with reported collapse.

ANIMALS

Seventy-three client-owned dogs with resting cortisol concentrations were measured and presented to a University teaching hospital for collapse.

METHODS

Retrospective review of medical records of dogs at a single center.

RESULTS

The prevalence of episodes of collapse in dogs that had a resting cortisol measurement was 73/856 (8.5%; 95% confidence interval [95% CI], 6.7%-10.6%). Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 19 dogs. Cortisol concentration after ACTH stimulation was <2 μg/dL (<55 nmol/L) in 1 of the 73 dogs in this cohort, consistent with a diagnosis of hypoadrenocorticism, giving a prevalence estimate of hypoadrenocorticism of 1.3% (95% CI, 0.15%-6.2%). In 8 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). The most common diagnosis was vasovagal syncope (10/73), followed by sick sinus syndrome and third-degree atrioventricular block (2/73). The final diagnosis was unknown in 24/73 dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

Hypoadrenocorticism was the final diagnosis in 1 of 73 dogs presented to a teaching hospital either in a collapsed state or with a previous history of episodes of collapse. No dog presenting as cardiovascularly stable for intermittent collapse was found to have hypoadrenocorticism.

Comparison between typical primary and eunatraemic, eukalaemic hypoadrenocorticism: 92 cases

BACKGROUND

Naturally occurring hypoadrenocorticism is an uncommon endocrine disorder in dogs but has significant morbidity and mortality. Some dogs present with apparent glucocorticoid deficiency alone as evidenced by eunatraemia and eukalaemia. Few studies have compared dogs with hypoadrenocorticism with or without electrolyte disturbances and there are no large case series of affected dogs from Ireland.

METHODS

Retrospective observational study.

RESULTS

Ninety-two cases diagnosed with hypoadrenocorticism subdivided into those with supportive electrolyte disturbances (Group 1; n = 72) and those without (Group 2; n = 20). Dogs in Group 1 were significantly (p = 0.001) younger (4.0 (3.0-6.0) years) than dogs in Group 2 (6.0 (4.75-8.25) years). Dogs in Group 1 presented significantly more commonly with vomiting (Group 1: 52/71 (73.2%), Group 2: 6/20 (30.0%); p < 0.001), total hyperproteinaemia (Group 1: 21/71 (29.6%), Group 2: 1/20 (5.0%); p = 0.023), increased urea (Group 1: 52/72 (72.2%), Group 2: 5/20 (25.0%); p < 0.001), increased creatinine (Group 1: 31/72 (43.1%), Group 2: 3/20 (15.0%); p = 0.021) and hyperphosphataemia (Group 1: 40/71 (56.3%), Group 2: 2/20 (10.0%); p < 0.001), and significantly less commonly with reticulocytosis (Group 1: 4/38 (10.5%), Group 2: 5/13 (38.5%), p = 0.023). An undetectable basal aldosterone concentration had a positive predictive value of 94.3% for diagnosing undetectable post-ACTH aldosterone concentration. Of the thirteen dogs in Group 2 that had aldosterone concentrations measured and secondary disease excluded, 7 (53.8%) had or subsequently developed evidence of aldosterone deficiency, although not always with electrolyte abnormalities.

CONCLUSIONS

Dogs with hypoadrenocorticism from Ireland are similar to other reported cases. An undetectable basal aldosterone concentration is highly predictive of mineralocorticoid deficiency. Dogs with apparent glucocorticoid deficiency alone can progress to more typical disease and should be monitored appropriately.

Effects of heat stress on oxidative balance and sperm quality in dogs

Introduction

Heat stress negatively affects both animal reproductive performance and their overall wellbeing and welfare. When temperatures soar, the body responds to maintain balance, resulting in heat stress. This triggers various responses, including the buildup of reactive oxygen species (ROS), which can harm sperm vitality through lipid peroxidation. Oxidative damage can result in sperm dysfunction. This study aimed to evaluate the effects of environmental heat stress on canine quantitative and qualitative ejaculate parameters.

Methods

Thirty-six male crossbred dogs were involved in the trial. This study was performed in 2022, precisely from May to August. Dogs were subdivided in two groups, one heat stressed (HS) and one in thermoneutrality (TN). Thermo Hygrometric Index (THI) was hourly measured and ranged from 60 to 71 in TN dogs and from 60 to 83 for HS dogs. Semen and blood samples were collected at 30-day intervals, starting from May (0 days), and then at 30 days, 60 days, and 90 days and analysis for evaluating biochemical profile, semen oxidative status, and semen quality were performed.

Results

In HS dogs, serum total protein, albumin, and urea concentrations showed a significant decrease after 60 days (P < 0.01), with values lower than those observed in TN dogs (P < 0.01). Both catalase and glutathione peroxidase concentrations were reduced after 60 days in HS dogs, showing lower levels than the TN group (P < 0.01 and P < 0.05, respectively). Antioxidant potential increased over time in HS dogs, reaching higher values at 60 days (P < 0.05) and 90 days (P < 0.01). On the other hand, ROS in the sperm of HS animals rose by day 90, surpassing the values recorded at previous time points and in TN dogs (P < 0.01). Semen concentration (P > 0.01) and total sperm count (P < 0.05) declined after 30 days in the HS group and remained lower than the TN group throughout the trial.

Discussion

The study demonstrates that heat stress negatively affects the oxidative status and sperm quality of male dogs, reducing reproductive performance. However, further research is needed due to the lack of complete breed homogeneity in the study groups.

Video capsule endoscopy findings in dogs with chronic enteropathy and in healthy dogs

BACKGROUND

Video capsule endoscopy is a noninvasive technique for evaluation of the gastrointestinal tract.

OBJECTIVE

To investigate the safety of using the video capsule ALICAM in dogs with chronic enteropathy (CE) >10 kg, and to compare macroscopic gastrointestinal morphology between CE dogs and healthy controls (HC).

ANIMALS

Fifteen CE dogs and 15 similarly breed, age and body weight matched HC.

METHODS

All dogs underwent a clinical work up including blood analyses, fecal samples, abdominal ultrasonographic examination, and blood pressure measurement. The dogs were withheld from food for 16 hours before and 8 hours after they PO received an ALICAM. All recordings were quality assessed, and blindly evaluated by 2 trained observers.

RESULTS

The median age of CE dogs and HC was 3.3 (interquartile range [IQR] 2.5-5.9) years and 4.7 (IQR 3.3-5.6) years, respectively. The median body weight in the CE dogs and HC was 25.9 (IQR 20.6-30.9) kg, and 29 (IQR 16.2-30.5) kg, respectively. Complete recordings of the gastrointestinal tract were obtained from all dogs without complications. No significant differences were found between groups regarding number of abnormalities such as irregular mucosa, erythema, nonbleeding erosions, bleeding erosions, and dilated lacteals, as well as severity and extent of the abnormalities.

CONCLUSIONS AND CLINICAL IMPORTANCE

The use of ALICAM for evaluation of the gastrointestinal tract in CE dogs and HC seems safe and feasible regarding gastrointestinal transit and macroscopic morphology assessment in dogs >10 kg. Abnormalities were found in similar proportions in CE dogs and HC.

Prevalence of eunatremic, eukalemic hypoadrenocorticism in dogs with signs of chronic gastrointestinal disease and risk of misdiagnosis after previous glucocorticoid administration

BACKGROUND

Dogs with eunatremic, eukalemic hypoadrenocorticism (EEH) typically show signs of chronic gastrointestinal disease (CGD). Previous glucocorticoid administration (PGA) can give false-positive results on the ACTH stimulation test (ACTHst).

HYPOTHESIS/OBJECTIVES

To determine the prevalence of EEH in dogs with signs of CGD, and to identify clinical and clinicopathological features for EEH and PGA.

ANIMALS

One hundred twelve dogs with CGD (101 non-PGA and 11 PGA), 20 dogs with EEH.

METHODS

Multicenter prospective cohort study. Basal serum cortisol (BSC) concentration was measured in dogs with signs of CGD. When BSC was <2 μg/dL and in PGA dogs, ACTHst plus measurement of endogenous ACTH (eACTH) were performed. Records of dogs with EEH from 2009 to 2021 were reviewed.

RESULTS

The BSC concentration was <2 μg/dL in 48/101 (47.5%) non-PGA and in 9/11 (82%) PGA dogs. EEH was diagnosed in 1/112 dog (prevalence 0.9%; 95% CI, 0.1%-4.8%); the ACTHst provided false-positive results in 2/11 PGA dogs. PGA dogs showed lower C-reactive protein-to-haptoglobin ratio (median 0.01, range 0.003-0.08; P = .01), and higher haptoglobin (140, 26-285 mg/dL; P = .002) than non-PGA dogs (0.04, 0.007-1.5; 38.5, 1-246 mg/dL, respectively). eACTH was higher (P = .03) in EEH (396, 5->1250 pg/mL) than in non-PGA dogs (13.5, 7.3-46.6 pg/mL). Cortisol-to-ACTH ratio was lower (P < .0001 and P = .01, respectively) in EEH (0.002, 0.0002-0.2) than in non-PGA (0.1, 0.02-0.2) and PGA dogs (0.1, 0.02-0.2).

CONCLUSIONS AND CLINICAL IMPORTANCE

The prevalence of EEH in dogs with signs of CGD was lower than previously reported. The clinical and clinicopathological features herein identified could increase the index of suspicion for EEH or PGA in dogs with an unclear history of glucocorticoid administration.

Comparison of Cortisol Concentrations in Different Matrices in Alpine Ibex (Capra ibex) at the Zoo

The usefulness of blood collection using venipuncture versus kissing bugs or medicinal leeches and the collection of saliva, faeces, hair, urine, and tears for measuring "immunoreactive" C (iC) concentration in Alpine ibexes was verified using commercial enzyme immunoassays. The mean value of serum C was highest in serum collected using venipuncture and lowest in serums collected using kissing bugs. Statistically significant differences were observed between venipuncture and kissing bugs and between leeches and kissing bugs. However, no statistically significant difference was found in C concentrations between samples collected with venipuncture and those collected with leeches. The highest mean value of C concentration was measured in serum (all three methods), followed by that in hair and faeces, and the lowest mean value was found in saliva. Statistically significant differences were found between saliva and faeces samples and between saliva and hair samples. The difference between the concentrations for faeces and hair was not statistically significant. A significant difference in C concentration between males and females was found in saliva. A significant difference in C concentration among different ages was measured in serum obtained using venipuncture in all three groups and in faeces between the groups older than ten years and younger than 10 months. Highly significant differences in C concentrations were also found between hair sampled in summer and hair sampled in autumn. Collecting tear and urine samples is a laborious procedure and is therefore less acceptable for C determination. Due to the small number of samples, statistical values are not given for these two matrices.

Diagnostic predictivity of transtubular potassium gradient for primary hypoadrenocorticism in hyperkalemic dogs: a cross-sectional study

OBJECTIVES

Transtubular potassium gradient has never been evaluated in the diagnosis of primary hypoadrenocorticism in dogs. The objective of this study is to evaluate the diagnostic utility of transtubular potassium gradient for the diagnosis of primary hypoadrenocorticism in dogs with serum K+  > 5.5 mol/L.

MATERIALS AND METHODS

Cross-sectional study including dogs with primary hypoadrenocorticism and dogs with other disease. Differences in signalment and laboratory parameters between groups were assessed by binary logistic regression modelling. Variables significantly associated with primary hypoadrenocorticism were evaluated for their diagnostic accuracy of this condition by receiver operator characteristic curve analysis and by multivariable logistic regression analysis, respectively.

RESULTS

Dogs with primary hypoadrenocorticism (n=39) were significantly younger than hyperkalemic dogs without primary hypoadrenocorticism (n=41). Moreover they had higher serum and urinary concentrations of Na+ and Na+ :K+ , but lower transtubular potassium gradient than hyperkalemic dogs without hypoadrenocorticism. Serum Na+ (sNa+ ) had the highest diagnostic accuracy (area under the curve [AUC]: 0.87, 95% confidence interval, 0.78 to 0.96), followed by the transtubular potassium gradient (AUC: 0.81, 0.72 to 0.91), however the accuracy of the two AUCs was not statistically different. The transtubular potassium gradient-sNa+ additive index (i.e. transtubular potassium gradient+sNa+ /10) had a greater accuracy (AUC: 0.88, 0.79 to 0.94) than transtubular potassium gradient or sNa+ , although it was not statistically superior to the latter. The multivariable logistic regression model showed that transtubular potassium gradient (adjusted odds ratio [aOR]: 0.51, 0.3 to 0.84), sNa+ (aOR: 0.86, 0.78 to 0.95) and spayed female (aOR: 24.96, 2.32 to 267.66) were associated with primary hypoadrenocorticism.

CLINICAL SIGNIFICANCE

Transtubular potassium gradient-sNa+ additive index can contribute to decision-making on diagnosis of primary hypoadrenocorticism in dogs presenting with hyperkalaemia.

Clinical utility of an immunoglobulin A-based serological panel for the diagnosis of chronic enteropathy in dogs

BACKGROUND

A panel of IgA-based serologic assays might aid in the diagnosis of chronic enteropathy (CE) in dogs, a syndrome encompassing conditions such as food-responsive enteropathy, immunosuppressant-responsive enteropathy, and inflammatory bowel disease (also referred to as chronic inflammatory enteropathy). However, it is unclear whether these biomarkers discriminate between CE and other types of primary intestinal disorders.

OBJECTIVES

To evaluate a diagnostic panel that measures serum concentrations of IgA directed against OmpC (ACA), canine calprotectin (ACNA), and gliadin-derived peptides (AGA) in dogs with well-characterized intestinal diseases.

ANIMALS

Fifty-five dogs with primary intestinal disease.

METHODS

Serum ACA, ACNA, and AGA concentrations were measured in 30 dogs with CE and 25 dogs with other intestinal diseases (non-CE population), including histoplasmosis, parasitism, E. coli-associated granulomatous colitis, and lymphoma. Serum IgA concentrations were compared among populations, and sensitivities and specificities were calculated using laboratory-provided cut-points.

RESULTS

Twenty-six of 30 (87%) CE dogs and 21 of 25 (84%) non-CE dogs had abnormal concentrations (intermediate or high) of at least 2 markers; these proportions were not significantly different (P = .99). A serum ACA concentration ≥15 EU/mL was 86.7% (95% confidence interval [CI], 69.3%-96.2%) sensitive and 24.0% (95% CI, 9.4%-45.1%) specific for CE diagnosis. High AGA concentrations were observed in 16 of 25 (64%) non-CE dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The evaluated serologic markers were poorly specific for CE diagnosis, which raises concerns that their use in clinical practice might lead to misdiagnoses and delayed or even detrimental treatments in dogs with non-CE intestinal diseases.

Successful use of a benchtop fluorescent enzyme immunoassay analyzer to measure serum cortisol concentration as a screening test for hypoadrenocorticism in dogs

OBJECTIVE

To assess the diagnostic performance of a benchtop fluorescent enzyme immunoassay analyzer (AIA-360; Tosoh Bioscience Inc) for the measurement of serum cortisol concentration as a screening test for hypoadrenocorticism in dogs.

ANIMALS

173 client-owned dogs (20 with hypoadrenocorticism and 153 with nonadrenal illness).

PROCEDURES

Medical records of all dogs that underwent an ACTH stimulation test between June 2015 and October 2019 were reviewed retrospectively. Dogs were excluded if the ACTH stimulation test was performed on the basis of a suspicion of hypercortisolism, serum cortisol concentrations were measured using an analyzer other than the one assessed in the present study, or dogs had received medication known to affect the pituitary-adrenal axis in the 4 weeks1,2 preceding ACTH stimulation testing. The diagnostic performance of the benchtop analyzer was evaluated by calculating sensitivity, specificity, and likelihood ratios at various cutoff points.

RESULTS

Serum resting cortisol cutoff point concentrations of 0.8 μg/dL (22 nmol/L), 1 μg/dL (28 nmol/L), and 2 μg/dL (55 nmol/L) had a sensitivity of 100%. An optimal serum resting cortisol cutoff point of 0.58 μg/dL (16 nmol/L) had a sensitivity, specificity, and positive and negative likelihood ratios of 100%, 97%, and 30.6 and 0.0, respectively.

CLINICAL RELEVANCE

Findings indicated that previously derived cutoff points could be used with excellent sensitivity to exclude hypoadrenocorticism in this population of dogs when serum cortisol concentration was measured with the evaluated benchtop analyzer. An ACTH stimulation test may need to only be performed to diagnose hypoadrenocorticism if resting serum cortisol concentration is ≤ 0.58 μg/dL when measured with the evaluated benchtop analyzer.

Diagnosis of canine spontaneous hypoadrenocorticism

Hypoadrenocorticism is characterized by a reduction in mineralocorticoid and/or glucocorticoid production by the adrenal glands. Several subtypes have been described with different clinical and clinicopathological consequences. Most affected dogs have vague and non-specific signs that precede an eventual life-threatening crisis. This review aims to appraise classification, the available data on epidemiology and the clinical and laboratory features of naturally occurring canine hypoadrenocorticism.

Canine hypoadrenocorticism is a relatively uncommon endocrine disease that can present with a wide variety of clinical signs resulting from cortisol or aldosterone deficiency or both. Hypoadrenocorticism should be considered in all dogs with severe illness and typical electrolyte abnormalities but also in those with waxing and waning clinical signs. Multiple clinical and laboratory features are suggestive of the disease and should prompt evaluation of adrenal function. The ACTH stimulation test is the best test for diagnosing hypoadrenocorticism but, in those cases without the typical presentation, evaluation of aldosterone secretory capacity and endogenous ACTH concentrations should be performed to distinguish primary from secondary disease. In this review we discuss the pathophysiology of the disease, the clinical signs and laboratory features that should raise suspicion of hypoadrenocorticism and the performance of the different diagnostic tests.

Investigation of the urine cortisol to creatinine ratio for the diagnosis of hypoadrenocorticism in dogs

OBJECTIVE

To evaluate the urine cortisol-to-creatinine ratio (UCCR) for the diagnosis of hypoadrenocorticism (HA) in dogs and to determine whether the method of urine cortisol measurement affects results.

ANIMALS

41 dogs with naturally occurring HA and 107 dogs with nonadrenal illness.

PROCEDURES

Urine samples were prospectively collected from dogs undergoing testing for HA. Urine cortisol concentrations were measured at a veterinary diagnostic laboratory using either a radioimmunoassay (RIA) or a chemiluminescent immunoassay (CLIA). Receiver operating characteristic (ROC) curves were constructed to assess UCCR performance by both methods for HA diagnosis. Sensitivities, specificities, accuracies, and predictive values were calculated for various cutpoints.

RESULTS

The areas under the ROC curves for UCCR diagnosis of HA were 0.99 (95% CI, 0.98 to 1.00) and 1.00 (95% CI, 1.00 to 1.00) when urine cortisol was determined by RIA and CLIA, respectively. An RIA UCCR of ≤ 2 was 97.2% sensitive, 93.6% specific, and 94.7% accurate for HA diagnosis, whereas a CLIA UCCR of ≤ 10 was 100% sensitive, specific, and accurate. An RIA UCCR > 4 and a CLIA UCCR of > 10 had negative predictive values of 100%.

CLINICAL RELEVANCE

The UCCR was an accurate diagnostic test for HA in this study population, although equivocal results are possible. Case characteristics, method of cortisol measurement, and laboratory-specific cutpoints must be considered when interpreting results.

Effects of EDTA on chemiluminescent immunoassay measurement of ACTH, cortisol, and thyroid hormones in dogs

When measuring blood hormones, pre-analytical sample handling can impact the quality of the results. Previous studies have shown improved stability of canine cortisol in ethylenediaminetetraacetic acid (EDTA) plasma compared to serum and interchangeability of serum and plasma when cortisol is measured by radioimmunoassay. Additionally, cortisol samples were also interchangeable when measured by chemiluminescent immunoassay if the EDTA concentration was consistent with that of optimally filled tubes, whereas excess EDTA interfered with the measurement of cortisol and serum and EDTA plasma were not interchangeable when measuring total thyroxine (TT4). The main limitation of these studies was that they were performed by spiking pooled serum samples with EDTA or in previously collected blood samples submitted to a clinical pathology laboratory. The purpose of the present study was to evaluate the effect of EDTA on the measurement of adrenocorticotropic hormone (ACTH), cortisol, TT4, free thyroxine (FT4), and thyroid stimulating hormone (TSH) in healthy dogs using the Siemens IMMULITE 1000. Whole blood from forty dogs was aliquoted into three Monoject sample tubes: no additive, completely filled EDTA tube, and 50% filled EDTA tube. Handling and storage conditions were identical, and all samples were analyzed on the same day. Bland-Altman plots and Passing-Bablok regression were used to assess agreement and risks for error, respectively. Proportional errors were found between serum and plasma samples for ACTH, cortisol, TT4, FT4, and TSH; systematic errors were also found for FT4. There was poor agreement and clinically significant differences between the measured concentrations of all hormones in serum and plasma, proving that these sample types are not interchangeable. Incompletely filled EDTA tubes were associated with significantly lower ACTH concentrations compared to completely filled EDTA tubes. When measured by chemiluminescent immunoassays that utilize alkaline phosphatase at the reporter enzyme, serum should be used for cortisol, TT4, FT4, and TSH, while plasma from completely filled EDTA tubes should be used for ACTH.

Effect of heat stress on vital and hematobiochemical parameters of healthy dogs

Background and Aim:

Heat stress is a major challenge for animals, impairing their welfare and performance. This study aimed to determine the effect of heat stress on the vital and hematobiochemical parameters of healthy dogs.

Materials and Methods:

The experimental subjects comprised 10 dogs, encompassing seven males and three non-pregnant females between 2 and 3 years of age. Ambient temperature (AT) and relative humidity (RH) were recorded 2 hourly during the day and the temperature humidity index was calculated. Vital parameters [i.e., rectal temperature (RT), respiratory rate, and heart rate (HR)] were assessed and blood was collected from each dog daily for hematobiochemical analysis.

Results:

The RT (38.5±0.2°C) of dogs exposed to high AT and high RH (HA/HR) conditions was significantly (p<0.05) higher than that of dogs exposed to HA and low RH (LR) conditions (37.2±0.11°C). Under HA/HR conditions, packed cell volume, hemoglobin concentrations, and white blood cell counts were significantly lower than those of the same dogs exposed to HA/LR conditions. Conversely, under HA/HR conditions, the lymphocyte, monocyte, eosinophil, alanine aminotransferase, aspartate aminotransferase, and cortisol values were significantly higher (p<0.05) than the values obtained in dogs exposed to HA/LR conditions. Meanwhile, the alkaline phosphatase, urea, and glucose levels were significantly lower (p<0.05) in dogs exposed to HA/HR conditions.

Conclusion:

The exposure of healthy dogs to HA/HR conditions induced heat stress, which may have an adverse effect on their immune status, thereby affecting their health and welfare.

Urinary cortisol-creatinine ratio in dogs with hypoadrenocorticism

Background

Basal serum cortisol (BSC) ≥2 μg/dL (>55 nmol/L) has high sensitivity but low specificity for hypoadrenocorticism (HA).

Objective

To determine whether the urinary corticoid:creatinine ratio (UCCR) can be used to differentiate dogs with HA from healthy dogs and those with diseases mimicking HA (DMHA).

Animals

Nineteen healthy dogs, 18 dogs with DMHA, and 10 dogs with HA.

Methods

Retrospective study. The UCCR was determined on urine samples from healthy dogs, dogs with DMHA, and dogs with HA. The diagnostic performance of the UCCR was assessed based on receiver operating characteristics (ROC) curves, calculating the area under the ROC curve.

Results

The UCCR was significantly lower in dogs with HA (0.65 × 10⁻⁶; range, 0.33‐1.22 × 10⁻⁶) as compared to healthy dogs (3.38 × 10⁻⁶; range, 1.11‐17.32 × 10⁻⁶) and those with DMHA (10.28 × 10⁻⁶; range, 2.46‐78.65 × 10⁻⁶) (P < .0001). There was no overlap between dogs with HA and dogs with DMHA. In contrast, 1 healthy dog had a UCCR value in the range of dogs with HA. The area under the ROC curve was 0.99. A UCCR cut‐off value of <1.4 yielded 100% sensitivity and 97.3% specificity in diagnosing HA.

Conclusions and Clinical Importance

The UCCR seems to be a valuable and reliable screening test for HA in dogs. The greatest advantage of this test is the need for only a single urine sample.

Evaluation of resting cortisol concentration testing in dogs with chronic gastrointestinal signs

Background

Resting cortisol concentrations are routinely measured in dogs with chronic gastrointestinal signs to rule out hypoadrenocorticism based on a concentration >2 μg/dL (>55 nmol/L).

Hypothesis/Objectives

To assess the cross‐sectional prevalence of hypoadrenocorticism in a group of dogs with chronic gastrointestinal signs presented to a referral internal medicine service.

Animals

Two‐hundred and eighty‐two client‐owned dogs with chronic gastrointestinal signs and with resting cortisol concentration testing performed.

Methods

Retrospective review of medical records (final diagnosis, resting cortisol concentration, and adenocorticotropic hormone [ACTH] stimulation test results) of a referral population of dogs between May 2013 and September 2017.

Results

Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 79 patients (28%). Repeated resting cortisol concentration measurements were performed in 28 dogs, and in 8, resting cortisol concentrations remained <2 μg/dL (<55 nmol/L). Post‐ACTH cortisol concentration was <2 μg/dL (<55 nmol/L) in 1 dog, consistent with a diagnosis of hypoadrenocorticism and giving a prevalence estimate of hypoadrenocorticism in this population of dogs of 0.3% (95% confidence interval [95CI], 0.03‐1.5%). In 19 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). Overall, the most common diagnosis was chronic primary inflammatory enteropathy (176/282, 62.4%), followed by extragastrointestinal neoplasia (17/282, 6%), protein‐losing enteropathy, pancreatitis and megaesophagus (10/282, 3.5% each).

Conclusions and Clinical Importance

Although dogs with hypoadrenocorticism can present with chronic gastrointestinal signs, it was the final diagnosis in only 1 of 282 dogs presenting to a referral internal medicine service for signs of chronic enteropathy. Repeated resting cortisol concentration may be considered as a test to try and exclude hypoadrenocorticism.

Comparison of Hydrocortisone Continuous Rate Infusion and Prednisolone or Dexamethasone Administration for Treatment of Acute Hypoadrenocortical (Addisonian) Crisis in Dogs

Objectives

To determine whether administration of intravenous hydrocortisone is a safe and effective alternative treatment in comparison to the traditional treatment with prednisolone/dexamethasone in dogs presenting with Addisonian crisis; and to assess if there is any advantage of the former over the latter in normalisation of electrolyte imbalances and in hospitalisation length in these dogs.

Methods

Medical records of client-owned dogs with hypoadrenocorticism were retrospectively reviewed. Time until normalisation of sodium and potassium concentration, intravenous fluid needs over the first 24 h and hospitalisation length were compared between hydrocortisone and prednisolone/dexamethasone treated dogs.

Results

Twenty-five dogs met the inclusion criteria; 13 received hydrocortisone and 12 prednisolone/dexamethasone. Intravenous hydrocortisone was well-tolerated but failed to prove superiority in terms of time to normalisation of sodium and potassium concentration. Interestingly, potassium normalised in all dogs prior to discharge, but sodium did not in 1/11 hydrocortisone and 5/9 prednisolone/dexamethasone treated dogs with initial hyponatraemia (p = 0.05). Hydrocortisone treated dogs, however, had more electrolyte re-checks [hydrocortisone treated dogs, median (range): 4 (2–16); prednisolone/dexamethasone treated dogs: 2 (0–6); p = 0.001]. There was no difference in intravenous fluid needs over the first 24 h but hydrocortisone treated dogs had longer hospitalisation [hydrocortisone: 81 (45–309) h; prednisolone/dexamethasone: 52 (22–138) h; p = 0.01].

Clinical Significance

Intravenous hydrocortisone is well-tolerated and safe, but no clear additional benefit over traditional glucocorticoid replacement could be identified. Also, it might result in longer hospitalisation time and more intensive monitoring.

Prednisolone and dexamethasone are systemically absorbed after topical application of ophthalmic suspensions in healthy dogs

OBJECTIVE

To quantify plasma concentrations of prednisolone and dexamethasone (peripheral and jugular) and cortisol following topical ophthalmic application of 1% prednisolone acetate and 0.1% dexamethasone to healthy adult dogs.

ANIMALS

12 purpose-bred Beagles.

PROCEDURES

Dogs received 1 drop of 1% prednisolone acetate (n = 6) or neomycin polymyxin B dexamethasone (ie, 0.1% dexamethasone; 6) ophthalmic suspension in both eyes every 6 hours for 14 days. Blood samples (peripheral and jugular) were collected on days 0, 1, 7, and 14 and analyzed for plasma prednisolone and dexamethasone concentrations. Plasma cortisol concentrations were measured at the beginning of the study and following topical drug administration.

RESULTS

Both drugs demonstrated systemic absorption. Prednisolone was detected on days 1, 7, and 14 (median plasma concentration, 24.80 ng/mL; range, 6.20 to 74.00 ng/mL), and dexamethasone was detected on days 1, 7, and 14 (2.30 ng/mL; 0 to 17.70 ng/mL). Neither prednisolone nor dexamethasone were detected in plasma samples on day 0 (baseline). Sampling from the jugular vein resulted in higher plasma drug concentrations than from a peripheral vein when samples from each day were combined. Plasma cortisol concentrations were significantly lower than baseline following 14 days of treatment with topical prednisolone acetate and dexamethasone.

CLINICAL RELEVANCE

Prednisolone and dexamethasone are detected in the plasma of healthy dogs following topical ophthalmic administration 4 times/d with prednisolone concentrations being close to a physiologic dose of orally administered prednisolone. Additional research is needed to evaluate the systemic absorption of these medications in dogs with ocular inflammation.

Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)

Background

Despite the common use of topical ophthalmic corticosteroids in dogs, detailed reports on systemic and dermatologic adverse effects are limited.

Results

Nine purpose-bred research Beagles were treated with difluprednate 0.05% ophthalmic emulsion in one or both eyes 2–3 times daily. Some difluprednate treated dogs developed mild to severe alopecia of the periocular region, face, and distal pinna (5/9). The median duration of treatment prior to onset of dermatologic signs for difluprednate treated dogs was 550 days (453–1160 days). Diagnostic testing included complete blood count (CBC) and serum biochemistry, adrenocorticotropic hormone (ACTH) stimulation testing combined with endogenous ACTH measurement, and skin biopsy. The CBC and chemistry were within normal limits for all dogs. There were varying degrees of suppression of the hypothalamic-pituitary-adrenocortical (HPA) axis with difluprednate treatment. Dogs with the most profound alopecic changes had less pronounced HPA axis suppression compared to dogs with no integumentary changes. Skin biopsies demonstrated follicular atrophy and follicular keratosis. When topical difluprednate was reduced to unilateral therapy, the hair regrew on the untreated side of the face. In addition to the affected research dogs, a 7-year old female spayed Chihuahua that was being treated as a clinical patient with long-term difluprednate 0.05% ophthalmic emulsion developed generalized hypotrichosis on the head and body and a potbellied appearance. ACTH stimulation testing revealed suppression of the HPA axis with a mild increase in serum alkaline phosphatase (ALP) activity and a urine specific gravity of 1.016. The combination of clinical signs and laboratory abnormalities was supportive of iatrogenic hyperadrenocorticism.

Conclusions

In dogs long-term use of difluprednate ophthalmic emulsion results in HPA axis suppression and in some cases iatrogenic hyperadrenocorticism. A novel pattern of localized alopecia is suspected to be related to dermal absorption and local action due to superior potency and penetration compared to other commonly utilized ophthalmic corticosteroids.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-03072-9.

Evaluation of urine electrolytes for the diagnosis of hypoadrenocorticism in dogs

BACKGROUND

Most dogs with primary hypoadrenocorticism (HA) have a mineralocorticoid deficiency, which decreases renal tubular sodium reabsorption and potassium excretion. Limited information is available concerning the clinical value of measuring urine electrolytes to aid in an HA diagnosis.

OBJECTIVES

We aimed to evaluate the diagnostic utility of urine electrolyte measurements in dogs with HA.

METHODS

Urine sodium and potassium concentrations were measured in 89 dogs, including 39 dogs with HA and 50 controls with nonadrenal illness. Fractional excretions of sodium (FE_Na ) and potassium (FE_K ) were also calculated. Urine electrolytes and fractional excretion values were compared between the groups. Sensitivities and specificities were determined for various cut-points.

RESULTS

The median urine sodium to potassium (Na:K) ratio was twofold greater (P < .001), and median FE_Na was fourfold greater (P < .001) in HA dogs as compared with controls. However, no cut-point for any variable with >90% sensitivity or specificity provided a corresponding specificity or sensitivity of >50%. When only dogs with abnormal serum or plasma electrolytes were included in the analyses, absolute urine electrolyte concentrations and FE_Na were not different between study populations (P > .05 for all comparisons), but the FE_K was increased (P = .005) and the urine potassium:creatinine ratio was decreased (P < .001) in the control dogs compared with the dogs with HA.

CONCLUSIONS

Urine electrolyte concentrations and fractional excretions are altered in dogs with HA. However, substantial overlap exists with control dogs with nonadrenal illness. Therefore, these values are unlikely to have diagnostic utility for dogs with HA.

Syndrome of inappropriate antidiuretic hormone secretion secondary to trauma in a dog

OBJECTIVE

To describe a case of inappropriate antidiuretic hormone (ADH) secretion in a dog secondary to trauma.

CASE SUMMARY

A 14-year-old neutered female mixed breed dog presented for evaluation of bite wounds. The dog sustained multiple puncture wounds to the cervical area, stifle, and elbow. Treatment was initiated with isotonic crystalloid fluids, analgesia, broad-spectrum antimicrobials, and gastroprotectants. The dog developed hyponatremia with concurrent serum hypoosmolality and inappropriate urine hyperosmolality and urine sodium secretion, leading to a diagnosis of the syndrome of inappropriate ADH secretion. The hyponatremia improved, and the dog improved clinically and was discharged 3 days after admission.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first case description of the syndrome of inappropriate ADH secretion in a dog suffering from trauma. Inappropriate ADH secretion is largely under-recognized in veterinary patients. Increased awareness of this syndrome can lead to initiation of appropriate treatment and improved outcomes.

Low-dose desoxycorticosterone pivalate treatment of hypoadrenocorticism in dogs: A randomized controlled clinical trial

Background

Desoxycorticosterone pivalate (DOCP) is a commonly used mineralocorticoid replacement for dogs with primary hypoadrenocorticism (HA), but manufacturer‐recommended dosing protocols can be cost‐prohibitive. Recent reports also have raised concerns that label dose protocols could be excessive.

Objective

To investigate the relative efficacy and adverse effects of 2 DOCP dosages in dogs with primary glucocorticoid and mineralocorticoid deficient HA.

Animals

Thirty‐seven dogs, including 19 test population dogs and 18 controls.

Methods

Randomized controlled double‐blinded clinical trial. Dogs with newly diagnosed primary HA were assigned to standard (2.2 mg/kg q30d, control population) or low‐dose (1.1 mg/kg q30d, test population) DOCP treatment. Clinical and laboratory variables were assessed 10 to 14 days and approximately 30 days after each DOCP treatment for 90 days.

Results

Mean serum sodium to potassium ratios at reevaluations were ≥32 in both populations throughout the study. No dog developed electrolyte abnormalities warranting medical treatment, although hypokalemia occurred on at least 1 occasion in 9 controls and 6 test population dogs. Urine specific gravities (median, interquartile range) were lower in control dogs (1.022, 1.016‐1.029) as compared to test population dogs (1.033, 1.023‐1.039; P = .006). Plasma renin activity was overly suppressed on 84 of 104 (80.8%) assessments in control dogs whereas increased renin activity occurred on 23 of 112 (20.5%) assessments in test population dogs.

Conclusions and Clinical Importance

Low‐dose DOCP protocols appear to be safe and effective for treatment of HA in most dogs. Standard‐dose protocols are more likely to result in biochemical evidence of overtreatment.

Ménétrier-like disease in a Pointer with concurrent granulomatous gastritis, helicobacteriosis and leishmaniosis: a case report

Background

Ménétrier-like disease is a rare hypertrophic canine gastropathy, reported in only seven dogs. Clinical signs are vomiting, anorexia and weight loss. Macroscopically, giant cerebriform gastric mucosal folds are typically seen in the corpus and fundus of the stomach. Histopathologically, fundic mucous cell hyperplasia and loss of parietal and chief cells are typical.

Case presentation

A nine-year-old spayed female Pointer had a history of intermittent vomiting, marked weight loss and hypoalbuminaemia. A gastroduodenoscopy was performed three times within three months with macroscopic changes remaining the same. The gastric mucosa of the corpus, fundus and proximal antrum was markedly irregular, with cerebriform mucosal folds. In the first gastric biopsies, histopathology revealed a moderate granulomatous gastritis, with a severe manifestation of Helicobacter-like organisms. Treatment for Helicobacter spp. decreased the vomiting slightly. The dog was diagnosed with concurrent leishmaniosis; the conventional anti-Leishmania treatment decreased the vomiting moderately, the hypoalbuminaemia resolved and the dog gained weight back to a normal body condition. Granulomatous gastritis was not present in the gastric biopsies after these treatments. The dog increased vomiting when palliative treatment (maropitant citrate, ondansetron and esomeprazole) was discontinued, and thus, full-thickness biopsies of the stomach were taken and Ménétrier-like disease was diagnosed. The affected area was too large to be surgically removed; thus, palliative treatment was reinstated. The dog remained clinically well 39 months after the first clinical presentation.

Conclusions

This is the first report of Ménétrier-like disease in a dog with a simultaneous manifestation of granulomatous gastritis, helicobacteriosis and leishmaniosis. The clinical signs decreased after treatment of helicobacteriosis and leishmaniosis, but vomiting remained probably as a sign of Ménétrier-like disease. Treatment options for dogs are surgical removal of the abnormal area or palliative treatment. In humans, promising results for a cure have been shown with cetuximab treatment, a human monoclonal antibody, but no canine antibody is commercially available yet. The dog here was doing well 39 months after first presentation, which is the longest reported survival time for Ménétrier-like disease with only palliative treatment in dogs. Full-thickness biopsies are preferred in macroscopic hypertrophic lesions of the stomach for better assessment of Ménétrier-like disease.

Glucocorticoid metabolism in critically ill dogs (Canis lupus familiaris)

Critical illness due to sepsis is a major global health concern associated with a high burden of mortality and cost. Glucocorticoid dysregulation in human sepsis is associated with poorer outcomes. This study examines glucocorticoid metabolism in septic canine patients to delineate elements of cellular dysregulation in common with critically ill humans and explore potential differences. This was a prospective case-control study conducted in the veterinary specialist critical care departments of two University teaching hospitals. Critically ill canine patients with naturally occurring sepsis or septic shock were compared with an in-hospital control population. Serum total, bound, and free cortisol concentrations were increased in septic shock (P < 0.001), and higher bound cortisol was associated with nonsurvival (P = 0.026). Urinary Gas Chromatography-Tandem Mass Spectrometry was performed to assess urinary glucocorticoid metabolites and estimate intracellular glucocorticoid metabolism. Decreased renal 11β-hydroxysteroid dehydrogenase 2 (11βHSD2) activity inferred from increased urinary cortisol-to-cortisone ratio was observed in critically ill dogs (P < 0.001). Decreased 11βHSD2 activity (P = 0.019) and increased A-ring reduction of cortisone (P = 0.001) were associated with nonsurvival within the critically ill dogs. Intriguingly, two dogs were identified with low circulating total cortisol (<2 mg/dL) associated with increased A-ring reduction of cortisol, not previously described. Investigation of spontaneous canine sepsis and septic shock reveals dysregulation of cortisol to cortisone conversion similar to that observed in human patients, but with differences in A-ring reduction compared with those reported in humans. In addition, two dogs with high levels of cortisol inactivation associated with low circulating cortisol concentrations were identified.

Prevalence and characterization of hypoadrenocorticism in dogs with signs of chronic gastrointestinal disease: A multicenter study

Background

Dogs with hypoadrenocorticism (HA) frequently show signs of gastrointestinal disease (SGD). The prevalence of dogs presented for chronic SGD with HA is unknown.

Objectives

The aims of this study were to determine the prevalence of HA in dogs with chronic SGD and to identify clinical and laboratory variables for HA in this population.

Animals

One hundred fifty‐one dogs with chronic SGD.

Methods

In this multicentered prevalence study a standardized workup was performed in prospectively enrolled dogs with SGD > 3 weeks duration. Basal serum cortisol concentration was measured in every dog with ACTH stimulation test (ACTHST) if basal serum cortisol concentration was <3 μg/dL.

Results

Basal serum cortisol concentration was <3 μg/dL in 80/151 (53%) dogs, <2 μg/dL in 42/151 (28%) dogs, and < 1 μg/dL in 9/151 (6%) dogs. In 6/151 dogs HA was diagnosed based on ACTHST (stimulated serum cortisol concentration < 2 μg/dL), a prevalence of 4%. There was no difference in history, physical examination, and laboratory variables between dogs with HA and those with other causes of chronic SGD. In 4/6 dogs with HA, there was melena or hematochezia indicating gastrointestinal blood loss. Hyperkalemia, hyponatremia, or both was not observed in any dog.

Conclusion and Clinical Importance

The prevalence of HA among dogs with chronic SGD is higher than in the general population. Based on these results, testing adrenal function should be performed as a standard screening test in dogs with chronic SGD to differentiate between HA and chronic enteropathies.

Effect of EDTA on measurement of cortisol and thyroxine by chemiluminescent enzyme immunoassay in dogs

The addition of ethylenediamine tetra-acetic acid (EDTA) to serum can affect the measurement of cortisol by chemiluminescent enzyme immunoassay (CEIA); addition of magnesium chloride (MgCl₂) may reverse the effects. However, similar characteristics for thyroxine (T4) measurement are unknown. We measured cortisol and T4 in paired EDTA-anticoagulated plasma and serum samples from 50 dogs. Additionally, both hormones were measured in 15 samples of each type after the addition of MgCl₂. Samples were collected under routine clinical conditions; therefore, specific EDTA concentrations in plasma samples were unknown. Cortisol and T4 values were significantly different comparing plasma and serum samples in the absence of MgCl₂. For cortisol and T4, EDTA-plasma concentrations were 51.2% and 43.7% higher than serum, respectively (p < 0.001 for both). The addition of MgCl₂ to plasma significantly decreased the measured cortisol concentrations (p < 0.001) but not T4 (p = 0.44). After addition of MgCl₂, cortisol concentrations in EDTA-plasma were no longer significantly different from serum, whereas T4 concentrations in EDTA-plasma remained significantly different from serum. In the clinical setting in which tubes may be underfilled, use of EDTA-plasma significantly increases the measured concentration of cortisol and T4 obtained by CEIA. Addition of MgCl₂ to EDTA-plasma can overcome the effects of EDTA when measuring cortisol, but not T4. Thus, T4 should not be measured in EDTA-plasma.

DLA class II haplotypes show sex-specific associations with primary hypoadrenocorticism in Standard Poodle dogs

Addison's disease (AD) is a life-threatening endocrine disorder that occurs spontaneously in both humans and dogs. Associations between MHC class II genes and AD have been shown in several human studies. Our goal was to identify MHC class II associations with AD in a large population of Standard Poodles, a breed highly predisposed to AD. We sequenced exon 2 of the class II genes DLA-DRB1, DLA-DQA1, and DLA-DQB1 in 110 affected and 101 unaffected Standard Poodles and tested for association with AD. After correcting for population structure, two haplotypes were found to confer risk of developing AD in a sex-specific manner: DLA-DRB1*015:01-DQA1*006:01-DQB1*023:01 in males (x²p = 0.03, OR 2.1) and DLA-DRB1*009:01-DQA1*001:01-DQB1*008:01:1 in females (x²p = 0.02, OR 8.43). Sex-specific associations have been previously described in human populations, but this is the first report of this kind in dogs. Consistent with findings in other studies, we found the DLA-DQA1*006:01 allele (x²p = 0.04) to be associated with AD in males independent of haplotype. In females, the haplotype DLA-DRB1*009:01-DQA1*001:01-DQB1*008:01:1 confers a very high risk for developing AD, although its frequency was rare (9 of 124 females) in our study population. Further studies are warranted to validate the findings of this exploratory dataset and to assess the usefulness of this haplotype as a risk marker for AD in female Standard Poodles. Our results highlight the importance of evaluating MHC class II disease associations in large populations, and accounting for both biological sex and population structure.

Low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism

BACKGROUND

Low-dose ACTH stimulation testing would lower cost and may increase sensitivity for identification of partial ACTH deficiency.

HYPOTHESIS

(1) The low-dose ACTH stimulation test will provide comparable results to the standard-dose ACTH stimulation test in dogs suspected of hypoadrenocorticism and (2) partial ACTH deficiency exists in dogs and can result in chronic, intermittent gastrointestinal signs.

ANIMALS

Thirty-one client-owned dogs suspected of having hypoadrenocorticism.

METHODS

Prospective study. Dogs suspected of having hypoadrenocorticism received 1 μg/kg cosyntropin IV for the first ACTH stimulation test; the second test was performed 4 h later and dogs received 5 μg/kg cosyntropin IV. Blood samples were obtained pre-ACTH and 1 hour post-ACTH for each dose (4 measurements total). Samples for endogenous ACTH measurement were obtained at the time of initial blood collection.

RESULTS

No significant difference was observed in the basal cortisol concentration before administration of a 1 μg/kg versus before a 5 μg/kg dose of cosyntropin (P = .544). For dogs suspected of having hypoadrenocorticism, the ACTH-stimulated cortisol concentrations in response to both doses of ACTH were equivalent (90% confidence interval [CI], 80.5-97.2%; P = .04). No cases with partial ACTH deficiency were identified conclusively.

CONCLUSIONS AND CLINICAL IMPORTANCE

A 1 μg/kg dose of cosyntropin is equivalent to a 5 μg/kg dose of cosyntropin for screening dogs suspected of hypoadrenocorticism. The existence of partial ACTH deficiency was not identified in this small group of dogs.

Novel Treatment of Disseminated Coccidioidomycosis in a Dog with Voriconazole

A dog with disseminated coccidioidomycosis involving the vertebral, cutaneous, and pulmonary systems was treated successfully with voriconazole after failing traditional therapy with fluconazole and terbinafine. This report is the first to describe the successful management of refractory coccidioidomycosis with voriconazole in a dog.

ATR-101, a selective ACAT1 inhibitor, decreases ACTH-stimulated cortisol concentrations in dogs with naturally occurring Cushing's syndrome

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.

Management of hypoadrenocorticism (Addison's disease) in dogs

Hypoadrenocorticism (HOAC; Addison’s disease) is an endocrine condition seen in small animal practice. Dogs with this disease can present in a variety of ways from acute hypovolemic collapse to vague, chronic, waxing, and waning clinical signs. In the most common form of this disease, animals have both mineralocorticoid and glucocorticoid deficiency, resulting in hyponatremia and hyperkalemia, and signs of cortisol deficiency. The etiology may be immune-mediated destruction of the adrenal cortex, drug-induced adrenocortical necrosis (mitotane), enzyme inhibition (trilostane), or infiltrative processes such as neoplastic or fungal disease. Much less commonly, dogs have signs of cortisol deficiency, but no electrolyte changes. This is referred to as atypical HOAC. The veterinarian needs to have a clinical suspicion for HOAC to make a diagnosis in a timely manner. Treatment of dogs with an acute presentation prioritizes correcting the hypovolemia, hyperkalemia, acidosis, and hypoglycemia. Fluid therapy addresses most of these issues, but other directed therapies may be required in the most severe cases. For chronic management, all patients with Addison’s disease will require replacement of glucocorticoids (usually prednisone), and most patients require replacement of mineralocorticoids with either desoxycorticosterone pivalate or fludrocortisone. Atypical Addisonians do not require mineralocorticoid supplementation, but electrolytes should be monitored in case the need arises in the future. The prognosis for dogs treated for HOAC promptly and appropriately is excellent; most patients die from other diseases. However, if the diagnosis is missed, patients may die as a consequence of HOAC. Thus, knowledge of the hallmarks of Addison’s disease is imperative.

Urine sodium concentrations are predictive of hypoadrenocorticism in hyponatraemic dogs: a retrospective pilot study

OBJECTIVES

To determine if a urine sodium concentration could be used to rule out hypoadrenocorticism in hyponatraemic dogs.

MATERIALS AND METHODS

Medical records were reviewed for hyponatraemic dogs (serum sodium<135 mmol/L) that had recorded urine sodium concentrations. Twenty hyponatraemic dogs were included: 11 diagnosed with classical hypoadrenocorticism and nine with non-adrenal causes of hyponatraemia. A Wilcoxon rank-sum test was used to compare results between groups.

RESULTS

No dog with hypoadrenocorticism had a urine sodium concentration less than 30 mmol/L. Urine sodium concentration in dogs with hypoadrenocorticism was significantly higher (median 103 mmol/L, range: 41 to 225) than in dogs with non-adrenal illness (median 10 mmol/L, range: 2 to 86) (P<0·0005). Serum sodium concentrations were not significantly different between dogs with hypoadrenocorticism and dogs with non-adrenal illness.

CLINICAL SIGNIFICANCE

These results suggest that urine sodium concentrations can be used to prioritise a differential diagnosis of hypoadrenocorticism in hyponatraemic dogs. A urine sodium concentration less than 30 mmol/L in a hyponatraemic dog makes classical hypoadrenocorticism an unlikely cause of the hyponatraemia. Nevertheless, because of the small sample size our results should be interpreted with caution and a larger follow-up study would be valuable.

Extended low-dose dexamethasone suppression test for diagnosis of atypical Cushing's syndrome in dogs

The purpose of this study was to evaluate extension of the low-dose dexamethasone suppression (LDDS) test from 8 h to 12 h to detect possible hypercortisolemia associated with atypical hyperadrenocorticism (AHAC). Twelve client-owned dogs were enrolled in the study: 6 healthy dogs (group 1) and 6 dogs with suspected AHAC (group 2). Baseline EDTA plasma samples were collected for endogenous ACTH determination using an immunoradiometric assay. Serum samples were collected before and at 4, 8, 10, and 12 h post-administration of 0.01 mg/kg dexamethasone IV for cortisol concentration determination via chemiluminescent assay. Mean endogenous ACTH concentration did not differ between groups (group 1: 22.4 pg/mL, group 2: 20.0 pg/mL; P > 0.2). Mean baseline cortisol concentration also did not differ significantly between groups (group 1: 3.03 μg/dL, group 2: 4.95 μg/dL; P > 0.2) nor was there any difference in mean cortisol concentration between the groups at any other time point (P > 0.2). The cortisol concentration from 1 dog in group 2 suppressed to 0.7 μg/dL at 8 h but increased to 1.5 μg/dL at 10 h and 3.7 μg/dL at 12 h post-dexamethasone. Based on results of this study, use of an extended LDDS test could not differentiate between healthy dogs and dogs with AHAC. Diagnosis of AHAC should continue to be based on prior established criteria until new testing has been identified.

Effect of Intravenous or Perivascular Injection of Synthetic Adrenocorticotropic Hormone on Stimulation Test Results in Dogs

Background

Standard protocols for adrenocorticotropic hormone (ACTH) stimulation testing (ACTHst) often involve intravenous (IV) injection of corticotropin. ACTH might be unintentionally injected into the perivascular (PV) space.

Objective

To compare stimulation test results after IV and PV injections of ACTH.

Animals

Twenty privately owned dogs were studied: 10 healthy and 10 with trilostane‐treated naturally occurring hyperadrenocorticism (HAC).

Methods

Prospective study. Each of 20 dogs underwent 2 ACTHst not <4 nor more than 14 days apart. Five healthy and 5 HAC dogs had an IV ACTHst first and PV second; 5 healthy and 5 HAC dogs had a PV ACTHst first and IV second. Blood samples for measurement of serum cortisol concentration were collected before and 1 hour after ACTH administration.

Results

No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in all 20 dogs (median μg/dL; interval μg/dL: 8.2; 1.4–17.4 versus 7.8; 0.9–16.9; P = .23). No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in the 10 healthy dogs (median μg/dL; interval μg/dL: 10.9; 7.3–17.4 versus 10.6; 7.1–16.9; P = .54) or in the 10 HAC dogs (median μg/dL; interval μg/dL: 6.3; 1.4–8.6 versus 5.2; 0.9–8.7; P = .061).

Conclusions and Clinical Importance

Perivascular administration of ACTH does not significantly alter stimulation test results in healthy dogs or in dogs with HAC undergoing therapy with trilostane.