Cardiovascular indicators and mitral valve disease in dogs with spontaneous hypercortisolism - prospective evaluation

Background: Canine hypercortisolism (HC) is the most prevalent endocrinopathy in dogs in southern Brazil. The prognosis depends on several factors including the general health status, owners´ commitment, and the development of disease complications and comorbidities occurrence, such as cardiovascular complications including mitral valve disease (MVD), systemic arterial hypertension, and left ventricular hypertrophy. The main objective of the present study was to assess cardiovascular parameters in canine HC, based on investigating survival-related variables. The study also aimed to evaluate the influence of concurrent preclinical (MVD) on dogs` survival and the impact of HC on MVD progression. Materials, Methods & Results: A total of 25 dogs with spontaneous HC were enrolled and divided into 2 subgroups accordingly to their echocardiographic findings: group HC (normal echocardiography at first evaluation, n = 16); and group HC + MVD (concurrent presence of stages B1 and B2 MVD diagnosed at the first evaluation, n = 9). The patients were evaluated at diagnosis (T0); 6 months after treatment begging (T1); and after 12 months of treatment (T2). The owners were further contacted by phone or e-mail for 1 more year after T2 regarding survival information. A control group (CG, n = 20) was also evaluated at T0 and T1. At each evaluation, dogs were submitted to a complete clinical evaluation and physical exam, associated with a minimum database (CBC, serum biochemistry, and urine analysis) and cardiovascular evaluation composed of systolic blood pressure determination, electrocardiogram (ECG), and echodopplercardiography. In the HC group, 11/16 dogs underwent the evaluation at T2, while 4/9 dogs from the HC + MVD group and 17/20 dogs from the CG underwent the evaluation at T2. Five dogs (31.25%) from the HC group and 4 dogs (44.44%) from the HC + MVD group died before the end of the follow-up period. In the control group, only 1 dog (5.26%) died before the end of the study. Despite the higher mortality in the HC + MVD group during the follow-up period, there was no significant difference (P = 0.632) in survival when compared with the HC group. The MVD of 4 dogs included in the HC + MVD group was classified as stage B1, while the other 5 dogs were classified as stage B2. Only 1 dog from the CG developed stage B1 MVD in the period studied; however, progression of the MVD stage was documented in 1/4 of dogs in the HC + MVD group and MVD development was documented in 3/11 of dogs from the HC group from T0 to T2. The odds ratio (OR) and respective 95% confidence interval (95%CI) for HC as a risk factor for MVD progression were 4.267 (0.4268 - 42.65; P = 0.342). Exercise intolerance (12/16 dogs) and dyspnea (6/16 dogs) were the cardiorespiratory clinical signs with the highest incidence in the HC group at T0. When compared to the control group, both exercise intolerance (P < 0.001) and dyspnea (P = 0.03) occurrence were significantly higher in the HC group. The age (P = 0.001) and the occurrence of dyspnea (P = 0.036) at diagnosis were significantly higher in dogs with HC that died during the follow-up than those that remained alive. Regarding the occurrence of cardiac arrhythmias verified by ECG, no statistically significant differences were observed among groups. Discussion: The study suggests that systemic hypertension and altered echocardiographic measurements did not interfere with dogs' survival; however, dyspnea was associated with a worse prognosis. Finally, it is possible to conclude that mitral valve degeneration is a common comorbidity in dogs with HC, however, it was not evidenced their interference in the survival of dogs with this endocrine disease or even a role of the HC in the progression of the MVD.

Ultrasonographic findings in dogs diagnosed with hyperadrenocorticism ­ retrospective study (2013 to 2020) / Achados ultrassonográficos em cães diagnosticados com hiperadrenocorticismo ­ estudo retrospectivo (2013 a 2020)

Hyperadrenocorticism is a relatively common endocrinopathy in middle-aged and older dogs, which has become increasingly frequent in the clinical routine. The diagnosis is made by information obtained by history, physical exam findings and results of screening and specific endocrine tests. In addition to laboratory tests, imaging diagnosis, such as ultrasound, can aid on evaluation of possible changes in these cases; also, they may reveal the possible involvement of other organs and systems. The aim of this study was to present the main ultrasonographic changes observed in 18 dogs with hyperadrenocorticism, diagnosed from 2013 to 2020 by the low-dose dexamethasone suppression test, among which hepatomegaly, splenomegaly, gallbladder sludge, renal changes, cystitis and changes in adrenal size, such as bilateral and/or unilateral adrenomegaly, can be cited. Ultrasound examination, therefore, is an examination that can help the clinician in confirming the diagnosis of hyperadrenocorticism, in addition to allowing differentiation between pituitary-dependent hyperadrenocorticism (PDH) and adrenal tumors, and the evaluation of possible secondary changes to the disease.(AU)

iperadrenocorticismo é uma endocrinopatia relativamente comum em cães de meia idade e idosos, que tem se tornado cada vez mais frequente na rotina clínica O diagnóstico é confirmado por informações obtidas pelo histórico, achados de exame físico e resultados de exames de triagem e endócrinos específicos. Além dos exames laboratoriais, os exames de ima-gem, como a ultrassonografia, podem auxiliar na avaliação de possíveis alterações nesses casos; ademais, eles também podem revelar o possível envolvimento de outros órgãos e sistemas. O objetivo deste estudo foi apresentar as principais alterações ultrassonográficas observadas em 18 cães com hiperadrenocorticismo, diagnosticados de 2013 a 2020 pelo teste de supressão por dexametasona em baixa dose, dentre as quais podem ser citadas hepatomegalia, esplenomegalia, lama biliar, alterações renais, cistite e alterações no tamanho e formato das adrenais, como adrenomegalia bilateral e/u unilateral. A avaliação ultras-sonográfica, portanto, é um exame que pode ajudar o clínico a confirmar o diagnóstico de hiperadrenocorticismo, além de ajudar a diferenciar entre hiperadrenocorticismo hipófise-dependente (HHD) e tumores adrenais, e na avaliação de possíveis alterações secundárias à doença.(AU)

Adenocarcinoma de la glándula suprarrenal en una perra / Adenocarcinoma of the adrenal gland in a female dog / Adenocarcinoma da glândula adrenal em uma cadela

El objetivo de este artículo es describir un caso de neoplasia adrenocortical con manifestación de hiperadrenocorticismo. Los tumores adrenocorticales se originan a partir de diferentes tipos de células y presentan una variada manifestación clínica, que puede ser funcionante o no funcionante. Los adenocarcinomas son autónomos y funcionales en la mayoría de los casos, lo que lleva a una secreción excesiva de glucocorticoides, independientemente del control pituitario. Corroboran la aparición de hiperadrenocorticismo (HAC) al interferir con la síntesis de cortisol. Los signos clínicos observados pueden ser poliuria, polidipsia compensatoria, polifagia, alteraciones de la presión arterial, disfunciones cardíacas, renales y endocrinas, entre otras, estas manifestaciones clínicas pueden presentarse de forma aislada o en asociación. El diagnóstico se puede obtener de varias maneras, como mediciones de cortisol urinario, estimulación con hormona adrenocorticotrópica, pruebas de supresión con dosis bajas de dexametasona y pruebas de imagen. Sin embargo, el diagnóstico definitivo se basa en el uso de la histopatología. Este artículo reporta el caso de una mujer mestiza de 13 años con signos de poliuria y polidipsia. Tras descartar los diagnósticos iniciales (diabetes mellitus y/o alteraciones renales), se sospechó HAC, realizándose nuevas pruebas. Los resultados de los exámenes mostraro

The aim of this article is to describe a case of adrenocortical neoplasm with manifestation of hyperadrenocorticism. Adrenocortical tumors originate from different types of cells and present varied clinical manifestations, which can be functional or non-functional. Adenocarcinomas are autonomous and functional in most cases, leading to excessive secretion of glucocorticoids, regardless of pituitary control. They corroborate the occurrence of hyperadrenocorticism (HAC) due to interference in the synthesis of cortisol. Clinical signs can be observed, as polyuria, compensatory polydipsia, polyphagia, blood pressure alterations, cardiac, renal and endocrine dysfunctions, among others. Diagnosis can be made in various ways, such as urinary cortisol measurements, adrenocorticotropic hormone stimulation, low-dose dexamethasone suppression tests, and imaging tests and histopathology. This article reports the case of a 13-year-old mixed-breed female dog with signs of polyuria and polydpsia. After discarding the initial diagnoses (diabetes mellitus and/or renal alterations), HAC was suspected, with further tests being performed. The test results showed an increase in the adrenal region, and adrenalectomy and hormone replacement with trilostane were recommended. The diagnosis of HAC was confirmed by histopathology as HAC secondary to adrenal gland adenocarcinoma. The patient also develope

O objetivo deste artigo é descrever um caso de neoplasia adrenocortical com manifestação de hiperadrenocorticismo. Tumores adrenocorticais são originados de diversos tipos de células e apresentam manifestação clínica variada, podendo ser funcionantes ou não funcionantes. Os adenocarcinomas são autônomos e funcionantes na maioria dos casos, levando a secreção excessiva de glicocorticóides, independente do controle da hipófise. Eles corroboram com a ocorrência de hiperadrenocorticismo (HAC) por interferência na síntese de cortisol. Os sinais clínicos observados podem ser poliúria, polidipsia compensatória, polifagia, alterações pressóricas, disfunções cardíacas, renais e endócrinas, entre outros, estas manifestações clínicas podem se apresentar de forma isolada ou associada. O diagnóstico pode ser obtido de diversas formas, como dosagens de cortisol urinário, estimulação de hormônio adrenocorticotrópico, testes de supressão com baixa dose de dexametasona e por testes de imagem. No entanto, o diagnóstico definitivo baseia-se no uso da histopatologia. Este artigo relata o caso de uma fêmea sem raça definida, de 13 anos de idade, com sinais de poliúria e polidpsia. Após o descarte dos diagnósticos iniciais (diabetes mellitus e/ou alterações renais), suspeitou-se de HAC, com a realização de novos exames. Os resultados dos exames evidenciaram aumento da região adrenal, sendo recomenda

Adenocarcinoma of the adrenal gland in a female dog / Adenocarcinoma da glândula adrenal em uma cadela / Adenocarcinoma de la glándula suprarrenal en una perra

The aim of this article is to describe a case of adrenocortical neoplasm with manifestation of hyperadrenocorticism. Adrenocortical tumors originate from different types of cells and present varied clinical manifestations, which can be functional or non-functional. Adenocarcinomas are autonomous and functional in most cases, leading to excessive secretion of glucocorticoids, regardless of pituitary control. They corroborate the occurrence of hyperadrenocorticism (HAC) due to interference in the synthesis of cortisol. Clinical signs can be observed, as polyuria, compensatory polydipsia, polyphagia, blood pressure alterations, cardiac, renal and endocrine dysfunctions, among others. Diagnosis can be made in various ways, such as urinary cortisol measurements, adrenocorticotropic hormone stimulation, low-dose dexamethasone suppression tests, and imaging tests and histopathology. This article reports the case of a 13-year-old mixed-breed female dog with signs of polyuria and polydpsia. After discarding the initial diagnoses (diabetes mellitus and/or renal alterations), HAC was suspected, with further tests being performed. The test results showed an increase in the adrenal region, and adrenalectomy and hormone replacement with trilostane were recommended. The diagnosis of HAC was confirmed by histopathology as HAC secondary to adrenal gland adenocarcinoma. The patient also developed diabetes mellitus during postoperative treatment with prednisone, which made it necessary to discontinue the medication.

O objetivo deste artigo é descrever um caso de neoplasia adrenocortical com manifestação de hiperadrenocorticismo. Tumores adrenocorticais são originados de diversos tipos de células e apresentam manifestação clínica variada, podendo ser funcionais ou não funcionais. Os adenocarcinomas são autônomos e funciona na maioria dos casos, levando a secreção excessiva de glicocorticóides, independente do controle da hipófise. Eles corroboram com a ocorrência de hiperadrenocorticismo (HAC) por interferência na síntese de cortisol. Os sinais clínicos observados podem ser poliúria, polidipsia compensatória, polifagia, alterações pressóricas, disfunções cardíacas, renais e endócrinas, entre outros. Estas manifestações clínicas podem se apresentar de forma isolada ou associada. O diagnóstico pode ser obtido de diversas formas, como dosagens de cortisol urinário, estimulação de hormônio adrenocorticotrópico, testes de supressão com baixa dose de dexametasona e por testes de imagem. No entanto, o diagnóstico definitivo baseia-se no uso da histopatologia. Este artigo relata o caso de uma fêmea sem raça definida, de 13 anos de idade, com sinais de poliúria e polidpsia. Após o descarte dos diagnósticos iniciais (diabetes mellitus e/ou alterações renais). suspeitou-se de HAC, com a realização de novos exames. Os resultados dos exames evidenciaram aumento da região adrenal, sendo recomendada a adrenalectomia e reposição hormonal com trilostano. O diagnóstico de HAC foi confirmado pela histopatologia como sendo HAC secundário a adenocarcinoma de glândula adrenal. A paciente desenvolveu ainda um quadro de diabetes mellitus durante o tratamento com prednisona no pós-operatório, sendo necessário interromper a medicação.

El objetivo de este artículo es describir un caso de neoplasia adrenocortical con manifestación de hiperadrenocorticismo. Los tumores adrenocorticales se originan a partir de diferentes tipos de células y presentan una variada manifestación clínica, que puede ser funcionante o no funcionante. Los adenocarcinomas son autónomos y funcionales en la mayoría de los casos, lo que lleva a una secreción excesiva de glucocorticoides, independientemente del control pituitario. Corroboran la aparición de hiperadrenocorticismo (HAC) al interferir con la síntesis de cortisol. Los signos clínicos observados pueden ser poliuria, polidipsia compensatoria, polifagia, alteraciones de la presión arterial, disfunciones cardíacas, renales y endocrinas, entre otras. Estas manifestaciones clínicas pueden presentarse de forma aislada o en asociación. El diagnóstico se puede obtener de varias maneras, como mediciones de cortisol urinario, estimulación con hormona adrenocorticotrópica, pruebas de supresión con dosis bajas de dexametasona y pruebas de imagen. Sin embargo, el diagnóstico definitivo se basa en el uso de la histopatología. Este artículo reporta el caso de una perra mestiza de 13 años con signos de poliuria y polidipsia. Tras descartar los diagnósticos iniciales (diabetes mellitus y/o alteraciones renales), se sospechó HAC, realizándose nuevas pruebas. Los resultados de los exámenes mostraron un aumento en la región suprarrenal, por lo que se recomendó adrenalectomía y reemplazo hormonal con trilostano. El diagnóstico de CAH se confirmó por histopatología como CAH secundaria a adenocarcinoma de la glándula suprarrenal. La paciente también desarrolló diabetes mellitus durante el tratamiento con prednisona en el postoperatorio, siendo necesario suspender la medicación.

Hyperadrenocorticism in a crab-eating fox (Cerdocyon thous) kept under human care / Hiperadrenocorticismo em cachorro-do-mato (Cerdocyon thous) mantido sob cuidados humanos

Hyperadrenocorticism is a relatively common endocrine disease affecting the adrenal glands of domestic dogs. However, there are few reports of this disease in wild canids. A crab-eating fox (Cerdocyon thous) kept under human care was diagnosed with the disease after detection of conformational abnormalities in the adrenal glands visualized by ultrasonography, a cortisol suppression test after low-dose dexamethasone, and the detection of proteinuria and bacteria in urinalysis. After the diagnosis, the patient was treated with trilostane with a satisfactory clinical response. This report aims to report the sonographic and laboratory findings of hyperadrenocorticism and its treatment in a specimen of the species.

O hiperadrenocorticismo é uma doença endócrina que acomete as glândulas adrenais relativamente comum em cães domésticos. Porém, em canídeos selvagens, poucos são os relatos descritos dessa enfermidade. Um exemplar de cachorro-do-mato (Cerdocyon thous), mantido sob cuidados humanos, foi diagnosticado com a doença após detecção de anormalidades conformacionais em glândulas adrenais visibilizadas via ultrassonografia, teste de supressão de cortisol após uso de baixa dose de dexametasona, além de detecção de proteinúria e bactérias em urinálise. Após o diagnóstico, instituiu-se tratamento medicamentoso a base de trilostano com resposta clínica satisfatória. Este relato objetiva reportar os achados ultrassonográficos e laboratoriais de hiperadrenocosticismo e seu tratamento em um exemplar da espécie.

Chronic expanding hematoma secondary to excision of recurrent myxomas in a bitch

Background: Expanding chronic hematoma is a relatively common postoperative complication in humans, not in dogs, nevertheless, is important understand this condition because it may affect the animal's health. A hematoma could be formed within hours and usually stabilizes spontaneously with the reabsorption of its content. However, occasionally the hematoma slowly expands, becomes encapsulated and forms a mass, causing a chronic expanding hematoma. Possibly skin and adipose tissue are displaced secondary to trauma, causing the formation of blood-filled cysts surrounded by a fibrous capsule. The aim of this document is to present the first report of a postsurgical chronic expanding hematoma in dog. Case: A case of chronic expanding hematoma secondary to excision of recurrent myxoma in a bitch was described. Physical examination showed a hard, firm, non-mobile mass enclosed within the deep muscular layers. This mass was between the sternum and the cranial abdomen, similar to previous lesions excised by another veterinarian. Fine needle aspiration indicated the presence of blood. Radiology demonstrated that the bone-cartilage tissue was not involved. Due to the size of the mass, a skin stretching pre-suturing technique using self-adhesive tape was applied around the mass 48 h before surgery. The mass was removed with wide excision margins and portions of the affected muscles, but a large wound with great tension was created; consequently, a parallel to the wound incision and the thoraco-lumbar vertebrae was made. Six months after surgery, the animal presented recurrence of the same lesion, which was also removed. The bleeding times were within the normal range, but the animal was diagnosed with hyperadrenocorticism. After both surgeries histopathological exam revealed a hematoma, that had thrombosis and granulation tissue with fibrosis and severe panniculitis, in addition of multifocal, chronic, moderate lymphohistiocytic myositis; all these changes were compatible with a chronic expanding hematoma. Discussion: Chronic expanding hematoma is a mass that grows slowly secondary to hemorrhage and does not exhibit elements of malignancy. However, it can occasionally be confused for a soft-tissue neoplasm. It has been reported frequently in humans but not in small animals. The first case was reported in 2002: 5 puppies with a cervical hematoma classified as a chronic expanding hematoma was described. In addition, 3 cases were reported: 1 cat with perirenal chronic expanding hematoma; 1 bitch with intra-abdominal presentation, and 1 cat with this pathology on the right pelvic limb after an intramuscular injection. The etiology of chronic expansive hematoma is unidentified in dogs, nevertheless, it is stipulated that is not an inflammatory process as previously assumed, but rather a neoplastic process. As in other cases, it was difficult to determine the origin of the chronic expanding hematoma. The coagulation times and platelets count were within ranges. Similarly, it is very complicated to relate hyperadrenocorticism with chronic expanding hematoma because dogs with Cushing's disease generally present hypercoagulopathies. Myxomas are associated with endocrinopathies in humans and dogs, therefore, hyperadrenocorticism is possibly related with this neoplasia. Myxomas have an expansive growth pattern, contrasting with myxosarcomas, which are infiltrating; Although in the present case the skin mass appeared to be invasive, both macroscopical and histopathological appearance of it corresponded to a well-shaped capsule compatible with chronic expanding hematoma. In summary, to the best of our knowledge, this is the first report of a post-surgical chronic expanding hematoma in a dog.

Calcinosis cutis with large extension and uncommon location in a dog

Background: Calcinosis cutis is an uncommon dermatopathy characterized by the deposition of minerals in the skin,usually involving collagen and elastic fibers in the dermis. Usually, it results from dystrophic calcification and can begeneralized or focal. The dermatopathy may be primary or secondary to certain disorders, especially chronic proliferativeotitis, foreign body reactions, hyperadrenocorticism (HAC) and less frequently percutaneous penetration of calcium-richproducts. The aim of this report is to describe a presentation of calcinosis cutis affecting the skin of the back, internal faceof hind limbs and anal region of a 9-years-old bitch.Case: A 9-year-old, non-defined breed, bitch, ovariohysterectomized, weighing 9.45 kg, was attended at the DermatologicalService of companion animals at the Veterinary Hospital of the Federal University of Jataí (UFJ). The animal came in withthe complaint of extensive dorsal alopecia, covered by firm lesions, with a 3-month evolution, additionally to polyuria andpolydipsia. After physical examination, alopecic areas of great extension were confirmed on the dorsum, on the internalsurface of the hind limbs and in the anal region. Also, an exudative and painful lesion located on the back was detected,plus loss of elasticity of the ventral abdomen skin and visible abdominal vessels. The screening tests showed a markedincrease in the alanine aminotransferase enzyme (ALT), alkaline phosphatase (ALP) and total cholesterol. The specificurinary density was decreased. On the ultrasound examination, hepatomegaly and an increase in the caudal pole of the leftadrenal were detected. Based on these findings, calcinosis cutis secondary to spontaneous hyperadrenocorticism (HAC)was suspected. For confirmation, skin biopsy and low dose dexamethasone suppression test (LDDS) were performed.LDDS test showed no reduction of serum cortisol after 8 h of dexamethasone dose administration and histopathological...

Calcinosis cutis with large extension and uncommon location in a dog

Background: Calcinosis cutis is an uncommon dermatopathy characterized by the deposition of minerals in the skin,usually involving collagen and elastic fibers in the dermis. Usually, it results from dystrophic calcification and can begeneralized or focal. The dermatopathy may be primary or secondary to certain disorders, especially chronic proliferativeotitis, foreign body reactions, hyperadrenocorticism (HAC) and less frequently percutaneous penetration of calcium-richproducts. The aim of this report is to describe a presentation of calcinosis cutis affecting the skin of the back, internal faceof hind limbs and anal region of a 9-years-old bitch.Case: A 9-year-old, non-defined breed, bitch, ovariohysterectomized, weighing 9.45 kg, was attended at the DermatologicalService of companion animals at the Veterinary Hospital of the Federal University of Jataí (UFJ). The animal came in withthe complaint of extensive dorsal alopecia, covered by firm lesions, with a 3-month evolution, additionally to polyuria andpolydipsia. After physical examination, alopecic areas of great extension were confirmed on the dorsum, on the internalsurface of the hind limbs and in the anal region. Also, an exudative and painful lesion located on the back was detected,plus loss of elasticity of the ventral abdomen skin and visible abdominal vessels. The screening tests showed a markedincrease in the alanine aminotransferase enzyme (ALT), alkaline phosphatase (ALP) and total cholesterol. The specificurinary density was decreased. On the ultrasound examination, hepatomegaly and an increase in the caudal pole of the leftadrenal were detected. Based on these findings, calcinosis cutis secondary to spontaneous hyperadrenocorticism (HAC)was suspected. For confirmation, skin biopsy and low dose dexamethasone suppression test (LDDS) were performed.LDDS test showed no reduction of serum cortisol after 8 h of dexamethasone dose administration and histopathological...(AU)

Cutaneous asthenia in a domestic cat (Felis silvestris catus)

Background: Cutaneous asthenia or Ehlers-Danlos syndrome is an inherited and rare disease. This infirmity is from an autosomal mutation that influences the collagen synthesis of the carrier. Thus, its skeleton, formed of fibers, is structurally defective. The disease is characterized by hyperelasticity and skin fragility, leading to lesions throughout the skin. The lesions may manifest in specific places or in a generalized way, being more frequent in the limbs, neck, and back. This disease does not have a specific treatment, only management care to avoid new traumas. Case: A 3-year-old male castrated, no defined race cat, was attended at one veterinary clinic with a history of intense itching. The rapid tests for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) were negative. On physical examination, infestation by fleas, lesions all over the body, and skin hyperelasticity were observed. Topical treatment for ectoparasites as well as for body wounds was established. After the treatment, he returned without itching, but with the complaints of new lesions that did not heal. The patient underwent a total shearing to facilitate the treatment of the skin, and then he underwent blood tests, biochemistry, hormonal tests, and ultrasound, which showed no suggestive changes for hyperadrenocorticism and diabetes mellitus. His clinical signs, besides not matching with these diseases, also did not indicate skin fragility due to his history of age and balanced diet. The confirmation of the cutaneous asthenia syndrome was acquired through biopsy of skin fragment, in which it was observed disarray of collagen fibers, hypertrophy, and fibroblast hyperplasia, together with the rate of extensibility of the skin where the value reached the mark of 27.5%. Throughout the hospitalization, it was noted the progression of the disease with the appearance of new lesions, where there was no bleeding and they appeared even with the patient wearing padded clothes. Its progression lasted one year until the patient's euthanasia. Discussion: For the disposal of diabetes mellitus and hyperadrenocorticism as causes of the appearance of lesions by the body in the patient, he was submitted to the suppression tests with dexamethasone, in which he presented normality, in the biochemical examination it was dosed with fructosamine and glucose. The fructosamine was in the reference value, but the glucose was slightly altered, this increase may have been a result of stress at the time of blood collection. In addition to the patient not showing specific clinical signs such as polyphagia, polyuria, polydipsia, and weight loss, these are characteristic clinical signs of the disease. For the diagnosis of Ehlers-Danlos syndrome, histological examination, and calculation of the skin extensibility index were used, where the results obtained confirmed the suspicion. This genetic anomaly has no treatment, being progressive, so only environmental management is done to mitigate the appearance of the lesions and provide animal welfare. This case report contributes to aggregating the scientific literature in the area of veterinary medicine since skin asthenia is a rare disease and when its extent is total it becomes even more atypical. The availability of this article will provide a vision of palliative treatment for other cases, demonstrating the progressive nature of the lesions and the methods of diagnosis.

Canine endogenous adrenocorticotrophic hormone preanalytical stability after sample shipping in dry ice or recyclable ice bars / Estabilidade pré-analítica do hormônio adrenocorticotrófico endógeno canino após remessa de amostras em gelo seco ou com barras de gelo reciclável

Endogenous adrenocorticotrophic hormone (eACTH) measurement is useful in hypercortisolism and hypoadrenocorticism investigation; however, since the hormone is highly unstable, blood samples require proper processing and storage, as well as shipping is often a step limiting since few laboratories offer this assay in Brazil. The aim of this note was to compare overnight dog´s eACTH preanalytical stability when frozen samples were shipped in dry ice (DI), or with recyclable ice bars (RIB). A total of 56 paired samples for eACTH measurement were analyzed. Blood samples were properly handled, plasma aliquots transferred into plastic microtubes, and stored at -80ºC. The fifty-six paired samples were overnight shipped in two thermic isolated boxes with DI or involved by RIB. Despite there was a high correlation between results from both shipping methods (r Spearman = 0.958, P<0.001), the Wilcoxon matched-pairs rank test showed that the shipping method may influence results (P<0.001). However, this difference does not affect results interpretation. By this way, when DI shipping was not possible, RIB shipping may represent a risk to eACTH preanalytical stability.(AU)

A mensuração do hormônio adrenocorticotrófico endógeno (ACTHe) é útil na investigação do hipercortisolismo e hipoadrenocorticismo. No entanto, como o hormônio é bastante instável, as amostras de sangue necessitam um manejo adequado no processamento e armazenamento, assim como o envio para laboratórios pode ser um passo limitante, uma vez que poucos laboratórios oferecem este ensaio no Brasil. O objetivo deste trabalho foi comparar a estabilidade pré-analítica do ACTHe durante longo período de envio de amostras congeladas em gelo seco (GS), ou com barras de gelo reciclável (BGR). Um total de 56 amostras pareadas para mensuração de ACTHe foram analisadas. As amostras de sangue foram adequadamente manejadas, sendo o plasma transferido para micro tubos plásticos estocados a -80ºC. Os 56 pares de amostras foram enviados à tarde para chegada ao laboratório na manhã seguinte em dois isopores, um com GS e outro com BGR. Apesar de uma alta correlação entre os resultados dos diferentes métodos de envio (r Spearman = 0,958, P<0,001), o teste de Wilcoxon para amostras pareadas mostrou que o método de envio influencia os resultados P<0,001). Apesar desta diferença, os resultados não afetaram a interpretação dos resultados. Desta forma, quando o envio em gelo seco não for possível, o envio das amostras com barras de gelo reciclável pode representar um risco à estabilidade pré-analítica do ACTHe.(AU)

Preventive blood evaluation in obese dogs (Canis lupus familiares) / Análise sanguínea preventiva em cães obesos (Canis lupus familiares)

The objective of this study was to evaluate serum hematological and biochemical changes in obese young dogs clinically healthy. Twenty-six animals were selected, which were separated into two groups: thirteen with normal weight and thirteen with obesity. Exclusion criteria were used for the selection of groups, age between one and eight years, physical evaluation, blood count, and a questionnaire to investigate pre-existing pathologies (diabetes mellitus, hypothyroidism, hyperadrenocorticism, hepatic and/or renal insufficiency, congenital or acquired heart disease, locomotor problems, inflammatory and/or infectious diseases or physiological conditions such as pregnancy or lactation). 5-mL blood samples were collected from each patient by puncture of the cephalic vein in the morning after a feeding restriction of 10 hours. Hematocrit, total erythrocyte count, hemoglobin concentration, total leukocyte count, leukocyte differential count and serum albumin, total protein, globulins, ALT, ALP, HDL cholesterol, total cholesterol, triglycerides, creatinine, urea, glucose, and insulin were assessed. No statistically significant differences were found between the groups in the hematological assessments. Among the biochemical tests, there were significant differences in total cholesterol, HDL cholesterol, and glucose (p ≤ 0.05).

O objetivo deste estudo foi avaliar as alterações hematológicas e bioquímicas séricas em cães jovens, obesos, e cli-nicamente saudáveis. Foram selecionados 26 animais e separados em dois grupos: 13 com peso normal e 13 com obesidade. Foram utilizados critérios de exclusão para seleção de grupos como: idade entre um e oito anos, avaliação física, hemograma completo e um questionário com o objetivo de investigar patologias pré-existentes (diabetes mellitus, hipotireoidismo, hipe-radrenocorticismo, insuficiência hepática e, ou renal, doença cardíaca congênita ou adquirida, problemas locomotores, doen-ças inflamatórias e, ou infecciosas ou condições fisiológicas como gravidez ou lactação). Amostras de 5 mL de sangue foram coletadas de cada paciente por punção da veia cefálica na manhã seguinte a uma restrição alimentar de 10 horas. Foram ava-liados: hematócrito, contagem total de eritrócitos, concentração de hemoglobina, contagem total de leucócitos e albumina sérica, ALT, colesterol HDL, colesterol total, creatinina, ALP, frutosamina, globulinas, glicose, insulina, proteína total, sódio, triglicerídeos e uréia. Não foram encontradas diferenças estatisticas significantes entre os grupos nas avaliações hematológicas. Entre os testes bioquímicos, houve diferenças significativas no colesterol total, HDL-colesterol e glicose (p ≤ 0,05).

Preventive blood evaluation in obese dogs (Canis lupus familiares) / Análise sanguínea preventiva em cães obesos (Canis lupus familiares)

The objective of this study was to evaluate serum hematological and biochemical changes in obese young dogs clinically healthy. Twenty-six animals were selected, which were separated into two groups: thirteen with normal weight and thirteen with obesity. Exclusion criteria were used for the selection of groups, age between one and eight years, physical evaluation, blood count, and a questionnaire to investigate pre-existing pathologies (diabetes mellitus, hypothyroidism, hyperadrenocorticism, hepatic and/or renal insufficiency, congenital or acquired heart disease, locomotor problems, inflammatory and/or infectious diseases or physiological conditions such as pregnancy or lactation). 5-mL blood samples were collected from each patient by puncture of the cephalic vein in the morning after a feeding restriction of 10 hours. Hematocrit, total erythrocyte count, hemoglobin concentration, total leukocyte count, leukocyte differential count and serum albumin, total protein, globulins, ALT, ALP, HDL cholesterol, total cholesterol, triglycerides, creatinine, urea, glucose, and insulin were assessed. No statistically significant differences were found between the groups in the hematological assessments. Among the biochemical tests, there were significant differences in total cholesterol, HDL cholesterol, and glucose (p ≤ 0.05).(AU)

O objetivo deste estudo foi avaliar as alterações hematológicas e bioquímicas séricas em cães jovens, obesos, e cli-nicamente saudáveis. Foram selecionados 26 animais e separados em dois grupos: 13 com peso normal e 13 com obesidade. Foram utilizados critérios de exclusão para seleção de grupos como: idade entre um e oito anos, avaliação física, hemograma completo e um questionário com o objetivo de investigar patologias pré-existentes (diabetes mellitus, hipotireoidismo, hipe-radrenocorticismo, insuficiência hepática e, ou renal, doença cardíaca congênita ou adquirida, problemas locomotores, doen-ças inflamatórias e, ou infecciosas ou condições fisiológicas como gravidez ou lactação). Amostras de 5 mL de sangue foram coletadas de cada paciente por punção da veia cefálica na manhã seguinte a uma restrição alimentar de 10 horas. Foram ava-liados: hematócrito, contagem total de eritrócitos, concentração de hemoglobina, contagem total de leucócitos e albumina sérica, ALT, colesterol HDL, colesterol total, creatinina, ALP, frutosamina, globulinas, glicose, insulina, proteína total, sódio, triglicerídeos e uréia. Não foram encontradas diferenças estatisticas significantes entre os grupos nas avaliações hematológicas. Entre os testes bioquímicos, houve diferenças significativas no colesterol total, HDL-colesterol e glicose (p ≤ 0,05).(AU)

Conduta diagnóstica em equino da raça Crioula com síndrome de Cushing / Diagnostic process in a crioulo horse with Cushing’s syndrome

Background: Equine pituitary pars intermedia dysfunction, also known as equine Cushing’s syndrome, is a neurodegenerative disease. An important risk factor for Cushing’s is advanced aging and it is the most common endocrine disorder inolder horses. The prevalence in horses aged over 10 and 15 years is reported as 9.3% and 21%, respectively. Due to the slowprogressive nature of the disease, seasonal variation in hormone output and overlapping endocrine response to other events,accurate diagnosis is challenging. The diagnosis requires the combination of anamnesis, clinical signs, in addition to laboratory tests results. This study aimed to report Cushing’s syndrome in a Crioulo breed horse focusing on diagnostic methods.Case: A 13-year-old male Crioulo breed, orchiectomized, was attended at the Universidade de Passo Fundo (UPF), in PassoFundo, RS, Brazil. The owner reported that the animal had progressive weight loss and coat abnormal growth, with curlyappearance. From visual inspection, body condition score was 4 (1-9) bulging abdomen was noticed, hirsutism, depressionand lethargy. Also, there was a large neoplastic mass on the left side of gluteal region. Later, this mass was classified inhistopathological examination as a fibroblastic sarcoid and was treated. The animal presented physical parameters withinthe physiological limits of the specie. Normochromic normocytic anemia and neutrophilic leukocytosis were reported in thehematologic evaluation. In coproparasitological examination, there were 300 eggs per gram of feaces. Hyperadrenocorticismwas suspected in the clinical examination and dexamethasone suppression test was performed to confirm the fact. Basal serumwas collected at 17 h (M0) and subsequently 40 µg/kg of dexamethasone was administered intramuscular...

Crises epilépticas reativas por hiperlipidemia em cão Maltês / Reactive seizures due to hyperlipidemia in a maltese dog

Background: Primary hyperlipidemia is a condition that affects some specific breeds. It has been previously describedin Miniature Shnauzer, Beagles, Shetland Shepdog and West Highland White Terrier. There are no reports of primaryhyperlipidemia in Maltese dogs. It is a hereditary disorder of lipoprotein metabolism. The etiology is unknown and maybe related to a genetic problem in lipoprotein lipase or to the absence of apaprotein CII. Clinical signs include spontaneousarterosclerosis, retinal lipemia, cutaneous xanthomas, abdominal pain, lethargy, vomiting and / or diarrhea. Neurologicalmanifestations such as seizures and behavioral changes may also occur. The aim of this report is to describe a case ofreactive seizures due to hyperlipidemia in a dog.Case: A 5-year-old male Maltese dog was admitted with a history of seizures. Hypertension and abdominal distensionwith large amounts of intestinal gases were found in general physical examination. Neurological examination revealedimpaired nasal septum sensory perception, which was slightly bilaterally reduced, and pain on cervical palpation and inthe brachial plexus region. Based on history and clinical examination, it was possible to locate the lesion in the thalamocortical region and to suspect idiopathic epilepsy, reactive seizures, and symptomatic epilepsy due to meningoencephalitisof unknown origin. The diagnosis of primary hyperlipidemia was made by exclusion with the aid of laboratory tests andultrasound. After the establishment of a fat restriction diet, bezafibrate, phenobarbital, and omega-3 supplementation, theanimal improved significantly with the reduction of epileptic seizures.Discussion: The initial clinical suspicion was hyperadrenocorticism as the primary cause of hyperlipidemia. This suspicion was based on the presence of polyphagia, polydipsia, polyuria and abdominal distension, together with laboratory...

Crises epilépticas reativas por hiperlipidemia em cão Maltês / Reactive seizures due to hyperlipidemia in a maltese dog

Background: Primary hyperlipidemia is a condition that affects some specific breeds. It has been previously describedin Miniature Shnauzer, Beagles, Shetland Shepdog and West Highland White Terrier. There are no reports of primaryhyperlipidemia in Maltese dogs. It is a hereditary disorder of lipoprotein metabolism. The etiology is unknown and maybe related to a genetic problem in lipoprotein lipase or to the absence of apaprotein CII. Clinical signs include spontaneousarterosclerosis, retinal lipemia, cutaneous xanthomas, abdominal pain, lethargy, vomiting and / or diarrhea. Neurologicalmanifestations such as seizures and behavioral changes may also occur. The aim of this report is to describe a case ofreactive seizures due to hyperlipidemia in a dog.Case: A 5-year-old male Maltese dog was admitted with a history of seizures. Hypertension and abdominal distensionwith large amounts of intestinal gases were found in general physical examination. Neurological examination revealedimpaired nasal septum sensory perception, which was slightly bilaterally reduced, and pain on cervical palpation and inthe brachial plexus region. Based on history and clinical examination, it was possible to locate the lesion in the thalamocortical region and to suspect idiopathic epilepsy, reactive seizures, and symptomatic epilepsy due to meningoencephalitisof unknown origin. The diagnosis of primary hyperlipidemia was made by exclusion with the aid of laboratory tests andultrasound. After the establishment of a fat restriction diet, bezafibrate, phenobarbital, and omega-3 supplementation, theanimal improved significantly with the reduction of epileptic seizures.Discussion: The initial clinical suspicion was hyperadrenocorticism as the primary cause of hyperlipidemia. This suspicion was based on the presence of polyphagia, polydipsia, polyuria and abdominal distension, together with laboratory...(AU)

Conduta diagnóstica em equino da raça Crioula com síndrome de Cushing / Diagnostic process in a crioulo horse with Cushings syndrome

Background: Equine pituitary pars intermedia dysfunction, also known as equine Cushings syndrome, is a neurodegenerative disease. An important risk factor for Cushings is advanced aging and it is the most common endocrine disorder inolder horses. The prevalence in horses aged over 10 and 15 years is reported as 9.3% and 21%, respectively. Due to the slowprogressive nature of the disease, seasonal variation in hormone output and overlapping endocrine response to other events,accurate diagnosis is challenging. The diagnosis requires the combination of anamnesis, clinical signs, in addition to laboratory tests results. This study aimed to report Cushings syndrome in a Crioulo breed horse focusing on diagnostic methods.Case: A 13-year-old male Crioulo breed, orchiectomized, was attended at the Universidade de Passo Fundo (UPF), in PassoFundo, RS, Brazil. The owner reported that the animal had progressive weight loss and coat abnormal growth, with curlyappearance. From visual inspection, body condition score was 4 (1-9) bulging abdomen was noticed, hirsutism, depressionand lethargy. Also, there was a large neoplastic mass on the left side of gluteal region. Later, this mass was classified inhistopathological examination as a fibroblastic sarcoid and was treated. The animal presented physical parameters withinthe physiological limits of the specie. Normochromic normocytic anemia and neutrophilic leukocytosis were reported in thehematologic evaluation. In coproparasitological examination, there were 300 eggs per gram of feaces. Hyperadrenocorticismwas suspected in the clinical examination and dexamethasone suppression test was performed to confirm the fact. Basal serumwas collected at 17 h (M0) and subsequently 40 µg/kg of dexamethasone was administered intramuscular...(AU)

Aortic and iliac thrombosis in a dog with adrenal-dependent hypercortisolism due to bilateral adrenocortical adenoma / Trombose aórtica e ilíaca em um cão com hipercortisolismo adrenal-dependente devido a adenoma adrenocortical bilateral

Hypercortisolism is a common endocrinopathy in dogs; however, in a few cases, bilateral functional adrenocortical adenomas cause spontaneous disease, and thrombotic events are considered uncommon complications. The aim of this report was to describe a case of bilateral adrenocortical adenoma in a dog with hyperadrenocorticism associated with distal aortic and iliac thrombosis, with emphasis on clinical and pathological aspects. A 15-year-old spayed female Dachshund with a previous clinical history of hyperadrenocorticism presented with acute bilateral hindlimb paraparesis. A vertebral thoracolumbar radiography was performed and did not present any evidence of intervertebral disk disease or vertebral abnormalities; however, abdominal ultrasound and vascular Doppler evaluation revealed bilateral adrenal enlargement in addition to an aortic and external iliac artery thrombus. The animal was euthanized. At necropsy, both adrenal glands were enlarged by well-demarcated neoplastic nodules in the parenchyma, and a thrombus caudal to the abdominal aorta bifurcation within the external iliac arteries that extended to the left external iliac artery was noted. Histological evaluation revealed a well-differentiated neoplastic proliferation of cortical epithelial cells, consistent with bilateral adenoma, and muscular necrosis in the pelvic limbs was also observed. Bilateral functional adrenocortical adenoma; although, very rare, should be considered as a cause of hypercortisolism, and aortic thrombosis in dogs should be considered as a possible consequence.(AU)

Hipercortisolismo é uma endocrinopatia comum em cães, no entanto, apenas em poucos casos adenomas adrenocorticais funcionais bilaterais são a causa de doença espontânea, e eventos trombóticos são considerados complicações incomuns. O objetivo deste relato foi descrever um caso de adenoma adrenocortical bilateral em um cão com hiperadrenocorticismo associado a trombose aórtica distal e ilíaca, com ênfase nos aspectos clínicos e patológicos. Um cão, Dachshund, fêmea castrada, de 15 anos, com histórico clínico prévio de hiperadrenocorticismo, apresentou paraparesia aguda dos membros posteriores. Foi realizada radiografia toracolombar vertebral, a qual não mostrou nenhuma evidência de doença do disco intervertebral ou anormalidades vertebrais; no entanto, ultrassonografia abdominal e Doppler vascular revelaram um trombo na aorta e artéria ilíaca externa, e adrenomegalia bilateral. O animal foi submetido à eutanásia. Na necropsia, ambas as adrenais estavam distendidas por nódulos neoplásicos bem delimitados no parênquima e notou-se um trombo caudalmente à bifurcação da aorta abdominal às artérias ilíacas externas, estendendo-se à ilíaca externa esquerda. Na avaliação histológica observou-se proliferação neoplásica bem diferenciada de células epiteliais corticais, consistente com adenoma bilateral; também foi observada necrose muscular nos membros pélvicos. O adenoma adrenocortical funcional bilateral, embora muito raro, deve ser considerado uma causa de hipercortisolismo, e a trombose aórtica em cães deve ser considerada uma possível consequência.(AU)

Técnica de microagulhamento para tratamento de alopecia x em cães / Microneedling technique for treatment of alopecia X in dogs

A alopecia X é uma dermatopatia hormonal que afeta principalmente raças nórdicas e tem como características a ocorrência de alopecia não inflamatória bilateral e simétrica, melanodérmica. Ela não afeta a região distal dos membros e cabeça, acometendo, sobretudo, a região cervical, dorsal e perianal. O diagnóstico é baseado nos sinais clínicos que o animal apresenta, na exclusão de dermatopatias endócrinas como hiperadrenocorticismo e hipotireoidismo, em exames laboratoriais e em biopsia cutânea. O tratamento consiste na castração, melatonina, trilostano e/ou hormônio do crescimento. Recentemente, o microagulhamento tem sido uma alternativa viável em pacientes com alopecia X. O presente trabalho teve como objetivo relatar o uso da técnica de microagulhamento em cães com alopecia X. Foram acompanhados dois cães, machos, da raça Spitz Alemão, com 2 e 5 anos de idade respectivamente, com um quadro alopécico e melanodermia na região de dorso e flanco e região cervical, caudal e perianal há mais de 2 anos. Depois de caracterizados como pacientes alopécicos X, os animais foram conduzidos à técnica de microagulhamento, exibindo repilação nas áreas alopécicas. Conclui-se dessa forma que o microagulhamento é uma técnica promissora para o tratamento da alopecia X.

Alopecia X is a hormonal dermatopathy that affects mainly Nordic breeds and has as its characteristics the occurrence of bilateral and symmetrical, melanodermic non-inflammatory alopecia. It does not affect the distal region of the limbs and head, mainly affecting the cervical, dorsal and perianal regions. The diagnosis is based on the clinical signs that the animal presents in the exclusion of endocrine dermatopathies such as hyperadrenocorticism and hypothyroidism, in laboratory tests and in cutaneous biopsy. Treatment consists of castration, melatonin, trilostan and/or growth hormone. Recently, microneedling has been a viable alternative in patients with alopecia X. The present work aimed to report the use of the microneedling technique in dogs with alopecia X. Two male German Spitz dogs, 2 and 5 years old respectively, with alopecia and melanodermia in the dorsum and flank region and cervical, caudal and perianal region for more than 2 years were followed. After being characterized as alopecia X patients, the animals were conducted to the microneedling technique, exhibiting repopulation in the alopecia areas. The conclusion is that microneedling is a promising technique for the treatment of alopecia X.

Infecção de trato urinário inferior por Citrobacter sp em cadela com hipoadrenocorticismo / Citrobacter sp lower urinary tract infection in a bitch with hypoadrenocorticism

Citrobacter sp. é um microrganismo frequentemente encontrado em vagina de cadelas, mas corresponde a menos de 3% do total de microrganismos isolados em urocultura. O hipoadrenocorticismo (HA) é uma doença endócrina incomum e que leva a poliúria e hipostenúria. O objetivo deste trabalho é relatar o caso de uma fêmea da espécie canina, da raça Teckel, 11 anos, atendida com queixa de urina de odor alterado há vários dias, além de vômito, diarreia e inapetência há três dias, e poliúria e polidipsia há 2 meses, com histórico de tratamento anterior com mitotano para hiperadrenocorticismo. O diagnóstico foi de ITU por Citrobactersp., além de HA iatrogênico. Como destaques nos exames, relação sódio:potássio de 22,6 foi observada, sugestiva de HA, que foi confirmado por teste de estimulação com ACTH, além de urina inicialmente hipostenúrica (densidade 1,006), o que pode ser atribuído ao washout medular renal devido à hiponatremia causada pelo hipoadrenocorticismo. O tratamento foi feito com amoxicilina associada a ácido clavulânico por 20 dias, além da terapia específica para HA com prednisona e fludrocortisona, que foi continuado. A paciente recuperou-se bem, a densidade urinária aumentou após início do tratamento para HA e não houve recidiva da ITU em período de acompanhamento de 8 meses. Acredita-se que a baixa densidade urinária causada pelo HA tenha sido fator essencial para a ocorrência da ITU por Citrobacter.

Citrobacter sp. is a normal constituent of bitches' vagina, but it is related to less than 3% of total isolated microorganism in uroculture. Hypoadrenocorticism (HA) is an endocrine disease uncommonly diagnosed that leads to polyuria and hypostenuria. The aim of this work is report the case of a Teckel bitch, 11 years old, attended with complaint of altered urinary smell for several days, besides vomiting, diarrhea and inappetence for three days, and polyuria and polydispsia for two months, with previous mitotane treatment for hyperadrenocorticism. The diagnosis was Citrobacter UTI, besides iatrogenic HA. The most important exam results include sodium:potassium ratio of 22.6, suggestive of HA, that was confirmed by ACTH stimulation test. Besides, hypostenuria (urinary specific gravity ­ USG - of 1.006) was noted, attributed to renal medular washout due to hyponatremia seen in HA. Therapy comprised amoxicillin associated with clavulanic acid for 20 days, in addition to specific therapy for AH with prednisone and fludrocortisone. The patient recovery well, USG increased after the beginning of the treatment for HA and there was no UTI reinfection for a 8 month period. It is believed that low USG due to HA was essential for the occurrence of Citrobacter UTI.

Diabetes insipidus central em felino jovem / Central diabetes insipidus in a young feline

Background: Central diabetes insipidus (CDI) is an endocrine disorder caused by the failure to produce, transport, orrelease ADH. This disease may show a primary etiology (idiopathic or congenital) or a secondary one (trauma or neoplasms). It is characterized by signs such as polyuria and polydipsia. The definitive diagnosis is obtained by the two-stepwater deprivation test; the absence of adequate urinary concentration in the first stage confirms the diagnosis of diabetesinsipidus and, in the second stage, the response to the application of synthetic desmopressin confirms a central origin.Because CDI is rare in felines, the aim of this study was to report the occurrence of a case of CDI, probably of congenitalprimary origin, in an 8-month-old kitten.Case: An 8-month-old male feline, castrated, 3.2 kg, was brought to consultation with a report of polydipsia, polyuria,smaller size and weight, and lower activity when compared to his brother, for several months. On physical examination,lethargy, body score 2/5, and mild dehydration were noted, as well as deciduous teeth that should have already been replaced. Abdominal ultrasound and laboratory tests were requested, which ruled out chronic kidney disease (CKD), diabetesmellitus (DM), hyperadrenocorticism (HAC), and hyperthyroidism. Due to the fact that urinalysis evidenced hyposthenuria(urinary density [UD] 1.004), CDI was suspected. The patient underwent a water deprivation test and, after 7.5 h, lost4.7% of his initial weight, while UD was 1.012, confirming the diagnosis of DI. The investigation then proceeded to theevaluation of the response to synthetic desmopressin by the application of 5 U IM. Two h later, UD was 1.019, confirming...