Juvenile panhypopituitarism in a dog - what are the therapeutic challenges?

Background: Juvenile panhypopituitarism is an endocrinopathy that affects young dogs and must be differentiated from other causes of height disorders, as one could have a deficiency of one or more adenohypophysis hormones, besides growth hormone. Diagnosis consists of excluding endocrine and non-endocrine causes. Treatment requires administration of heterologous porcine growth hormone or progestins, as well as supplementing other hormones that are deficient in the circulation. The prognosis for these patients tends to be unfavorable and they have a shorter life expectancy. The present case aimed to report the therapeutic challenges in a dog diagnosed with juvenile panhypopituitarism. Case: This study presents the case of a 6-month-old crossbred Labrador/Brazilian Fila dog, not neutered, 6.7 kg of body weight (body condition score 5/9), with a growth disorder and persistence of the puppy coat, when compared to other members of the same litter. During inspection, it was possible to observe an undersized dog and soft puppy coat, besides no bone irregularities or joint tenderness was noted. The other physical examination parameters were within the normal range for the species. No changes in complete blood count and only increases in urea, cholesterol and alkaline phosphatase activity were observed. Thyroid and abdominal ultrasound (US) examination did not reveal any remarkable changes. After serum dosage of insulin-like growth factor, thyroxine, thyrostimulating hormone, and cortisol, the patient was diagnosed with juvenile panhypopituitarism and underwent therapy with medroxyprogesterone and thyroid hormone supplementation. Monitoring was instituted at intervals of 3, 6, and 12 weeks, and currently every 3 or 4 months and the IGF-1 values normalized after 6 months with. After 8 months of therapy, the patient had good body growth and bone mineralization compared to the time of diagnosis. However, skeletal development was completed only 12 months after hormone replacement, accompanied by the presence of vertebral osteophytes and coxofemoral osteoarticular alterations. Considering chronic use of progestins, ovariosalpingohysterectomy (OSH) was recommended, but for personal reasons, the owners chose to do not submit her to surgery. After 18 months of treatment, the dog starts to exhibit prostration, selective appetite, and increased abdominal volume. After imaging exam, she was forwarded for OSH, due to consistent findings of pyometra. Subsequently, even the supervision of possible comorbidities involved in the chronic use of progestins was maintained at half-yearly intervals, the bitch returned to the service with skin thickening, increased limb volume, and macroglossia after 60 months of therapy. At this point IGF-1 values were higher when compared to the previous measurements and the application of medroxyprogesterone was suspended. Its supplementation was reintroduced only after 8 months when IGF-1 was significantly reduced. To date, the patient is close to 6 years of age and with a good quality of life. Discussion: The greatest therapeutic challenge for these patients involves dealing with the adverse effects of progestins, mainly related to reproductive disorders and alopecia at the application site, as well as maintaining adequate hormone replacement in order to avoid hypersomatotropism. Although longevity is lower in these individuals, the patient in this report has achieved 6 years of age and has had an excellent quality of life so far.

Evidence of pituitary hypoplasia associated with partial central diabetes insipidus in a young Persian cat

Background: Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat. Case: A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, reduced serum concentration of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), thyroid hormones, and testosterone were documented, confirming the diagnosis of hyposomatotropism, hypogonadism, and secondary hypothyroidism. Furthermore, therapeutic diagnosis with desmopressin revealed partial central diabetes insipidus (CDI). As the sibling showed normal development aging 13-months, a radiographic examination of the forelimb (carpus) was performed on both cats. There was lack of growth plate fusion in the patient, without any other evidence of dysgenesis, whereas complete epiphyseal closure was observed in the sibling. Despite therapeutic prescriptions of desmopressin and levothyroxine, the owners refused further follow-up to the...

Evidence of pituitary hypoplasia associated with partial central diabetes insipidus in a young Persian cat

Background: Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat. Case: A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, reduced serum concentration of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), thyroid hormones, and testosterone were documented, confirming the diagnosis of hyposomatotropism, hypogonadism, and secondary hypothyroidism. Furthermore, therapeutic diagnosis with desmopressin revealed partial central diabetes insipidus (CDI). As the sibling showed normal development aging 13-months, a radiographic examination of the forelimb (carpus) was performed on both cats. There was lack of growth plate fusion in the patient, without any other evidence of dysgenesis, whereas complete epiphyseal closure was observed in the sibling. Despite therapeutic prescriptions of desmopressin and levothyroxine, the owners refused further follow-up to the...(AU)

Pituitary dwarfism in a dog / Panhipopituitarismo juvenil em um cão

Clinical and pathologic alterations in a one year and half old German shepherd male dog with pituitary dwarfism were described. Lethargy, small stature, puppy coats of lanugo hair, oppened epiphysis, alopecia and hyperpigmentation of skin, spastic paralysis of the distal limbs and pryapism were the clinical abnormalities observed during, the four months period of observation. Cystic formations filled with eosinophylic material and replacing partially pituitary gland, thyroid and adrenal hypoplasia were the most proeminent pathologic and histopathologic features. The probable origin of the ciliated columnar epithelium that lined the cysts were discussed.

Descreveram-se as alterações clínicas, e anatomo-patológicas observadas em um animal da espécie canina, mestiço da raça Pastor Alemão, macho, de 1 ano e meio de idade. Letargia, desenvolvimento físico inadequado, pelame infantil, retardo na dentição e ausência do fechamento das cartilagens de conjugação, além de paralisia espástica dos membros pélvicos, priapismo, alopecia e hiperpigmentação das extremidades dos membros, foram as principais alterações clínicas encontradas no animal durante o período de observação. A presença de formações císticas na hipófise, hipoplasia da tireóide e da adrenal foram os achados mais proeminentes do exame anátomo e histopatológico. Discutiu-se a provável origem das células epiteliais cilíndricas secretoras de muco que constituiam o revestimento dessas formações císticas.

Pituitary dwarfism in a dog / Panhipopituitarismo juvenil em um cão

Clinical and pathologic alterations in a one year and half old German shepherd male dog with pituitary dwarfism were described. Lethargy, small stature, puppy coats of lanugo hair, oppened epiphysis, alopecia and hyperpigmentation of skin, spastic paralysis of the distal limbs and pryapism were the clinical abnormalities observed during, the four months period of observation. Cystic formations filled with eosinophylic material and replacing partially pituitary gland, thyroid and adrenal hypoplasia were the most proeminent pathologic and histopathologic features. The probable origin of the ciliated columnar epithelium that lined the cysts were discussed.

Descreveram-se as alterações clínicas, e anatomo-patológicas observadas em um animal da espécie canina, mestiço da raça Pastor Alemão, macho, de 1 ano e meio de idade. Letargia, desenvolvimento físico inadequado, pelame infantil, retardo na dentição e ausência do fechamento das cartilagens de conjugação, além de paralisia espástica dos membros pélvicos, priapismo, alopecia e hiperpigmentação das extremidades dos membros, foram as principais alterações clínicas encontradas no animal durante o período de observação. A presença de formações císticas na hipófise, hipoplasia da tireóide e da adrenal foram os achados mais proeminentes do exame anátomo e histopatológico. Discutiu-se a provável origem das células epiteliais cilíndricas secretoras de muco que constituiam o revestimento dessas formações císticas.