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.

Clinical and pathological aspects of progressive hyperphosphatasemia associated with vacuolar hepatopathy and hepatocellular carcinoma in a Scottish Terrier bitch / Aspectos clínicos e patológicos da hiperfosfatasemia progressiva associada à hepatopatia vacuolar e carcinoma hepatocelular em uma cadela da raça Scottish Terrier

ABSTRACT: Hyperphosphatasemia refers to an increase in alkaline phosphatase serum activity, and Scottish Terriers (STs) are predisposed to develop this condition of uncertain pathogenesis. This study describes a case of progressive hyperphosphatasemia with vacuolar hepatopathy and hepatocellular carcinoma (HCC) in a ST bitch. This dog had a five-year clinical follow-up with progressive hyperphosphatasemia (up to 5503 U/L) and with ultrasound findings and histologic diagnosis of vacuolar hepatopathy, in addition to posterior onset of HCC. A steroidogenic adrenal panel revealed an increase of adrenocortical hormones, especially progesterone and androstenedione, consistent with a subdiagnosed hypercortisolism. Euthanasia was elected and at necropsy, multinodular, yellow to red masses were observed in the liver, which were histologically and immunohistochemically defined as HCC. The association of the clinical, imaging, biochemical, adrenal panel and pathologic findings allowed to characterize and confirm a progressive disorder in this ST bitch associated with elevated adrenocortical hormones.

RESUMO: Hiperfosfatasemia é o aumento sérico de fosfatase alcalina, sendo que Scorrish Terriers estão predispostos a desenvolverem essa condição de patogênese desconhecida. Este trabalho descreve um caso de hiperfosfatasemia progressiva com hepatopatia vacuolar e carcinoma hepatocelular em um canino da raça Scottish Terrier. Uma cadela Scottish Terrier foi acompanhada clinicamente por cinco anos devido à hiperfosfatasemia persistente (até 5503 U/L), com achados ultrassonográficos e histológicos compatíveis com hepatopatia vacuolar, além de posterior desenvolvimento de carcinoma hepatocelular. O painel esteroidogênico realizado indicou aumento dos hormônios adrenocorticais, principalmente progesterona e androstenediona, consistente com diagnóstico de hipercortisolismo subdiagnosticado "atípico". Devido ao prognóstico desfavorável, a eutanásia foi realizada e na necropsia, massas amarelas a vermelhas e multinodulares foram observadas no fígado, com diagnóstico de carcinoma hepatocelular pela análise histológica e imuno-histoquímica. A associação dos achados clínicos, de imagem, bioquímicos, do painel androgênico e patológicos permitiram caracterizar e confirmar um distúrbio progressivo no canino da raça Scottish Terrier associado ao aumento dos hormônios adrenocorticais.

Clinical and pathological aspects of progressive hyperphosphatasemia associated with vacuolar hepatopathy and hepatocellular carcinoma in a Scottish Terrier bitch / Aspectos clínicos e patológicos da hiperfosfatasemia progressiva associada à hepatopatia vacuolar e carcinoma hepatocelular em uma cadela da raça Scottish Terrier

Hyperphosphatasemia refers to an increase in alkaline phosphatase serum activity, and Scottish Terriers (STs) are predisposed to develop this condition of uncertain pathogenesis. This study describes a case of progressive hyperphosphatasemia with vacuolar hepatopathy and hepatocellular carcinoma (HCC) in a ST bitch. This dog had a five-year clinical follow-up with progressive hyperphosphatasemia (up to 5503 U/L) and with ultrasound findings and histologic diagnosis of vacuolar hepatopathy, in addition to posterior onset of HCC. A steroidogenic adrenal panel revealed an increase of adrenocortical hormones, especially progesterone and androstenedione, consistent with a subdiagnosed hypercortisolism. Euthanasia was elected and at necropsy, multinodular, yellow to red masses were observed in the liver, which were histologically and immunohistochemically defined as HCC. The association of the clinical, imaging, biochemical, adrenal panel and pathologic findings allowed to characterize and confirm a progressive disorder in this ST bitch associated with elevated adrenocortical hormones.

Hiperfosfatasemia é o aumento sérico de fosfatase alcalina, sendo que Scorrish Terriers estão predispostos a desenvolverem essa condição de patogênese desconhecida. Este trabalho descreve um caso de hiperfosfatasemia progressiva com hepatopatia vacuolar e carcinoma hepatocelular em um canino da raça Scottish Terrier. Uma cadela Scottish Terrier foi acompanhada clinicamente por cinco anos devido à hiperfosfatasemia persistente (até 5503 U/L), com achados ultrassonográficos e histológicos compatíveis com hepatopatia vacuolar, além de posterior desenvolvimento de carcinoma hepatocelular. O painel esteroidogênico realizado indicou aumento dos hormônios adrenocorticais, principalmente progesterona e androstenediona, consistente com diagnóstico de hipercortisolismo subdiagnosticado "atípico". Devido ao prognóstico desfavorável, a eutanásia foi realizada e na necropsia, massas amarelas a vermelhas e multinodulares foram observadas no fígado, com diagnóstico de carcinoma hepatocelular pela análise histológica e imuno-histoquímica. A associação dos achados clínicos, de imagem, bioquímicos, do painel androgênico e patológicos permitiram caracterizar e confirmar um distúrbio progressivo no canino da raça Scottish Terrier associado ao aumento dos hormônios adrenocorticais.

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.

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)

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...

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)

Disfunção da Pars Intermédia da Pituitária (PPID) em equinos – em ascensão mas ainda pouco conhecida

A disfunção da pars intermédia da pituitária (ppid), também conhecida como Síndrome de Cushing, é uma doença degenerativa dos neurônios dopaminérgicos afetando a pars intermédia da glândula pituitária ou hipófise e está relacionada à idade em equinos. Um em cada quatro equinos a partir de 10 anos são diagnosticados nos eua e Austrália. Os sintomas da doença são hirsutismo, laminite, perda de musculatura epaxial, infecções recorrentes, feridas de difícil cicatrização e ocorrem devido ao aumento da produção de peptídeos derivados do pró-opiomelanocortina (pomc), como o adrenocorticotrófico (acth). Muitos pacientes vem a óbito devido ao diagnóstico tardio, cronicidade da doença e ineficiência do tratamento em casos avançados. Por isso o alerta para que o diagnóstico e tratamento sejam precoces e efetivos.

Disfunção da Pars Intermédia da Pituitária (PPID) em equinos em ascensão mas ainda pouco conhecida

A disfunção da pars intermédia da pituitária (ppid), também conhecida como Síndrome de Cushing, é uma doença degenerativa dos neurônios dopaminérgicos afetando a pars intermédia da glândula pituitária ou hipófise e está relacionada à idade em equinos. Um em cada quatro equinos a partir de 10 anos são diagnosticados nos eua e Austrália. Os sintomas da doença são hirsutismo, laminite, perda de musculatura epaxial, infecções recorrentes, feridas de difícil cicatrização e ocorrem devido ao aumento da produção de peptídeos derivados do pró-opiomelanocortina (pomc), como o adrenocorticotrófico (acth). Muitos pacientes vem a óbito devido ao diagnóstico tardio, cronicidade da doença e ineficiência do tratamento em casos avançados. Por isso o alerta para que o diagnóstico e tratamento sejam precoces e efetivos.(AU)

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014) / Aspectos epidemiológicos, clínicos e laboratoriais em uma série de cães com hiperadrenocorticismo: 115 casos (2010-2014)

Diseases' clinical-epidemiological characterization assists in directing the diagnosis. The objective of this study was to describe epidemiological, clinical and laboratorial aspects of a case series of canine hyperadrenocorticism (HAC). One-hundred fifteen records of dogs diagnosed by the low dose dexamethasone suppression test and/or ACTH stimulation test were evaluated. Of the cases, 81.3% were HAC ACTH-dependent and 18.7% HAC ACTH-independent. Females were more affected, representing 69.3% of the cases. The mean age was 10.3±2.5 years and 64.9% were gonadectomized. Most of the patients were small size dogs, weighting less than 10kg (73.9%). The most frequent breeds were: Poodle (27%), Dachshund (17.4%), and Yorkshire Terrier (10.4%). The most frequent clinical manifestations were polyphagia (86%), polydipsia (82.6%), polyuria (80%), abdominal enlargement (82.6%), thin skin (79.1%), muscular weakness (78.3%) and panting (74.8%). However, eventually unusual HAC-associated signs would be present in some dogs in a more important way compared with the classic disease´s clinical signs. The CBC showed neutrophilia (66%), eosinopenia (58.3%) and lymphopenia (42.6%) as main hematological abnormalities. The most common findings in serum biochemistry were increased alkaline phosphatase activity (81.74%), increased ALT activity (62.6%), hypercholesterolemia (66%) and hypertriglyceridemia (54.7%). Urinalysis revealed hyposthenuria in 14.9% and isostenuria in 13.5%; besides proteinuria in 50% of the cases. Abdominal ultrasound showed bilateral adrenal hyperplasia (92.2%) with adrenal asymmetry in 20.8% of the cases, in addition to hepatomegaly (80.9%), biliary sludge (67.8%) and hepatic hyperechogenicity (47.8%). It was concluded that small size gonadectomized female dogs, mainly Poodles and Dachshunds, presented higher frequency in the population studied, and that the main changes observed in clinical and complementary tests were polyphagia, polyuria, polydipsia, abdominal enlargement, adrenal hyperplasia, increased phosphatase alkaline and hyperlipidemia. These results corroborated to a better disease characterization at Brazil. This work concluded that the population studied resembles the profile describe in European and North American epidemiologic studies, and that the HAC dog´s clinical picture looks similar worldwide.(AU)

A caracterização clínica-epidemiológica de doenças auxilia no direcionamento do diagnóstico. O objetivo deste trabalho foi descrever aspectos epidemiológicos, clínicos e laboratoriais de uma série de casos de hiperadrenocorticismo (HAC) canino. Foram avaliados 115 prontuários de cães diagnosticados pelo teste de supressão por baixa dose de dexametasona e/ou teste de estimulação com ACTH. Os casos de HAC ACTH-dependentes representaram 81,3% da população, e 18,7% foram ACTH-independentes. As fêmeas foram mais acometidas, representando 69,3% dos casos. A média de idade foi 10,3 ± 2,5 anos e 64,9% eram gonadectomizados. A maioria dos cães foi de porte pequeno, de até 10 kg (73,9%). As raças mais frequentes foram Poodle (27%), Dachshund (17,4%) e Yorkshire (10,4%). As manifestações clínicas mais relatadas foram polifagia (86%), polidipsia (82,6%), poliúria (80%), abdome pendular (82,6%), atrofia cutânea (79,1%), fraqueza muscular (78,3%) e dispneia (74,8%). Entretanto, eventualmente sinais clínicos pouco associados ao HAC se manifestaram de forma mais importante que os sinais clássicos da doença. O hemograma revelou neutrofilia (66%), eosinopenia (58,3%) e linfopenia (42,6%) como principais alterações hematológicas. Na bioquímica sérica foi observado aumento de fosfatase alcalina (81,74% dos casos), aumento da atividade da ALT (62,6%), hipercolesterolemia (66%) e hipertrigliceridemia (54,7%). A urinálise revelou hipostenúria em 14,9% e isostenúria em 13,5%; além de proteinúria em 50% dos casos. A ecografia abdominal evidenciou hiperplasia bilateral de adrenal (92,2%) com assimetria de adrenais em 20,8% dos casos, além de hepatomegalia (80,9%), lama biliar (67,8%) e hiperecogenicidade hepática (47,8%). Concluiu-se que fêmeas castradas de pequeno porte, principalmente das raças Poodles e Dachshunds, apresentaram maior frequência na população estudada e que as principais alterações observadas clínicas e nos exames complementares foram polifagia, poliúria, polidipsia, aumento abdominal, hiperplasia da adrenal, aumento de fosfatase alcalina e hiperlipidemia. Estes resultados corroboram para melhor caracterização da doença no Brasil. Este estudo concluiu que a população estudada se assemelha ao perfil populacional de cães com HAC descrito em estudos Europeus e Norte Americanos de forma que o perfil dos casos ao redor do globo parece similar.(AU)

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014) / Aspectos epidemiológicos, clínicos e laboratoriais em uma série de cães com hiperadrenocorticismo: 115 casos (2010-2014)

Diseases' clinical-epidemiological characterization assists in directing the diagnosis. The objective of this study was to describe epidemiological, clinical and laboratorial aspects of a case series of canine hyperadrenocorticism (HAC). One-hundred fifteen records of dogs diagnosed by the low dose dexamethasone suppression test and/or ACTH stimulation test were evaluated. Of the cases, 81.3% were HAC ACTH-dependent and 18.7% HAC ACTH-independent. Females were more affected, representing 69.3% of the cases. The mean age was 10.3±2.5 years and 64.9% were gonadectomized. Most of the patients were small size dogs, weighting less than 10kg (73.9%). The most frequent breeds were: Poodle (27%), Dachshund (17.4%), and Yorkshire Terrier (10.4%). The most frequent clinical manifestations were polyphagia (86%), polydipsia (82.6%), polyuria (80%), abdominal enlargement (82.6%), thin skin (79.1%), muscular weakness (78.3%) and panting (74.8%). However, eventually unusual HAC-associated signs would be present in some dogs in a more important way compared with the classic disease´s clinical signs. The CBC showed neutrophilia (66%), eosinopenia (58.3%) and lymphopenia (42.6%) as main hematological abnormalities. The most common findings in serum biochemistry were increased alkaline phosphatase activity (81.74%), increased ALT activity (62.6%), hypercholesterolemia (66%) and hypertriglyceridemia (54.7%). Urinalysis revealed hyposthenuria in 14.9% and isostenuria in 13.5%; besides proteinuria in 50% of the cases. Abdominal ultrasound showed bilateral adrenal hyperplasia (92.2%) with adrenal asymmetry in 20.8% of the cases, in addition to hepatomegaly (80.9%), biliary sludge (67.8%) and hepatic hyperechogenicity (47.8%). It was concluded that small size gonadectomized female dogs, mainly Poodles and Dachshunds, presented higher frequency in the population studied, and that the main changes observed in clinical and complementary tests were polyphagia, polyuria, polydipsia, abdominal enlargement, adrenal hyperplasia, increased phosphatase alkaline and hyperlipidemia. These results corroborated to a better disease characterization at Brazil. This work concluded that the population studied resembles the profile describe in European and North American epidemiologic studies, and that the HAC dog´s clinical picture looks similar worldwide.(AU)

A caracterização clínica-epidemiológica de doenças auxilia no direcionamento do diagnóstico. O objetivo deste trabalho foi descrever aspectos epidemiológicos, clínicos e laboratoriais de uma série de casos de hiperadrenocorticismo (HAC) canino. Foram avaliados 115 prontuários de cães diagnosticados pelo teste de supressão por baixa dose de dexametasona e/ou teste de estimulação com ACTH. Os casos de HAC ACTH-dependentes representaram 81,3% da população, e 18,7% foram ACTH-independentes. As fêmeas foram mais acometidas, representando 69,3% dos casos. A média de idade foi 10,3 ± 2,5 anos e 64,9% eram gonadectomizados. A maioria dos cães foi de porte pequeno, de até 10 kg (73,9%). As raças mais frequentes foram Poodle (27%), Dachshund (17,4%) e Yorkshire (10,4%). As manifestações clínicas mais relatadas foram polifagia (86%), polidipsia (82,6%), poliúria (80%), abdome pendular (82,6%), atrofia cutânea (79,1%), fraqueza muscular (78,3%) e dispneia (74,8%). Entretanto, eventualmente sinais clínicos pouco associados ao HAC se manifestaram de forma mais importante que os sinais clássicos da doença. O hemograma revelou neutrofilia (66%), eosinopenia (58,3%) e linfopenia (42,6%) como principais alterações hematológicas. Na bioquímica sérica foi observado aumento de fosfatase alcalina (81,74% dos casos), aumento da atividade da ALT (62,6%), hipercolesterolemia (66%) e hipertrigliceridemia (54,7%). A urinálise revelou hipostenúria em 14,9% e isostenúria em 13,5%; além de proteinúria em 50% dos casos. A ecografia abdominal evidenciou hiperplasia bilateral de adrenal (92,2%) com assimetria de adrenais em 20,8% dos casos, além de hepatomegalia (80,9%), lama biliar (67,8%) e hiperecogenicidade hepática (47,8%). Concluiu-se que fêmeas castradas de pequeno porte, principalmente das raças Poodles e Dachshunds, apresentaram maior frequência na população estudada e que as principais alterações observadas clínicas e nos exames complementares foram polifagia, poliúria, polidipsia, aumento abdominal, hiperplasia da adrenal, aumento de fosfatase alcalina e hiperlipidemia. Estes resultados corroboram para melhor caracterização da doença no Brasil. Este estudo concluiu que a população estudada se assemelha ao perfil populacional de cães com HAC descrito em estudos Europeus e Norte Americanos de forma que o perfil dos casos ao redor do globo parece similar.(AU)

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014)

ABSTRACT: Diseases clinical-epidemiological characterization assists in directing the diagnosis. The objective of this study was to describe epidemiological, clinical and laboratorial aspects of a case series of canine hyperadrenocorticism (HAC). One-hundred fifteen records of dogs diagnosed by the low dose dexamethasone suppression test and/or ACTH stimulation test were evaluated. Of the cases, 81.3% were HAC ACTH-dependent and 18.7% HAC ACTH-independent. Females were more affected, representing 69.3% of the cases. The mean age was 10.3±2.5 years and 64.9% were gonadectomized. Most of the patients were small size dogs, weighting less than 10kg (73.9%). The most frequent breeds were: Poodle (27%), Dachshund (17.4%), and Yorkshire Terrier (10.4%). The most frequent clinical manifestations were polyphagia (86%), polydipsia (82.6%), polyuria (80%), abdominal enlargement (82.6%), thin skin (79.1%), muscular weakness (78.3%) and panting (74.8%). However, eventually unusual HAC-associated signs would be present in some dogs in a more important way compared with the classic disease´s clinical signs. The CBC showed neutrophilia (66%), eosinopenia (58.3%) and lymphopenia (42.6%) as main hematological abnormalities. The most common findings in serum biochemistry were increased alkaline phosphatase activity (81.74%), increased ALT activity (62.6%), hypercholesterolemia (66%) and hypertriglyceridemia (54.7%). Urinalysis revealed hyposthenuria in 14.9% and isostenuria in 13.5%; besides proteinuria in 50% of the cases. Abdominal ultrasound showed bilateral adrenal hyperplasia (92.2%) with adrenal asymmetry in 20.8% of the cases, in addition to hepatomegaly (80.9%), biliary sludge (67.8%) and hepatic hyperechogenicity (47.8%). It was concluded that small size gonadectomized female dogs, mainly Poodles and Dachshunds, presented higher frequency in the population studied, and that the main changes observed in clinical and complementary tests were polyphagia, polyuria, polydipsia, abdominal enlargement, adrenal hyperplasia, increased phosphatase alkaline and hyperlipidemia. These results corroborated to a better disease characterization at Brazil. This work concluded that the population studied resembles the profile describe in European and North American epidemiologic studies, and that the HAC dog´s clinical picture looks similar worldwide.

RESUMO: A caracterização clínica-epidemiológica de doenças auxilia no direcionamento do diagnóstico. O objetivo deste trabalho foi descrever aspectos epidemiológicos, clínicos e laboratoriais de uma série de casos de hiperadrenocorticismo (HAC) canino. Foram avaliados 115 prontuários de cães diagnosticados pelo teste de supressão por baixa dose de dexametasona e/ou teste de estimulação com ACTH. Os casos de HAC ACTH-dependentes representaram 81,3% da população, e 18,7% foram ACTH-independentes. As fêmeas foram mais acometidas, representando 69,3% dos casos. A média de idade foi 10,3 ± 2,5 anos e 64,9% eram gonadectomizados. A maioria dos cães foi de porte pequeno, de até 10 kg (73,9%). As raças mais frequentes foram Poodle (27%), Dachshund (17,4%) e Yorkshire (10,4%). As manifestações clínicas mais relatadas foram polifagia (86%), polidipsia (82,6%), poliúria (80%), abdome pendular (82,6%), atrofia cutânea (79,1%), fraqueza muscular (78,3%) e dispneia (74,8%). Entretanto, eventualmente sinais clínicos pouco associados ao HAC se manifestaram de forma mais importante que os sinais clássicos da doença. O hemograma revelou neutrofilia (66%), eosinopenia (58,3%) e linfopenia (42,6%) como principais alterações hematológicas. Na bioquímica sérica foi observado aumento de fosfatase alcalina (81,74% dos casos), aumento da atividade da ALT (62,6%), hipercolesterolemia (66%) e hipertrigliceridemia (54,7%). A urinálise revelou hipostenúria em 14,9% e isostenúria em 13,5%; além de proteinúria em 50% dos casos. A ecografia abdominal evidenciou hiperplasia bilateral de adrenal (92,2%) com assimetria de adrenais em 20,8% dos casos, além de hepatomegalia (80,9%), lama biliar (67,8%) e hiperecogenicidade hepática (47,8%). Concluiu-se que fêmeas castradas de pequeno porte, principalmente das raças Poodles e Dachshunds, apresentaram maior frequência na população estudada e que as principais alterações observadas clínicas e nos exames complementares foram polifagia, poliúria, polidipsia, aumento abdominal, hiperplasia da adrenal, aumento de fosfatase alcalina e hiperlipidemia. Estes resultados corroboram para melhor caracterização da doença no Brasil. Este estudo concluiu que a população estudada se assemelha ao perfil populacional de cães com HAC descrito em estudos Europeus e Norte Americanos de forma que o perfil dos casos ao redor do globo parece similar.

Carcinoma adrenocortical incidental em cão: aspectos clínicos, tomográficos e histopatológicos / Incidental adrenocortical carcinoma in dog: clinical, tomographic and histopathological aspects

Background: Adrenal incidentalomas are masses accidentally discovered during imaging examinations performed whenthere is no suspicion of adrenal disease. Even with a low prevalence, it is important to perform a reliable evaluation observing biological behavior and determining whether the hormonal activity is stimulated. Frequently, these masses are notfunctional, but in some cases, there is increased cortisol activity, and patients with adrenal incidentalomas may presenthyperadrenocorticism. This report aims to describe the clinical, tomographic, and histopathological aspects of a case ofadrenal incidentaloma detected in a routine abdominal ultrasound.Case: An 8-year-old, male, maltese dog with occasional emesis, halitosis, claudication of the left pelvic limb, and previous compensated and untreated cardiomyopathy was treated at the Veterinary Hospital of the Federal University of MatoGrosso (HOVET-UFMT). Physical examination revealed arterial hypertension and claudication, with the positive posteriordrawer test suggesting rupture of the cruciate ligament. The blood count showed no alteration, and the serum biochemistryrevealed a slight increase in the activity of alanine aminotransferase. In order to investigate this increase, an abdominalultrasound was performed. Slight hepatomegaly and a heterogeneous mass of irregular edges were observed with a moderate and difficult-to-delimit vascularization of the adrenal gland. Left knee radiography raised the suspicion of rupture ofthe cranial cruciate ligament due to the cranial displacement of the tibia in relation to the femur. Computed tomographywas performed to define the extent and delimitation of the mass, which was compatible with a tumor of the right adrenalgland characterized by the visualization of an abdominal mass...(AU)

Carcinoma adrenocortical incidental em cão: aspectos clínicos, tomográficos e histopatológicos / Incidental adrenocortical carcinoma in dog: clinical, tomographic and histopathological aspects

Background: Adrenal incidentalomas are masses accidentally discovered during imaging examinations performed whenthere is no suspicion of adrenal disease. Even with a low prevalence, it is important to perform a reliable evaluation observing biological behavior and determining whether the hormonal activity is stimulated. Frequently, these masses are notfunctional, but in some cases, there is increased cortisol activity, and patients with adrenal incidentalomas may presenthyperadrenocorticism. This report aims to describe the clinical, tomographic, and histopathological aspects of a case ofadrenal incidentaloma detected in a routine abdominal ultrasound.Case: An 8-year-old, male, maltese dog with occasional emesis, halitosis, claudication of the left pelvic limb, and previous compensated and untreated cardiomyopathy was treated at the Veterinary Hospital of the Federal University of MatoGrosso (HOVET-UFMT). Physical examination revealed arterial hypertension and claudication, with the positive posteriordrawer test suggesting rupture of the cruciate ligament. The blood count showed no alteration, and the serum biochemistryrevealed a slight increase in the activity of alanine aminotransferase. In order to investigate this increase, an abdominalultrasound was performed. Slight hepatomegaly and a heterogeneous mass of irregular edges were observed with a moderate and difficult-to-delimit vascularization of the adrenal gland. Left knee radiography raised the suspicion of rupture ofthe cranial cruciate ligament due to the cranial displacement of the tibia in relation to the femur. Computed tomographywas performed to define the extent and delimitation of the mass, which was compatible with a tumor of the right adrenalgland characterized by the visualization of an abdominal mass...

Granulosa cell tumor associated with occult hyperadrenocorticism in a yorkshire terrier bitch

Background: Hyperadrenocorticism (HAC), is considered a set of symptoms due to excessive exposure to cortisol. Naturally occurring HAC is most often related to pituitary tumors (pituitary-dependent HAC - PDH). Occult HAC, is referred as a clinical picture highly consistent with HAC; however, routine screening tests are negative. In addition, one or more steroids are elevated following administration of adrenocorticotrophic hormone (ACTH). Ovarian granulosa cell tumors, can produce steroids leading to paraneoplastic syndromes. The objective of this study was to report an unpublished case of ovarian granulosa cell tumor associated with occult hyperadrenocorticism in a Yorkshire Terrier.Case: A 13-year-old intact female dog, Yorkshire Terrier, was brought for consultation with slight weight loss, polyuria, polydipsia, irregular estrous cycles, increased abdominal volume and thin coat. On physical examination the animal was gasping and presented severe periodontal disease, bulging abdomen, alopecia and skin hyperpigmentation. Complete blood count presented no changes; however, serum biochemistry evaluation highlighted hyperalbuminemia, hypertriglyceridemia, alkaline phosphatase increased activity, and urinary specific gravity and creatinine below reference values. On abdominal ultrasonography left adrenal gland measured 2.08 cm x 1.08 cm and the right adrenal gland measured 2.11 cm x 0.84 cm, indicating bilateral adrenomegaly compatible with PDH. In the hypogastric abdomen, a large heterogeneous hypoechogenic mass was also observed, with areas of cystic cavities, measuring 5.80 cm x 7.30 cm. A low dose dexamethasone suppression test (LDDST) was performed, due to PDH suspicion. The test did not confirm HAC, suspecting, then, to be a case of occult/atypical HAC. Due to the strong clinical suspicion, and owner financial problems for further investigated occult HAC, trilostane treatment was initiated.[...](AU)

Granulosa cell tumor associated with occult hyperadrenocorticism in a yorkshire terrier bitch

Background: Hyperadrenocorticism (HAC), is considered a set of symptoms due to excessive exposure to cortisol. Naturally occurring HAC is most often related to pituitary tumors (pituitary-dependent HAC - PDH). Occult HAC, is referred as a clinical picture highly consistent with HAC; however, routine screening tests are negative. In addition, one or more steroids are elevated following administration of adrenocorticotrophic hormone (ACTH). Ovarian granulosa cell tumors, can produce steroids leading to paraneoplastic syndromes. The objective of this study was to report an unpublished case of ovarian granulosa cell tumor associated with occult hyperadrenocorticism in a Yorkshire Terrier.Case: A 13-year-old intact female dog, Yorkshire Terrier, was brought for consultation with slight weight loss, polyuria, polydipsia, irregular estrous cycles, increased abdominal volume and thin coat. On physical examination the animal was gasping and presented severe periodontal disease, bulging abdomen, alopecia and skin hyperpigmentation. Complete blood count presented no changes; however, serum biochemistry evaluation highlighted hyperalbuminemia, hypertriglyceridemia, alkaline phosphatase increased activity, and urinary specific gravity and creatinine below reference values. On abdominal ultrasonography left adrenal gland measured 2.08 cm x 1.08 cm and the right adrenal gland measured 2.11 cm x 0.84 cm, indicating bilateral adrenomegaly compatible with PDH. In the hypogastric abdomen, a large heterogeneous hypoechogenic mass was also observed, with areas of cystic cavities, measuring 5.80 cm x 7.30 cm. A low dose dexamethasone suppression test (LDDST) was performed, due to PDH suspicion. The test did not confirm HAC, suspecting, then, to be a case of occult/atypical HAC. Due to the strong clinical suspicion, and owner financial problems for further investigated occult HAC, trilostane treatment was initiated.[...]

Myolipoma associated with hyperadrenocorticism and diabetes mellitus in a female poodle / Miolipoma associado a hiperadrenocorticismo e diabetes mellitus em uma poodle fêmea

This report provides an unpublished account of an intra-abdominal myolipoma in a 11-year-old female Poodle with hyperadrenocorticism and diabetes mellitus. The patient was well controlled for both endocrine diseases; however, was suffering for severe abdominal discomfort. Ultrasound scan revealed a huge abdominal mass. At necropsy a pinkish mass (35cm x 28cm x 12cm) of elastic consistency attached to the broad ligament of the left uterine horn was reported. Histologically, this mass was constituted of a mixed population of well-differentiated adipocytes and of spindle-shaped mesenchymal cells. Both tumor cells were positive for vimentin at immunohistochemistry, while the spindle-shaped cells were positive for desmin and actin, compatible with smooth muscle cells. Immunohistochemistry was crucial for myolipoma characterization.(AU)

Este relato apresenta um caso inédito de miolipoma intra-abdominal em um poodle fêmea de 11 anos de idade com hiperadrenocorticismo e diabetes mellitus concomitante. A paciente apresentava um bom controle das doenças endócrinas, porém, grande desconforto abdominal. Ao ultrassom abdominal evidenciou-se uma massa de grandes proporções. Na necropsia uma massa rosácea (35cm x 28cm x 12cm) de consistência elástica unida ao ligamento largo do corno uterino esquerdo foi identificada. Histologicamente esta massa era constituída de uma população mista de adipócitos bem diferenciados e células fusiformes mesenquimais. Ambos tipos celulares foram positivos para vimentina na imuno-histoquímica, enquanto as células fusiformes foram positivas também para desmina e actina, compatível com músculo liso. A imuno-histoquímica foi crucial para o diagnóstico do miolipoma.(AU)

Adrenalectomy in dogs: retrospective study of 13 cases performed in Universidade Anhembi Morumbi Veterinary Hospital (2012-2015) / Adrenalectomia em cães: estudo retrospectivo de 13 casos realizados no hospital veterinário da Universidade Anhembi Morumbi (2012 a 2015)

Adrenalectomy is the most appropriate treatment for unilateral adrenal tumors. This study aimed at describing the epidemiological characteristics and perioperative behavior of canine patients submitted to adrenalectomy at Anhembi Morumbi Veterinary Hospital. Out of 13 dogs, eight were pure breeds and five were mixed breeds; 12 females, aged 9.5 ± 2.5 years old. Regarding the tumors, seven were located on the right and histopathological analysis revealed cortical adenoma in 11 and adenocarcinoma in only two dogs. Two cases had hypercortisolism recurrence associated with hyperplasia in the contralateral adrenal, as confirmed by ACTH stimulation test. The results of this study indicate that adrenalectomy is a safe procedure with few perioperative complications, despite the possibility of hypercortisolism recurrence.(AU)

Adrenalectomia é o tratamento mais indicado para neoplasias adrenais unilaterais. Objetivou-se descrever os aspectos epidemiológicos e o comportamento perioperatório em cães submetidos a adrenalectomia no Hospital Veterinário Anhembi Morumbi. Dos 13 casos, oito eram cães de raças puras e cinco eram SRD; 12 eram fêmeas e de idade de 9,5 ± 2,5 anos. Das massas adrenais, sete eram em lado direito. Os exames histopatológicos revelaram adenoma cortical em 11 cães e adenocarcinoma em dois. Dois casos recidivaram a condição de hipercortisolemia, associada à hiperplasia, na adrenal contralateral, confirmados pelo teste de estimulação por ACTH. Concluiu-se que a adrenalectomia é um procedimento seguro, com poucas complicações perioperatórias, ressalvando-se a possiblidade de recidiva do quadro de hipercortisolismo.(AU)

Adrenalectomy in dogs: retrospective study of 13 cases performed in Universidade Anhembi Morumbi Veterinary Hospital (2012-2015) / Adrenalectomia em cães: estudo retrospectivo de 13 casos realizados no hospital veterinário da Universidade Anhembi Morumbi (2012 a 2015)

Adrenalectomy is the most appropriate treatment for unilateral adrenal tumors. This study aimed at describing the epidemiological characteristics and perioperative behavior of canine patients submitted to adrenalectomy at Anhembi Morumbi Veterinary Hospital. Out of 13 dogs, eight were pure breeds and five were mixed breeds; 12 females, aged 9.5 ± 2.5 years old. Regarding the tumors, seven were located on the right and histopathological analysis revealed cortical adenoma in 11 and adenocarcinoma in only two dogs. Two cases had hypercortisolism recurrence associated with hyperplasia in the contralateral adrenal, as confirmed by ACTH stimulation test. The results of this study indicate that adrenalectomy is a safe procedure with few perioperative complications, despite the possibility of hypercortisolism recurrence.(AU)

Adrenalectomia é o tratamento mais indicado para neoplasias adrenais unilaterais. Objetivou-se descrever os aspectos epidemiológicos e o comportamento perioperatório em cães submetidos a adrenalectomia no Hospital Veterinário Anhembi Morumbi. Dos 13 casos, oito eram cães de raças puras e cinco eram SRD; 12 eram fêmeas e de idade de 9,5 ± 2,5 anos. Das massas adrenais, sete eram em lado direito. Os exames histopatológicos revelaram adenoma cortical em 11 cães e adenocarcinoma em dois. Dois casos recidivaram a condição de hipercortisolemia, associada à hiperplasia, na adrenal contralateral, confirmados pelo teste de estimulação por ACTH. Concluiu-se que a adrenalectomia é um procedimento seguro, com poucas complicações perioperatórias, ressalvando-se a possiblidade de recidiva do quadro de hipercortisolismo.(AU)