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 The objective of this study was to report an unpublished case of ovarian granulosa cell tumor associated with occult hyperadrenocorticism in a Yorkshire Terrier.Case: A 13-year-old intact female dog, Yorkshire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)

Síndrome da fragilidade cutânea adquirida e diabetes mellitus secundários ao hiperadrenocorticismo em um gato / Acquired skin fragility syndrome and diabetes mellitus secondary to hyperadrenocorticism in a cat

Background: Acquired skin fragility syndrome is a rare disorder which affects adult to senior cats with no history of skin trauma. Acquired skin fragility syndrome and diabetes mellitus, unlike the dog, are highly associated to feline hyperadrenocorticism (HAC) and, often, undiagnosed, what may accentuate the skin lesions and cause management complications. This report aimed to describe a case of acquired skin fragility syndrome and diabetes mellitus secondary to spontaneous hyperadrenocorticism in a cat, focusing on the chronic dermatological signs and their management, as well as on the treatment of the primary disease.Case: An approximately 7 year-old male mixed breed feline was admitted to the University Veterinary Hospital of an Institution with a history of polyphagia, polyuria and polydipsia, and skin ulcers on the trunk and in the cervical region about 2 months after onset and difficult to heal. Laboratory examinations indicated leukocytosis with lymphopenia, decreased urine specific gravity, glycosuria and hyperglycemia. The fasting plasma glucose level, the dexamethasone suppression test and the bilateral adrenal gland enlargement, visualized by ultrasonography, revealed diabetes mellitus and spontaneous hyperadrenocorticism, respectively. Histological skin findings indicated feline acquired skin fragility syndrome. Skin wound treatment through cleaning, protection and antibiotic therapy, and administration of insulin and trilostane were performed. After 6 months of trilostane therapy, adrenocorticotropic hormone (ACTH) stimulation test was performed, which demonstrated normal cortisol values 4 h after administration, which allowed maintenance of the dosage. After 12 months of the diagnosis of skin fragility syndrome and diabetes mellitus secondary to HAC, the patient did not present new skin lesions, fasting glycemia was within the reference values without insulin therapy and maintained only the prescription of trilostane.[...](AU)

Síndrome da fragilidade cutânea adquirida e diabetes mellitus secundários ao hiperadrenocorticismo em um gato / Acquired skin fragility syndrome and diabetes mellitus secondary to hyperadrenocorticism in a cat

Background: Acquired skin fragility syndrome is a rare disorder which affects adult to senior cats with no history of skin trauma. Acquired skin fragility syndrome and diabetes mellitus, unlike the dog, are highly associated to feline hyperadrenocorticism (HAC) and, often, undiagnosed, what may accentuate the skin lesions and cause management complications. This report aimed to describe a case of acquired skin fragility syndrome and diabetes mellitus secondary to spontaneous hyperadrenocorticism in a cat, focusing on the chronic dermatological signs and their management, as well as on the treatment of the primary disease.Case: An approximately 7 year-old male mixed breed feline was admitted to the University Veterinary Hospital of an Institution with a history of polyphagia, polyuria and polydipsia, and skin ulcers on the trunk and in the cervical region about 2 months after onset and difficult to heal. Laboratory examinations indicated leukocytosis with lymphopenia, decreased urine specific gravity, glycosuria and hyperglycemia. The fasting plasma glucose level, the dexamethasone suppression test and the bilateral adrenal gland enlargement, visualized by ultrasonography, revealed diabetes mellitus and spontaneous hyperadrenocorticism, respectively. Histological skin findings indicated feline acquired skin fragility syndrome. Skin wound treatment through cleaning, protection and antibiotic therapy, and administration of insulin and trilostane were performed. After 6 months of trilostane therapy, adrenocorticotropic hormone (ACTH) stimulation test was performed, which demonstrated normal cortisol values 4 h after administration, which allowed maintenance of the dosage. After 12 months of the diagnosis of skin fragility syndrome and diabetes mellitus secondary to HAC, the patient did not present new skin lesions, fasting glycemia was within the reference values without insulin therapy and maintained only the prescription of trilostane.[...]

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.[...]

Concurrent hyperadrenocorticism and diabetes mellitus in dogs.

Hyperadrenocorticism (HAC) and diabetes mellitus (DM) are two diseases that can occur concurrently in dogs. The objective of this study was to evaluate the coexistence of HAC and DM, and the risk factors involved that could contribute to the development of DM in dogs with HAC. A total of 235 dogs with HAC were studied and, according to their fasting glycemia, they were divided into three groups: <5.6mmol/L, between 5.6 and 10.08mmol/L and >10.08mmol/L. The following parameters were evaluated: age, gender, cause of HAC, body condition, glycemia, total cholesterol, triglycerides, urinary cortisol:creatinin ratio (UCCR) and survival time. A 13.61% concurrence of HAC and DM was observed. Dogs with a fasting glycemia >5.6mmol/L, with dislipemia, with Pituitary-Dependent Hyperadrenocorticism, UCCR >100×10-6 and non-castrated females showed a higher risk of developing DM. The development of DM in dogs with HAC reduces the survival time.

Alterações dermatológicas em cães com hiperadrenocorticismo - estudo retrospectivo / Dermatological disorders in dogs with hyperadrenocorticism - a retrospective study / Alteraciones dermatológicas en perros con hiperadrenocorticismo - estudio retrospectivo

Entre as principais alterações clínicas decorrentes do hipercortisolismo crônico, resultante do hiperadrenocorticismo ou síndrome de Cushing, estão as alterações tegumentares. O presente trabalho teve como objetivo identificar as alterações dermatológicas mais frequentes em 22 cães (dezesseis fêmeas e seis machos com idade média de 10 anos) com hiperadrenocorticismo hipófise¬-dependente e hiperadrenocorticismo adrenal-dependente atendidos em um Hospital Veterinário Escola de São Paulo, SP, durante um período de 24 meses. As lesões cutâneas foram identificadas em 72,72% dos casos, sendo as alterações mais frequentes relacionadas à presença de crostas melicéricas, alopecia, eritema, comedos, colarinhos epidérmicos, hiperpigmentação, escamas, pústulas e pápulas. As doenças dermatológicas associadas ao hipercortisolismo foram piordermite, demodiciose e calcinose cutânea.(AU)

Skin disorders are among the major clinical changes due to chronic hypercortisolism, which results from hyperadrenocorticism or Cushing's syndrome. The aim of our study was to identify the most common skin disorders in 22 dogs (16 females and six males, mean age = 10 years) that were referred to a Veterinary School Hospital in Sao Paulo, SP, within a 24-month period, presenting pituitary¬dependent or adrenal-dependent hyperadrenocorticism. Cutaneous injuries were identified in 72.72% of cases. The most frequent changes were related to the presence of meliceric crusting, hair loss, erythema, comedo, epidermal collarette, hyperpigmentation, scales, pustules and papules. The dermatological diseases related with hypercortisolism were pyodermitis, demodicosis and calcinosis cutis.(AU)

Dentro de las principales alteraciones clínicas del hipercortisolismo crónico, como resultado del hiperadrenocorticismo o Síndrome de Cushing, se encuentran las alteraciones dermatológicas. El presente trabajo tuvo como objetivo identificar las alteraciones dermatológicas más frecuentes en 22 perros (dieciséis hembras y seis machos con edad promedio de 10 años) con hiperadrenocorticismo hipófisis dependiente, e hiperadrenocorticismo adrenal dependiente que fueron atendidos en un hospital veterinano escuela de São Paulo, SP, durante un período de 24 meses. Las lesiones cutáneas fueron identificadas en el 72,72% de los casos, en los que las lesiones más frecuentes han sido las costras melicéricas, alopecia, eritema, comedones, collares epidérmicos, hiperpigmentación, escamas, pústulas y pápulas. Las enfermedades dermatológicas asociadas al hipercorisolismo fueron la piodermitis, demodicosis y calcino sis cutánea.(AU)

Alterações dermatológicas em cães com hiperadrenocorticismo - estudo retrospectivo / Dermatological disorders in dogs with hyperadrenocorticism - a retrospective study / Alteraciones dermatológicas en perros con hiperadrenocorticismo - estudio retrospectivo

Entre as principais alterações clínicas decorrentes do hipercortisolismo crônico, resultante do hiperadrenocorticismo ou síndrome de Cushing, estão as alterações tegumentares. O presente trabalho teve como objetivo identificar as alterações dermatológicas mais frequentes em 22 cães (dezesseis fêmeas e seis machos com idade média de 10 anos) com hiperadrenocorticismo hipófise¬-dependente e hiperadrenocorticismo adrenal-dependente atendidos em um Hospital Veterinário Escola de São Paulo, SP, durante um período de 24 meses. As lesões cutâneas foram identificadas em 72,72% dos casos, sendo as alterações mais frequentes relacionadas à presença de crostas melicéricas, alopecia, eritema, comedos, colarinhos epidérmicos, hiperpigmentação, escamas, pústulas e pápulas. As doenças dermatológicas associadas ao hipercortisolismo foram piordermite, demodiciose e calcinose cutânea.

Skin disorders are among the major clinical changes due to chronic hypercortisolism, which results from hyperadrenocorticism or Cushing's syndrome. The aim of our study was to identify the most common skin disorders in 22 dogs (16 females and six males, mean age = 10 years) that were referred to a Veterinary School Hospital in Sao Paulo, SP, within a 24-month period, presenting pituitary¬dependent or adrenal-dependent hyperadrenocorticism. Cutaneous injuries were identified in 72.72% of cases. The most frequent changes were related to the presence of meliceric crusting, hair loss, erythema, comedo, epidermal collarette, hyperpigmentation, scales, pustules and papules. The dermatological diseases related with hypercortisolism were pyodermitis, demodicosis and calcinosis cutis.

Dentro de las principales alteraciones clínicas del hipercortisolismo crónico, como resultado del hiperadrenocorticismo o Síndrome de Cushing, se encuentran las alteraciones dermatológicas. El presente trabajo tuvo como objetivo identificar las alteraciones dermatológicas más frecuentes en 22 perros (dieciséis hembras y seis machos con edad promedio de 10 años) con hiperadrenocorticismo hipófisis dependiente, e hiperadrenocorticismo adrenal dependiente que fueron atendidos en un hospital veterinano escuela de São Paulo, SP, durante un período de 24 meses. Las lesiones cutáneas fueron identificadas en el 72,72% de los casos, en los que las lesiones más frecuentes han sido las costras melicéricas, alopecia, eritema, comedones, collares epidérmicos, hiperpigmentación, escamas, pústulas y pápulas. Las enfermedades dermatológicas asociadas al hipercorisolismo fueron la piodermitis, demodicosis y calcino sis cutánea.

Hipertensión de causa adrenal y embarazo / Hypertension of adrenal origin and pregnancy

La hipertensión arterial de causa adrenal asociada al embarazo es infrecuente. Su presencia genera una elevada morbilidad y mortalidad materna y fetal. Los cambios de la fisiología endocrina que acontecen en esta etapa, modifican el cuadro clínico y bioquímico de las enfermedades adrenales causantes de hipertensión. El objetivo de esta revisión es brindar información actualizada sobre el hipercortisolismo endógeno, el aldosteronismo primario y el feocromocitoma en la gestación -a los profesionales de la salud vinculados con la atención a embarazadas- que les permita diagnosticar y tratarlas temprana y adecuadamente mediante la aplicación del método clínico. Se revisa la literatura y se exponen los avances médicos en el tema(AU)

Blood hypertension of adrenal origin associated to pregnancy is unfrequent and generates high maternal and fetal morbidity and mortality. Changes in the endocrine physiology during this phase modify the clinical and biochemical picture of hypertension-causing adrenal diseases. The objective of this review was to provide health professionals in charge of pregnancy care with updated information on endogenous hypercortisolism, primary aldosteronism and pheochromocytoma in pregnancy. This will allow them to diagnose and treat this disorder early and adequately by means of the clinical method. Relevant literature was reviewed and the latest medical advances in this field were presented(AU)

Hemostatic profile and thromboembolic risk in healthy dogs treated with prednisone: a randomized controlled trial.

BACKGROUND: Thrombosis has been associated to some diseases like hyperadrenocorticism (HAC). Several drugs can alter the balance, such as the corticosteroid prednisone, used mainly for its anti-inflammatory and immunosuppressive effects. It is known that hypercortisolism can stimulate thrombi formation by increasing coagulation factors and decreasing fibrinolysis. However it is not known how prednisone administration affects hemostasis in dogs and if it is dose dependent. The aim of this study, therefore, was to demonstrate the effects of prednisone administration on dogs' hemostatic profile. RESULTS: Significant decrease of antithrombin levels was observed in both groups (anti-inflammatory and immunosuppressive doses) after 15 days of treatment. An increase of platelet aggregation was observed in dogs receiving immunosuppressive doses of prednisone (Group II). CONCLUSIONS: From the results obtained in our study, it is not possible to infer that hypercortisolism can increase the thromboembolic risk, despite the decreased anticoagulant factors (antithrombin levels).

Síntomas psicóticos, paranoides y catatónicos como debut de enfermedad de Cushing en una paciente con síndrome de Turner: reporte de caso y revisión de la literatura / Psicotic, paranoid and catatonic symptoms as Cushing disease onset in a Turner syndrome patient: case report and literature revision

It is known that hipercortisolism and overactivity of the Hypotalamus pituitary adrenal axis are associated to psiquiatric diseases presentation. In patients with Cushing syndrome, mood disorders are common, also psicosis cases also are present during the disease. But, the presence and mostly the onset with a episode of catatonic psicosis is unusual. The cortisol excess produce structural damage in the Central Nervous System, reversible and irreversible, specially in the hypocampus. We show the case of a young woman with previous diagnostic of Turner syndrome, karyotype 45 X0, who presented a psychiatric episode caracterized for depresive psicotic symptoms and posteriorly a catatonic state as an unusual form of Cushing disease onset. This patient presented health improvement after pituitary resection. There is not evidencia that Turner syndrome influes over this unusual form of presentation.

Se conoce que el hipercortisolismo y la sobreactividad del eje hipotálamo pituitario adrenal están asociados a la presentación de enfermedades psiquiátricas. En pacientes con síndrome de Cushing son frecuentes los trastornos del ánimo aunque también se presentan casos de psicosis durante el curso de la enfermedad. Sin embargo es inusual la presencia y más aún el debut con un cuadro de psicosis catatónica. El exceso de cortisol produce daño estructural en el sistema nervioso central tanto reversible como irreversible, especialmente en el hipocampo. Presentamos el caso de una paciente mujer joven con diagnóstico previo de síndrome de Turner, cariotipo 45 X0, quien presentó un cuadro psiquiátrico caracterizado por síntomas depresivos psicóticos y posteriormente catatonia como forma inusual de debut de enfermedad de Cushing y presentó mejoría posterior a la resección de la pituitaria. No se tiene evidencia que el síndrome de Turner influya sobre esta rara forma de presentación.

Low dose of insulin detemir controls glycaemia, insulinemia and prevents diabetes mellitus progression in the dog with pituitary-dependent hyperadrenocorticism.

Diabetes is often associated with pituitary-dependent hyperadrenocorticism (PDH). Hypercortisolism causes insulin resistance and affects ß-cell function. The purpose of this study was to test if daily administration of a long-acting insulin analogue during the first month of anti-PDH treatment can prevent progress to diabetes in these animals. Twenty-six PDH dogs were divided into three groups: one group with glycaemia <5.83 mmol/L and two groups with glycaemia >5.83 mmol/L and <9.35 mmol/L, one of which received insulin detemir during 4 months. Dogs with glycaemia <5.83 mmol/L and those with glycaemia >5.83 mmol/L which received insulin did not develop diabetes. In the non-insulin group, 6/7 dogs developed diabetes after the third month. There is a 13-fold higher risk of diabetes in dogs with glycaemia >5.83 mmol/L and no insulin treatment. Administering insulin detemir to dogs with PDH and glycaemia >5.83 mmol/L could prevent progression to diabetes.

Adenoma de hipófise em uma gata com hiperadrenocorticismo / Pituitary adenoma in a cat with hyperadrenocorticism

Feline Cushing’s syndrome (FCS) is a disorder of excessive cortisol secretion by the adrenal glands and is rare in cats. The most frequently observed clinical signs are polyuria, polydipsia, and polyphagia which are also consistent with diabetes mellitus. These diabetic cats are often insulin resistants. The dexamethasone suppression test is considered the test of choice for the diagnosis of hyperadrenocorticism. The majority of cats with naturally occurring Cushing’s syndrome have pituitary-dependent hyperadrenocorticism and it is caused by functional microadenoma or macroadenoma pituitary. Computed tomography or magnetic resonance imaging is helpful in diagnosis of pituitary tumors. Treatments of pituitary-dependent hyperadrenocorticism include surgery of the pituitary or adrenals, radiation of the pituitary, and medical therapies. Bilateral adrenalectomy continues to represent the best long-term therapeutic strategy until hypophysectomy becomes more widely available. This paper reports a cat with macroadenoma pituitary causing hiperadrenocorticism and insulin resistance.

Adenoma de hipófise em uma gata com hiperadrenocorticismo / Pituitary adenoma in a cat with hyperadrenocorticism

Feline Cushings syndrome (FCS) is a disorder of excessive cortisol secretion by the adrenal glands and is rare in cats. The most frequently observed clinical signs are polyuria, polydipsia, and polyphagia which are also consistent with diabetes mellitus. These diabetic cats are often insulin resistants. The dexamethasone suppression test is considered the test of choice for the diagnosis of hyperadrenocorticism. The majority of cats with naturally occurring Cushings syndrome have pituitary-dependent hyperadrenocorticism and it is caused by functional microadenoma or macroadenoma pituitary. Computed tomography or magnetic resonance imaging is helpful in diagnosis of pituitary tumors. Treatments of pituitary-dependent hyperadrenocorticism include surgery of the pituitary or adrenals, radiation of the pituitary, and medical therapies. Bilateral adrenalectomy continues to represent the best long-term therapeutic strategy until hypophysectomy becomes more widely available. This paper reports a cat with macroadenoma pituitary causing hiperadrenocorticism and insulin resistance.(AU)

Combined corneal lipid and calcium degeneration in a dog with hyperadrenocorticism: a case report.

Corneal degeneration may occur with a deposition of lipids or calcium, or both. Calcareous and lipid degeneration may be either primary or secondary, associated with systemic diseases such as primary hyperlipidemia, hyperlipidemia associated with hyperadrenocorticism, and hypothyroidism. The authors report a case of bilateral corneal lipid and calcium degeneration in a 7-year-old female Poodle with hyperadrenocorticism. The condition worsened with Lysodren therapy but responded to surgical excision.

[Polycystic ovary syndrome of extra-ovarian origin. Review]. / Síndrome de ovarios poliquísticos de origen extraovárico. Revisión.

An established fact in the polycystic ovarian syndrome (POS) is an abnormal ovarian steroidogenesis. Though this suggest an intrinsic ovarian defect, the syndrome could also be influenced by factors outside the ovaries. Although of unknown etiology, the POS is one of the most frequent endocrine disorders in the gynecologic practice. The disorder is characterized by ultrasound findings of enlarged polycystic ovaries, hyperandrogenism, menstrual disorders, obesity and including the appearance of infertility. There are a series of mechanisms involved in the extraovarian androgen increase in patients with POS. Among these mechanisms are implicated those of central and peripheral origin, genetic factors and adrenocortical dysfunction. In the same way, the alterations produced could imply genetic, molecular biological, biochemical, physiological and endocrinological factors. Sometimes all these factors could interact at the same time. The high serum androgen level could stop the pituitary gonadotropin production, either as a direct mechanism or as a result of its peripheral conversion. The increased androgens also explain the manifestations of clinical acne, hirsutism, and the detention in follicular ovarian maturation. All these manifestations are related with the menstrual disorders, anovulation, and infertility that these patients develop. The characteristics of the extraovarian POS include the 17-hydroxyprogesterone elevation in response to the ACTH test and the dexamethasone suppression of adrenal androgens. It is possible to improve the ovarian function in some patients with POS. This could be achieved with clomiphene citrate associated with glucocorticoids to induce ovulation.