Iatrogenic symptomatic hypoadrenocorticism after treatment with trilostane for hyperadrenocorticism in dogs: eight cases (2008-2019).

OBJECTIVES: Trilostane is the medical treatment of choice for hyperadrenocorticism. Iatrogenic hypoadrenocorticism is thought to be rare, with most cases being transient and only a few cases of permanent hypoadrenocorticism have been reported. This study reports findings from eight cases of iatrogenic hypoadrenocorticism and examines the presence of concurrent diseases at the time of diagnosis. MATERIALS AND METHODS: Medical records of dogs treated for hyperadrenocorticism with trilostane since 2008 were reviewed, and cases of clinical iatrogenic hypoadrenocorticism were extracted. Cases were considered permanent if long-term replacement therapy was required. RESULTS: Eight dogs met the inclusion criteria. The time between the beginning of trilostane treatment and the diagnosis of hypoadrenocorticism ranged from 4 days to 13 months, and the dosage of trilostane ranged between 1 and 8 mg/kg/day. Six dogs had a suspicion of concurrent disease at the time of hypoadrenocorticism diagnosis. The trilostane dose was decreased in two dogs; trilostane was withdrawn in one case without further relapse of hyperadrenocorticism; and glucocorticoids with or without mineralocorticoid supplementation were prescribed in five dogs. Two of these five dogs were lost to follow-up, and the other three had a diagnosis of permanent hypoadrenocorticism. Adrenal gland ultrasonography in these three dogs showed a progressive reduction in gland sizes with heterogeneous echogenicity. CLINICAL SIGNIFICANCE: Iatrogenic hypoadrenocorticism is a rare but potentially life-threatening complication of trilostane treatment in dogs with hyperadrenocorticism. The occurrence of a concurrent disease might trigger the development of clinical signs of hypoadrenocorticism in previously subclinical dogs.

Hemorrhagic, Hemostatic, and Thromboelastometric Disorders in 35 Dogs with a Clinical Diagnosis of Leptospirosis: A Prospective Study.

BACKGROUND: Leptospirosis in dogs is occasionally associated with a hemorrhagic syndrome, the pathophysiology of which is not fully understood. HYPOTHESIS/OBJECTIVES: To characterize hematologic, hemostatic, and thromboelastometric abnormalities in dogs with leptospirosis and to study their association with hemorrhagic diatheses and outcomes. ANIMALS: Thirty-five client-owned dogs. METHODS: A prospective observational single cohort study was conducted. Results from the CBC, coagulation tests (prothrombin, activated partial thromboplastin and thrombin times, fibrinogen, fibrin(ogen) degradation products, and D-dimer concentrations), rotational thromboelastometry (TEM), signalment, hemorrhagic diatheses, occurrence of disseminated intravascular coagulation (DIC) at admission, and survival to discharge were recorded. RESULTS: The most common hematologic and hemostatic abnormalities were anemia (30/35), thrombocytopenia (21/35), and hyperfibrinogenemia (15/35). Eight dogs were diagnosed with DIC. A normal TEM profile was found in 14 dogs, a hypercoagulable profile in 14 dogs, and a hypocoagulable profile in 7 dogs. The 8 dogs with hemorrhagic diatheses at admission had significantly decreased platelet counts (P = .037) and increased D-dimer concentrations (P = .015) compared with other dogs. Dogs with a hypocoagulable profile exhibited more hemorrhagic diatheses compared with the dogs that had normal and hypercoagulable profiles (P = .049). The mortality rate was lower in dogs with a hypercoagulable profile than in those with a hypocoagulable profile (21% vs 57%; P = .043). Disseminated intravascular coagulation was not a significant prognostic factor. CONCLUSIONS AND CLINICAL IMPORTANCE: Thromboelastometric parameters were altered in dogs with both hypercoagulable and hypocoagulable profiles. A hypocoagulable profile was significantly correlated with hemorrhagic diathesis and higher mortality rate.

European consensus statement on leptospirosis in dogs and cats.

Leptospirosis is a zoonotic disease with a worldwide distribution affecting most mammalian species. Clinical leptospirosis is common in dogs but appears to be rare in cats. Both dogs and cats, however, can shed leptospires in the urine. This is problematic as it can lead to exposure of humans. The control of leptospirosis, therefore, is important not only from an animal but also from a public health perspective. The aim of this consensus statement is to raise awareness of leptospirosis and to outline the current knowledge on the epidemiology, clinical features, diagnostic tools, prevention and treatment measures relevant to canine and feline leptospirosis in Europe.