Stress as cause of signs and symptoms of pseudo-Cushing's syndrome in buffy-tufted marmosets (Callithrix aurita).

Hyperadrenocorticism is a medical condition caused by the increase in cortisol production by the cortex of the adrenal gland. Although infrequently described in most animal species, its naturally occurring form, called Cushing's syndrome, is the most prevalent endocrinopathy in dogs. Cushing's syndrome is also present in humans and might be confused with the pseudo-Cushing's syndrome (PCS), rarely described in animals. PCS shares many of the clinical and biochemical features of Cushing's syndrome. However, the hypercortisolemia seen is usually idiopathic and, in some circumstances, associated with psychological disruptions. This report describes PCS-like disorder in two marmosets Callithrix aurita that were exposed to environmental changes, suggesting stress as the main cause of the process and reviewing the mechanisms involved in the pathogeny of the two syndromes.

Picrosirius red and Massons Trichrome staining techniques as tools for detection of collagen fibers in the skin of dogs with endocrine dermatopathologies / Picrosirius red e Tricrômico de Masson como ferramentas para detecção de fibras colágenas em pele de cães com dermatopatologias endócrinas

Canine endocrinopathies, such as hypothyroidism and hyperadrenocortism,induce typical dermatological alterations. Collagen fibers are significant for the maintenance of structural integrity,as well as in the determination of tissue function. This study aimed at assessing the coloration caused by Picrosirius Red staining under circular polarization and Masson Trichrome staining, as tools to quantify the total collagen in the skin of dogs exhibiting endocrine dermatopathies. Skin samples taken from dogs with hypothyroidism and hyperadrenocorticism were stained using Hematoxylin and Eosin (HE), Massons Trichrome (MT) and Picrosirius Red (PSR). The animals with hyperadrenocorticism revealed a higher percentage of collagen area than did the animals with hypothyroidism PSRp (hypothyroidism = 43.76 ± 0.8255 and hyperadrenocorticism = 47.08 ± 0.8584). The percentage of the collagen area using MT between the groups is given in parenthesis (hypothyroidism = 52.06 ± 0.9371, hyperadrenocorticism = 61 ± 0.7529 and control = 56.88 ± 0.64) (p <0.05). It is therefore, evident that the special stains employed are useful in estimating the percentage of collagen area in the skin, as they revealed that dogs with hypothyroidism had lower collagen deposition whereas those animals with hyperadrenocorticism showed higher quantity of collagen in the dermis.(AU)

Endocrinopatias caninas como hipotireoidismo e o hiperadrenocortismo causam alterações dermatológicas características. As fibras de colágeno desempenham um papel vital na manutenção da integridade estrutural e também na determinação da função dos tecidos. O objetivo deste estudo foi avaliar as colorações de picrosirius red sob polarização circular e coloração tricômio de Masson como ferramentas para quantificar o colágeno total da pele de cães com dermatopatias endócrinas. Amostras de pele obtidas de cães com hipotireoidismo e hiperadrenocorticismo foram coradas por Hematoxilina e Eosina (HE), Tricrômio de Masson (MT) e Picrosirius red (PSR). A porcentagem de área de colágeno foi maior nos animais com hiperadrenocorticismo e menor nos animais com hipotireoidismo PSRp (hipotireoidismo = 43,76 ± 0.8255 e hiperadrenocorticismo = 47,08 ± 0.8584). Já a porcentagem de área de colágeno no MT entre os grupos (hipotireoidismo = 52,06 ± 0.9371, hiperadrenocorticismo = 61 ± 0,7529 e controle = 56,88 ± 0.64) (p <0.05). Concluiu-se que as colorações especiais utilizadas são úteis para avaliar a porcentagem de área de colágeno na pele, pois demonstraram que cães com hipotireoidismo demonstraram uma diminuição na deposição de colágeno e os animais com hiperadrenocorticismo apresentaram maior quantidade de colágeno na derme.(AU)

Picrosirius red and Masson’s Trichrome staining techniques as tools for detection of collagen fibers in the skin of dogs with endocrine dermatopathologies / Picrosirius red e Tricrômico de Masson como ferramentas para detecção de fibras colágenas em pele de cães com dermatopatologias endócrinas

Canine endocrinopathies, such as hypothyroidism and hyperadrenocortism,induce typical dermatological alterations. Collagen fibers are significant for the maintenance of structural integrity,as well as in the determination of tissue function. This study aimed at assessing the coloration caused by Picrosirius Red staining under circular polarization and Masson Trichrome staining, as tools to quantify the total collagen in the skin of dogs exhibiting endocrine dermatopathies. Skin samples taken from dogs with hypothyroidism and hyperadrenocorticism were stained using Hematoxylin and Eosin (HE), Masson’s Trichrome (MT) and Picrosirius Red (PSR). The animals with hyperadrenocorticism revealed a higher percentage of collagen area than did the animals with hypothyroidism PSRp (hypothyroidism = 43.76 ± 0.8255 and hyperadrenocorticism = 47.08 ± 0.8584). The percentage of the collagen area using MT between the groups is given in parenthesis (hypothyroidism = 52.06 ± 0.9371, hyperadrenocorticism = 61 ± 0.7529 and control = 56.88 ± 0.64) (p <0.05). It is therefore, evident that the special stains employed are useful in estimating the percentage of collagen area in the skin, as they revealed that dogs with hypothyroidism had lower collagen deposition whereas those animals with hyperadrenocorticism showed higher quantity of collagen in the dermis.

Endocrinopatias caninas como hipotireoidismo e o hiperadrenocortismo causam alterações dermatológicas características. As fibras de colágeno desempenham um papel vital na manutenção da integridade estrutural e também na determinação da função dos tecidos. O objetivo deste estudo foi avaliar as colorações de picrosirius red sob polarização circular e coloração tricômio de Masson como ferramentas para quantificar o colágeno total da pele de cães com dermatopatias endócrinas. Amostras de pele obtidas de cães com hipotireoidismo e hiperadrenocorticismo foram coradas por Hematoxilina e Eosina (HE), Tricrômio de Masson (MT) e Picrosirius red (PSR). A porcentagem de área de colágeno foi maior nos animais com hiperadrenocorticismo e menor nos animais com hipotireoidismo PSRp (hipotireoidismo = 43,76 ± 0.8255 e hiperadrenocorticismo = 47,08 ± 0.8584). Já a porcentagem de área de colágeno no MT entre os grupos (hipotireoidismo = 52,06 ± 0.9371, hiperadrenocorticismo = 61 ± 0,7529 e controle = 56,88 ± 0.64) (p <0.05). Concluiu-se que as colorações especiais utilizadas são úteis para avaliar a porcentagem de área de colágeno na pele, pois demonstraram que cães com hipotireoidismo demonstraram uma diminuição na deposição de colágeno e os animais com hiperadrenocorticismo apresentaram maior quantidade de colágeno na derme.

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.[...]

Hipercortisolismo cíclico por adenoma hipofisario / Cyclic hypercortisolism due to pituitary adenoma

A case study of a 41 years old woman with cyclic hypercortisolism is explained. AT the beginning, its manegment was shrinking the tumor, however afterward she needs medical treatment during cycles. The fluctuating clinical and discrepant bioquemical findings make it hard to diagnose. A review of this rare disorder is explained.

Síndrome de Cushing: Manifestações clínicas e avaliação diagnóstica / Cushing's syndrome: clinical manifestations and diagnostic evaluation

Resumo: Foram analisadas as manifestações clínicas e laboratoriais de 73 pacientes com síndrome de Cushing(SC) endógena, assim distribuidos: 46(63por cento) com doença de Cushing(DC), 21 (28,7por cento) com tumores adrenais (TA) e 6 (8,2por cento) com a síndrome do ACTH ectópico (SAE). Esta última resultou de 5 tumores carcinóides brônquicos e uma carcinóide tímico. A freqüência de manifestações clássicas do hipercortisolismo foi similar, independentemente da etiologia da SC. A DC e os TA (15 adenomas e 6 carcinomas) predominaram no sexo feminino e a SAE, no masculino. Em 100por cento dos casos de SC, observaram-se níveis do cortisol sérico (CS) >1,8mg/dL após supressão com doses baixas de dexametasona (DMS), além de elevação do cortisol à meia-noite (sérico ou salivar). Contudo o cortisol livre urinário foi normal em 11,5por cento dos pacientes. Os níveis de ACTH mostraram-se suprimidos nos pacientes com TA, normais ou elevados na DC e sempre elevados na SAE. No teste de supressão noturna com 8mg de DMS, supressão do CS>50 por cento foi observada em 78,2por cento dos casos de DC e 33,3por cento dos casos de SAE, enquanto uma supressão >80 por cento foi exclusiva da DC. Após estímulo com CRH ou DDAVP, um incremento do ACTH maior ou igual a 35 por cento aconteceu em 81 por cento dos indivíduos com DC e em 16,6 por cento daqueles com SAE, ao passo que um incremento do ACTH>50por cento restringiu-se à DC. A combinação de incremento do ACTH maior ou igual a35 e supressão do CS > 50por cento foi também exclusiva da DC. A ressonância magnética visualizou 100por cento dos macroadenomas e 59,4por cento dos microadenomas hipofisários nos casos de DC. Em 10 pacientes submetidos ao cateterismo bilateral do seio petroso inferior, um gradiente centroperiferia da ACTH maior ou igual a 3 pós-CRH ou DDAVP teve sensibilidade de 90por cento e especificidade de 100 por cento para a doença de Cushing

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.

Cirugía de la glándula suprarrenal / Surgery of the supradrenal gland

Es conocida en la literatura médica la baja incidencia de la patología suprarrenal. Constituyendo hoy en día un capítulo urológico fascinante. El objetivo de este trabajo es presentar la experiencia clínico-quirúrgica de la patología suprarrenal en nuestro hospital. Material y Métodos: Se revisaron 76 operados por patología suprarrenal primaria entre enero de 1969 y mayo de 1996. Resultados: de los 76 pacientes, 28 (36,8 por ciento) fueron feocromocitomas, seguidos por hiperaldosteronismo en 13 pacientes (17 por ciento), hipercortisolismo en 1 1 pacientes (14,5 por ciento). 5 pacientes (6,5 por ciento) se operaron por cáncer suprarrenal, 4 (5,2 por ciento) por metástasis, 4 (5,2 por ciento) fueron adenomas corticales, 3 hiperplasia nodulares, 2 hematomas, 2 linfangiomas quísticos, 2 angiomiolipomas, 1 paciente con tuberculosis y otro con lipoma periadrenal. De esto 76 pacientes 42 (55 por ciento) fueron mujeres y 34 varones. La edad promedio fue de 55,2 años, 50 pacientes (66 por ciento) se presentaron con clínica y/o laboratorio propios de su patología. El estudio endocrino, cuando se usó, permitió sospechar la patología en la mayoria de los casos 26 pacientes (34 por ciento) fueron nódulados no funcionables con tamaño promedio de 3,5 cm. siendo hallazgo por ECO y/o TAC en 16 casos (61,5 por ciento) distribuidos como 4 (25 por ciento) metástasis, 3 (19 por ciento) hiperplasias nodulares,3 (19 por ciento) adenomas corticales, 2 feocromocitomas, 1 cáncer, 1 an giomiolipoma, 1 hematoma y 1 linfangioma quístico. La TAC,ECO, cintigrafía, arteriografía y venografía permitieron (usando 1, 2 ó más de estos) el hallazgo o confirmación del diagnóstico, siendo la TAC el método más efectivo 10050 en los que se usó. El diagnóstico definitivo lo dió la histología en todos. El abordaje quirúrgico más usado fue la lumbotomía (87 por ciento) exepto para los feocromocitomas en los que se usó abordaje anterior. No hubo mortalidad operatoria y la morbilidad fue baja (2 por ciento). Concluciones: nuestra serie confinna que el diagnóstico de la patología adrenal puede ralizarse con bastante certeza en el preoperatorio. La TAC es el método de estudio de mayor rendimiento. Como procedimiento quirúrgico reglado, esta cirugía puede ser practicada con una baja morbimortalidad apoyada por un manejo perioperatorio adecuado estimulando su práctica como tratanúento electivo en diversas patologías adrenales

Hipercortisolismos / Hypercortisolisms

Se analiza la sintomatología y signología del hipercortisolismo que es un síndrome producido por la exposición prolongada del organismo a la acción de los glucocorticoides. Se revisan sus mecanismos patogénicos, destacando entre ellos las alteraciones primarias hipofisiarias y las corticosuprarrenales (hiperplasias y tumores). Hay también hipercortisolismos por producción ectópica de ATCH y por administración terapéutica de corticoesteroides. La clínica permite la sospecha diagnóstica pero el laboratorio la confirma a través de determinaciones hormonales (cortisol libre urinario) y localiza la lesión mediante expamens de imágenes. El tratamiento es básicamente quirúrgico

[The diagnosis of Cushing's disease by the nocturnal dexamethasone administration test]. / Diagnóstico de la enfermedad de Cushing mediante la prueba de administración nocturna de dexametasona.

Prospective study performed at the General Hospital, National Medical Center, XXI Century, Endocrinology Ward, Mexico-City, to compare the diagnostic sensitivity in Cushing's disease of the oral high doses (8 mg) dexametazone suppression test in single doses with nocturnal administration (DXM-N) and the classic doses of two days (DXM-C). Fourteen patients with hypercortisolism were studied; on thirteen the hypophyseal origin was surgical confirmed. Sensitivity of high doses of oral dexametazone test was proved by using serial samples of serum cortisol; the Fisher test was used for analysis of the suppression of serum cortisol after the test was done.

Tratamiento quirúrgico de los síndromes de hiperfuncion corticosuprarrenal / Surgical treatment of adrenal cortical hyperfunction syndros

Se presentan 20 pacientes adultos operados por hiperfunción corticosuprarrenalÑ 9 mostraron síndrome de Cushing (5 adenomas y 4 carcinomas), 6 hiperplasias por enfermedad de Cushing, 2 virilización, 2 hiperaldosteronismo y 1 feminización, confirmados por análisis de laboratorio. La TAC fue el método de localización preoperatorio de tumores adrenales más útil. Se encontró diferencia significativa en edad, duración de los síntomas y tamaño del tumor entre los pacientes con hipercortisolismo debido a adenoma y aquellos con carcinoma. La resección quirúrgica ofreció la curación a los pacientes con patología benigna, y un aceptable control de la enfermedad en carcinomas.

Tratamiento quirúrgico de los síndromes de hiperfuncion corticosuprarrenal / Surgical treatment of adrenal cortical hyperfunction syndros

Se presentan 20 pacientes adultos operados por hiperfunción corticosuprarrenalÑ 9 mostraron síndrome de Cushing (5 adenomas y 4 carcinomas), 6 hiperplasias por enfermedad de Cushing, 2 virilización, 2 hiperaldosteronismo y 1 feminización, confirmados por análisis de laboratorio. La TAC fue el método de localización preoperatorio de tumores adrenales más útil. Se encontró diferencia significativa en edad, duración de los síntomas y tamaño del tumor entre los pacientes con hipercortisolismo debido a adenoma y aquellos con carcinoma. La resección quirúrgica ofreció la curación a los pacientes con patología benigna, y un aceptable control de la enfermedad en carcinomas. (AU)