Zycortal Symposium Proceedings

Clinical Signs

Hypoadrenocorticism is associated with a range of clinical signs that vary from mild to severe, fluctuating to persistent and from acute to chronic. It is easy to miss cases. Clinicians should expect the unexpected with hypoadrenocorticism – and yet cannot perform ACTH stimulation tests on every case. This can make recognition of the condition challenging and it is therefore important to include hypoadrenocorticism as a potential differential diagnosis of numerous non-specific signs. The common and not so common clinical signs are summarised in Table 1 (below).

Common

Lethargy Anorexia Vomiting Poor peripheral pulses

Weakness Collapse Poor body condition Shock

Uncommon

Diarrhoea GI haemorrhage Weight loss Seizures

Abdominal pain PU/PD Muscle cramps Regurgitation

The historical findings may be vague, such as weight loss, lethargy and inappetence, or they may be more specific e.g. chronic gastrointestinal signs such as abdominal pain, melena or haematochezia or neurological abnormalities (episodic collapse). It is easy to confuse hypoadrenocorticism with other conditions. Physical examination findings can be as variable as the history and, unless the patient has been presented in a state of collapse, there are often no significant findings on examination. All of the clinical signs can respond to treatment with fluids (and/or steroids), and some will appear to respond to other treatments because of the relapsing nature of the condition. A significant minority of patients can present following acute collapse with no previously noted clinical signs, however the majority have a longer history on closer questioning of the owner.

There are no clinical signs that can be considered truly pathognomic however there are a few findings that can significantly increase the clinician’s suspicion of disease:

• Bradycardia or a normal heart rate despite findings of hypovolemia.

• More severe hypovolemia than would be expected from the fluid losses (vomiting and diarrhoea) reported.

• Poor body condition despite only a recent history of disease.

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