Dechra Brand Guidelines

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Hyperadrenocorticism. From the dog they thought they’d lost. A new vitality found.

Diagnosis of Spontaneous Canine Hyperadrenocorticism

Eventuallydeathmay result from thecomplicationsofuntreatedHAC thatcan includediabetesmellitus, systemichypertension,pancreatitis, urolithiasisandpulmonary thromboembolism ii However, farbefore thatHACwillhave significantlyaffected thequality of lifeofbothdogand itsowner.

Aconsensus statement i published in theJournalofVeterinary InternalMedicine in2013offersa consensusopinionon thediagnosisof spontaneouscaninehyperadrenocorticismand the reader is advised to read the statement for furtherdetail. ClinicalPresentation: Indications forDiagnosticTesting • Thepossibility thatapatienthashyperadrenocorticism (HAC) isbasedon thehistory andphysicalexamination.Endocrine tests shouldbeperformedonlywhenclinical signsconsistent withHACarepresent. • Theprimary indication forpursuingadiagnosisofHAC is thepresenceofoneormore of thecommonclinical signsandphysicalexaminationfindings (Table1). • Themoreabnormalities identified, the stronger the indication topursue testing. • If lesscommonclinicalpresentationsare identifiedfirst,a thorough reviewof thehistory, physicalexaminationfindings,and routine laboratory test results (Table2)oftenprovidesadditional evidence for thedisease. • Failure to identifyabnormalities listed inTables1and2 isamajornegative indicator for thepresenceofHAC. Biochemicalpanel,haematology,urinalysis,andurineprotein :creatinine ratio resultsandblood pressuremeasurementby themselvesarenot indications to test. Screening tests No test forHAChas100%diagnosticaccuracy.Whichever test ischosen, thediagnosticperformance of the testwillbe significantlyenhancedby increasing theprevalenceof thedisease in thepopulation under testbyperformingendocrine testsonlywhenclinical signsconsistentwithHACarepresent. DiagnosisofHACdependsondemonstrationofeither: 1) increasedcortisolproductionor 2) decreased sensitivityof thehypothalamic-pituitary-adrenalaxis (HPAA) to negativeglucocorticoid feedback. Any screening testmaybenegative inapatientwithHAC. Ifa test isnegativebut suspicion for HAC remains,another test shouldbeperformed. Ifmore thanone test isnegative, thepossibility that thepatientdoesnothaveHACmustbeconsidered.Alternatively, thepatientmayhavemildHAC and the testshavenot yetbecomepositive. Itmaybeworthwhile to retest in3–6months ifclinical signsprogress.

11-year-oldDachshunddisplaying typical signsofhyperadrenocorticism. ©Dr.S.Galac

taneousCanineHyperadrenocorticism: 2012ACVIMConsensusStatement

- to treator not to treat?UKVet 14(6): 1-5 on serum concentrations of aldosterone, cortisol andpotassium indogswith ism.AJVR 65(9): 245-50 e-daily, lowdose trilostane treatment administered orally indogswith naturally A 232(9): 1321-132 ly lower-dose trilostane treatment administeredorally indogswith naturally A 238: 1441-1451 nce and twicedaily administrationof trilostane todogswith xisKleintiere 40: 415-424 gh-dose trilostane treatment indogs (<5 kg)withpituitary-dependent

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10-year-oldBoxerdisplaying typical signsofhyperadrenocorticism. ©Dr.S.Galac

April2014

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