Richartz J, Neiger R
Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, der Justus-Liebig-Universität Gießen, Frankfurter Straße 126, 35392 Gießen.
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2011;39(3):163-9.
Evaluation of all dogs with hypoadrenocorticism (hAC) without classic electrolyte abnormalities that had been admitted during the previous 3.75 years.
Criteria for inclusion in this study were a confirmed diagnosis of hypoadrenocorticism (cortisol concentration before and after ACTH application <2 µg/dl) accompanied by a normal sodium:potassium ratio (≥ 27). Hyperkalaemic animals or those with a history of glucocorticoid, trilostane or mitotane administration were excluded. Information including signalement, history, physical examination, results of complete blood count, serum biochemical analysis, ACTH stimulation test, other laboratory tests and diagnostic imaging findings as well as information on the therapy were evaluated. Outcome, management and development of electrolyte shifts were assessed by owner telephone contact.
Seven dogs (among those two poodles) fulfilled the inclusion criteria. The median age was 3.6 years. The most common clinical signs observed were diarrhoea, vomiting, inappetence and lethargy. The median sodium-potassium ratio was 38 (27-41). One dog developed electrolyte abnormalities after 5 months. Prednisolone was given to five dogs while one dog received fludrocortisone. In one dog repeating of the ACTH stimulation test was recommended before the initiation of therapy. One dog was euthanized because of other problems 21 months after diagnosis. The other patients responded well to therapy and are in a good general condition at present. Two of them occasionally have diarrhoea.
Atypical hAC is an important disease in dogs with recurrent chronic gastrointestinal signs seen mainly in young animals with non-specific historical and physical findings. Therefore, an ACTH stimulation test should be considered before invasive diagnostic tests like endoscopy are performed in these patients. Since some dogs with primary hAC eventually develop classical electrolyte abnormalities serum electrolyte concentrations should be monitored regularly.
评估在过去3.75年期间收治的所有无典型电解质异常的肾上腺皮质功能减退症（hAC）犬只。
本研究的纳入标准为确诊肾上腺皮质功能减退症（促肾上腺皮质激素应用前后皮质醇浓度<2μg/dl）且钠钾比正常（≥27）。排除高钾血症动物或有糖皮质激素、曲洛司坦或米托坦用药史的动物。评估包括信号、病史、体格检查、全血细胞计数结果、血清生化分析、促肾上腺皮质激素刺激试验、其他实验室检查和诊断性影像学检查结果以及治疗信息。通过与主人电话联系评估结果、管理和电解质变化情况。
7只犬（其中2只为贵宾犬）符合纳入标准。中位年龄为3.6岁。观察到的最常见临床症状为腹泻、呕吐、食欲不振和嗜睡。中位钠钾比为38（27 - 41）。1只犬在5个月后出现电解质异常。5只犬给予泼尼松龙，1只犬接受氟氢可的松治疗。建议1只犬在开始治疗前重复进行促肾上腺皮质激素刺激试验。1只犬在诊断后21个月因其他问题安乐死。其他患者对治疗反应良好，目前总体状况良好。其中2只偶尔有腹泻。
非典型hAC是一种重要疾病，见于反复出现慢性胃肠道症状的犬只，主要发生在年轻动物，其病史和体格检查结果不具特异性。因此，在对这些患者进行内镜检查等侵入性诊断试验之前，应考虑进行促肾上腺皮质激素刺激试验。由于一些原发性hAC犬最终会出现典型的电解质异常，应定期监测血清电解质浓度。
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