Aldridge C, Behrend E N, Kemppainen R J, Lee-Fowler T M, Martin L G, Ward C R, Bruyette D, Pannu J, Gaillard P, Lee H P
Department of Clinical Sciences, Auburn University, Auburn, AL.
Department of Anatomy, Physiology, and Pharmacology, Auburn University, Auburn, AL.
J Vet Intern Med. 2016 Sep;30(5):1637-1641. doi: 10.1111/jvim.14528. Epub 2016 Jul 18.
Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical.
To compare the cortisol response to 1 and 5 μg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC.
Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15).
In this prospective study, healthy dogs had consecutive ACTH stimulation tests to ensure 2 tests could be performed in sequence. For the first test, cosyntropin (1 μg/kg IV) was administered; the second test was initiated 4 hours after the start of the first (5 μg/kg cosyntropin IV). Dogs suspected of having HAC or being treated with mitotane were tested as the healthy dogs. Dogs receiving trilostane treatment were tested on consecutive days at the same time post pill using the low dose on day 1.
In dogs being treated with mitotane or trilostane, the 2 doses were pharmacodynamically equivalent (90% confidence interval, 85.1-108.2%; P = 0.014). However, in dogs suspected of having HAC, the doses were not pharmacodynamically equivalent (90% confidence interval, 73.2-92.8%; P = 0.37); furthermore, in 23% of the dogs, clinical interpretation of test results was different between the doses.
For dogs suspected of having HAC, 5 μg/kg cosyntropin IV is still recommended for ACTH stimulation testing. For dogs receiving mitotane or trilostane treatment, a dose of 1 μg/kg cosyntropin IV can be used.
降低促肾上腺皮质激素（ACTH）刺激试验所需的促肾上腺皮质激素释放激素剂量将使该测试更经济。
比较在接受高肾上腺皮质功能亢进症（HAC）筛查的犬以及接受曲洛司坦或米托坦治疗垂体依赖性HAC的犬中，静脉注射1μg/kg和5μg/kg促肾上腺皮质激素释放激素时皮质醇的反应。
健康犬（n = 10）；客户拥有的疑似患有HAC的犬（n = 39）或正在接受米托坦（n = 12）或曲洛司坦（n = 15）治疗垂体依赖性HAC的犬。
在这项前瞻性研究中，健康犬连续进行ACTH刺激试验以确保可以依次进行2次试验。第一次试验，静脉注射促肾上腺皮质激素释放激素（1μg/kg）；第二次试验在第一次试验开始4小时后开始（静脉注射5μg/kg促肾上腺皮质激素释放激素）。疑似患有HAC或接受米托坦治疗的犬与健康犬的测试方式相同。接受曲洛司坦治疗的犬在服药后相同时间连续几天进行测试，第1天使用低剂量。
在用米托坦或曲洛司坦治疗的犬中，2种剂量在药效学上等效（90%置信区间，85.1 - 108.2%；P = 0.014）。然而，在疑似患有HAC的犬中，这些剂量在药效学上不等效（90%置信区间，73.2 - 92.8%；P = 0.37）；此外，在23%的犬中，不同剂量之间测试结果的临床解读不同。
对于疑似患有HAC的犬，静脉注射ACTH刺激试验仍推荐使用5μg/kg促肾上腺皮质激素释放激素。对于接受米托坦或曲洛司坦治疗的犬，可使用1μg/kg静脉注射促肾上腺皮质激素释放激素剂量。
