Cartwright J A, Stone J, Rick M, Dunning M D
Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG.
Pride Veterinary Centre, Derbyshire DE24 8HX.
J Small Anim Pract. 2016 Sep;57(9):491-4. doi: 10.1111/jsap.12535. Epub 2016 Aug 3.
A three-year-old, female neutered, Dobermann pinscher was presented for investigation of lethargy, episodic collapse, ataxia and myxoedema. Primary hypothyroidism and primary cortisol-deficient hypoadrenocorticism were diagnosed based on history, physical examination and compatible hormonal analysis. Increased serum concentrations of thyroglobulin autoantibodies and 21-hydroxylase autoantibodies indicated an immune-mediated aetiology. The case was complicated by lymphadenopathy with hand-mirror lymphocytes, classically identified in lymphoma. A polymerase chain reaction test for antigen receptor rearrangement indicated polyclonality and therefore reactive lymphadenopathy. The dog's clinical signs resolved following introduction of levothyroxine and prednisolone. Prioritising the problem-based approach in this case facilitated the diagnosis of hypoadrenocorticism in addition to hypothyroidism due to the persistence of clinical signs despite thyroxine replacement. Importantly, atypical adrenal gland dysfunction was not misinterpreted as inadequate therapeutic response to thyroxine supplementation. The observation that polyglandular endocrinopathy type II can occur in dogs suggests that in dogs with a suboptimal response to treatment for hypothyroidism or hypoadrenocorticism comorbid endocrinopathies should be investigated.
一只三岁已绝育的雌性杜宾犬因嗜睡、发作性虚脱、共济失调和黏液性水肿前来就诊。根据病史、体格检查和相关激素分析,诊断为原发性甲状腺功能减退和原发性皮质醇缺乏性肾上腺皮质功能减退。血清甲状腺球蛋白自身抗体和21-羟化酶自身抗体浓度升高表明病因是免疫介导的。该病例因淋巴结病伴有手镜状淋巴细胞而复杂化,这在淋巴瘤中经典可见。抗原受体重排的聚合酶链反应检测显示为多克隆性,因此为反应性淋巴结病。在使用左甲状腺素和泼尼松龙后,犬的临床症状得到缓解。在该病例中优先采用基于问题的方法,除了甲状腺功能减退外,还促进了肾上腺皮质功能减退的诊断,因为尽管补充了甲状腺素,但临床症状仍然持续。重要的是,非典型肾上腺功能障碍没有被误解为对甲状腺素补充治疗反应不足。观察到II型多内分泌腺病可发生在犬身上,这表明对于甲状腺功能减退或肾上腺皮质功能减退治疗反应欠佳的犬,应调查是否存在合并的内分泌病。