Hoffrogge Stefanie, Fels Lena, Schmicke Marion, Mischke Reinhard
Prof. Dr. Reinhard Mischke, Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 9, 30559 Hannover, E-Mail:
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2017 Jun 20;45(3):186-192. doi: 10.15654/TPK-160255. Epub 2017 Apr 27.
In a 12-year-old male Labrador Retriever, presented due to other disease symptoms, clinical signs of hyperadrenocorticism (polyuria, polydipsia, abdominal distention, muscle atrophy) were an incidental finding. Abnormal laboratory results and sonographic findings of the adrenal glands, but negative low-dose dexamethasone suppression tests with low basal cortisol concentrations, a negative andrenocorticotropic hormone (ACTH)-stimulation test and exclusion of iatrogenic hyperadrenocorticism, suggested an atypical hyperadrenocorticism (AHAC). Results of further examinations, particularly stimulation of progesterone production by ACTH (0 h value: 0.21 ng/ml; 1 h value: 4.9 ng/ml) and good response to therapy with trilostane, supported this diagnosis. However, it has to be critically considered, whether and to what extent additionally present diseases (arthroses, testicular tumour) played a role regarding the symptoms and laboratory results in this dog. This case illustrates the difficulties with the diagnosis of AHAC.
在一只12岁的雄性拉布拉多猎犬身上，因其他疾病症状就诊时，意外发现了肾上腺皮质功能亢进的临床体征（多尿、多饮、腹胀、肌肉萎缩）。实验室检查结果及肾上腺超声检查结果异常，但基础皮质醇浓度较低的低剂量地塞米松抑制试验呈阴性，促肾上腺皮质激素（ACTH）刺激试验阴性，且排除了医源性肾上腺皮质功能亢进，提示为非典型肾上腺皮质功能亢进（AHAC）。进一步检查结果，特别是ACTH刺激孕酮生成的结果（0小时值：0.21纳克/毫升；1小时值：4.9纳克/毫升）以及曲洛司坦治疗反应良好，支持了这一诊断。然而，必须审慎考虑另外存在的疾病（关节病、睾丸肿瘤）在多大程度上对该犬的症状和实验室检查结果产生了影响。该病例说明了AHAC诊断的困难之处。
