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对疑似肾上腺皮质功能减退的犬进行低剂量促肾上腺皮质激素刺激试验。

Low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism.

作者信息

Botsford Annabel, Behrend Ellen N, Kemppainen Robert J, Gaillard Philippe R, Oprandy Frank, Lee Hollie P

机构信息

Department of Clinical Sciences, Auburn University, Auburn, Alabama.

Atlantic Veterinary Internal Medicine and Oncology, Columbia, Maryland.

出版信息

J Vet Intern Med. 2018 Nov;32(6):1886-1890. doi: 10.1111/jvim.15256. Epub 2018 Sep 19.

Abstract

BACKGROUND

Low-dose ACTH stimulation testing would lower cost and may increase sensitivity for identification of partial ACTH deficiency.

HYPOTHESIS

(1) The low-dose ACTH stimulation test will provide comparable results to the standard-dose ACTH stimulation test in dogs suspected of hypoadrenocorticism and (2) partial ACTH deficiency exists in dogs and can result in chronic, intermittent gastrointestinal signs.

ANIMALS

Thirty-one client-owned dogs suspected of having hypoadrenocorticism.

METHODS

Prospective study. Dogs suspected of having hypoadrenocorticism received 1 μg/kg cosyntropin IV for the first ACTH stimulation test; the second test was performed 4 h later and dogs received 5 μg/kg cosyntropin IV. Blood samples were obtained pre-ACTH and 1 hour post-ACTH for each dose (4 measurements total). Samples for endogenous ACTH measurement were obtained at the time of initial blood collection.

RESULTS

No significant difference was observed in the basal cortisol concentration before administration of a 1 μg/kg versus before a 5 μg/kg dose of cosyntropin (P = .544). For dogs suspected of having hypoadrenocorticism, the ACTH-stimulated cortisol concentrations in response to both doses of ACTH were equivalent (90% confidence interval [CI], 80.5-97.2%; P = .04). No cases with partial ACTH deficiency were identified conclusively.

CONCLUSIONS AND CLINICAL IMPORTANCE

A 1 μg/kg dose of cosyntropin is equivalent to a 5 μg/kg dose of cosyntropin for screening dogs suspected of hypoadrenocorticism. The existence of partial ACTH deficiency was not identified in this small group of dogs.

摘要

背景

低剂量促肾上腺皮质激素(ACTH)刺激试验可降低成本,并可能提高识别部分ACTH缺乏症的敏感性。

假设

(1)低剂量ACTH刺激试验在疑似肾上腺皮质功能减退的犬中产生的结果与标准剂量ACTH刺激试验相当;(2)犬存在部分ACTH缺乏症,可导致慢性间歇性胃肠道症状。

动物

31只客户拥有的疑似肾上腺皮质功能减退的犬。

方法

前瞻性研究。疑似肾上腺皮质功能减退的犬在首次ACTH刺激试验中静脉注射1μg/kg的促肾上腺皮质激素;4小时后进行第二次试验,犬静脉注射5μg/kg的促肾上腺皮质激素。在每次注射ACTH前和注射后1小时采集血样(共4次测量)。在首次采血时采集用于测量内源性ACTH的样本。

结果

在注射1μg/kg促肾上腺皮质激素前与注射5μg/kg促肾上腺皮质激素前的基础皮质醇浓度之间未观察到显著差异(P = 0.544)。对于疑似肾上腺皮质功能减退的犬,两种剂量ACTH刺激后的皮质醇浓度相当(90%置信区间[CI],80.5 - 97.2%;P = 0.04)。未明确鉴定出部分ACTH缺乏症的病例。

结论及临床意义

对于筛查疑似肾上腺皮质功能减退的犬,1μg/kg剂量的促肾上腺皮质激素与5μg/kg剂量相当。在这一小群犬中未发现部分ACTH缺乏症的存在。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de27/6272038/97ed17393878/JVIM-32-1886-g001.jpg

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