Autoimmune polyendocrine syndrome in a standard poodle with concurrent non‐endocrine immune‐mediated diseases

Abstract

A 6-year-old female neutered standard poodle was referred with a 4-week history of rapidly progressive weight loss, muscle atrophy, hyporexia, hind limb weakness and lethargy. In the preceding 3-month period, the dog had been diagnosed with both keratoconjunctivitis sicca (KCS) and hypoadrenocorticism. Clinical deterioration had occurred despite treatment for hypoadrenocorticism. Following referral, the dog was diagnosed with concurrent hypothyroidism, exocrine pancreatic insufficiency (EPI) and suspected generalised myositis. Treatment with hormone replacement therapy, pancreatic enzyme supplementation and immunosuppressive doses of prednisolone and mycophenolate resulted in marked clinical improvement. This case describes a rapidly progressive, presumed autoimmune, polyglandular endocrinopathy in a dog with concurrent non-endocrine autoimmune diseases.

Histopathological evaluation of the adrenal glands in a cat with primary hypoadrenocorticism and multiple endocrine disease

“…Multiple endocrinopathies can occur in dogs with hypoadrenocorticism, with concurrent hypothyroidism being most common, but DM is also reported, and similarities have been drawn to autoimmune polyendocrine syndrome type II in humans. 6 – 10 , 19 , 20 However, neither histopathology of the endocrine organs nor serological testing for autoantibodies in these specific cases were performed to further assess this, and the autoimmune basis of canine DM has recently been drawn into question. 21 , 22 Multiple endocrine disease in a cat including hypoadrenocorticism has not yet been reported.…”

“…In dogs, PH can occur with other endocrinopathies; a concurrent endocrinopathy in feline PH has yet to be reported. 6 – 10 …”

“…4,5 In dogs, PH can occur with other endocrinopathies; a concurrent endocrinopathy in feline PH has yet to be reported. [6][7][8][9][10] We document a case of feline non-neoplastic-associated PH that developed diabetes mellitus (DM), and additionally report the adrenal histopathological findings including immunohistochemistry (IHC) staining.…”

Concurrent hypoadrenocorticism, immune‐mediated thrombocytopenia and immune‐mediated haemolytic anaemia in a Jack Russell Terrier dog

“…Thus there exists the concept of a mosaic of immune-mediated disease: concurrent or closely sequential presentation of two or more diseases suspected to be, or confirmed as, immune mediated. [6][7][8][9][10][11] Concurrent or sequential IMHA and IMTP (so-called Evans' syndrome) is well documented in human medicine 12 and canids infrequently present similarly. 13,14 Evans' syndrome can present with concurrent autoimmunity in people, most commonly associated with systemic lupus erythematosus.…”

“…It is not always known if concurrent immune‐mediated diseases in the same patient are coincidental or reflective of a common aetiopathogenesis, though the latter is often considered likely via an underlying predisposition (genetic, environmental) or immune trigger (infective, neoplastic, drug/toxin). Thus there exists the concept of a mosaic of immune‐mediated disease: concurrent or closely sequential presentation of two or more diseases suspected to be, or confirmed as, immune mediated 6–11 …”