Canine Pancreatic‐Specific Lipase Concentrations in Clinically Healthy Dogs and Dogs with Naturally Occurring Hyperadrenocorticism

BackgroundDogs with hyperadrenocorticism (HAC) may be more mildly affected at the time of diagnosis today, which could influence the prevalence of associated clinical and clinicopathological abnormalities and diagnostic test performance. Different low‐dose dexamethasone suppression test (LDDST) result patterns have not been evaluated individually.ObjectivesTo assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ.AnimalsOne hundred and twenty‐three dogs undergoing investigation for HAC.MethodsRetrospective evaluation of dogs in which a LDDST was performed and HAC confirmed or excluded by alternative means. Cases with basal cortisol concentrations (t 0) < 1 μg/dL were excluded. Each LDDST result was classified as (a) complete suppression (t 3 and t 8 < 1 μg/dL), (b) lack of suppression (t 3 and t 8 > 1 μg/dL and both > 50% t 0), (c) partial suppression (t 3 and t 8 > 1 μg/dL but either < 50% t 0), (d) escape (t 8 > 1 μg/dL and t 3 < 1 μg/dL) or (e) inverse (t 3 > 1 μg/dL and t 8 < 1 μg/dL) pattern.ResultsFifty‐nine (48%) dogs were diagnosed with HAC and 64 (52%) with non‐adrenal illness. Hyperadrenocorticism cases had similar clinicopathological abnormalities compared to previous reports. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (95% confidence interval [CI]) of the LDDST for diagnosing HAC were 96.6 (91.9‐100)%, 67.2 (55.7‐78.7)%, 73.1 (63.2‐82.9)%, and 95.6 (89.5‐100)%, respectively. Lack of suppression pattern had the highest PPV (93.9 [85.8‐100]%) followed by the partial suppression pattern (67.9 [50.6–85.2]%) and escape or inverse pattern (36.8 [15.1–58.5]%).Conclusions and Clinical ImportanceA lack of suppression LDDST pattern has the highest PPV for diagnosing HAC followed by a partial suppression pattern. By contrast, the escape or inverse pattern provided limited support of HAC.

Section: Discussionsupporting

confidence: 80%

supporting

confidence: 81%

Evaluation of individual low‐dose dexamethasone suppression test patterns in naturally occurring hyperadrenocorticism in dogs

Bennaim

Shiel

Forde

et al. 2018

“…Increases in Spec cPL concentration and increased numbers of SNAP cPL positive results were reported in dogs with naturally occurring hyperadrenocorticism, even when there was no evidence of clinical pancreatitis. 28 Similarly, hyperadrenocorticism in some of the dogs in our study could potentially explain some cases with increased lipase immunoassay concentrations or positive SNAP cPL results in the absence of a diagnosis of clinical pancreatitis (based on the consensus internist scores). Three patients (6%) in our study had suspected hyperadrenocorticism.…”

Section: Discussionmentioning

confidence: 66%

Evaluation of SNAP cPL, Spec cPL, VetScan cPL Rapid Test, and Precision PSL Assays for the Diagnosis of Clinical Pancreatitis in Dogs

Cridge

MacLeod²,

Pachtinger³

et al. 2018

109

BackgroundThe sensitivity, specificity, and agreement of 4 diagnostic assays (SNAP canine pancreatic lipase (cPL), specific cPL (Spec cPL), VetScan cPL Rapid Test, and Precision PSL) for pancreatitis in dogs have not been directly compared.Hypothesis/ObjectivesTo determine the level of agreement among each of the 4 assays and a clinical suspicion score, level of agreement among the assays, and sensitivity and specificity of each assay in a clinically relevant patient group.AnimalsFifty client‐owned dogs with clinical signs of gastrointestinal disease.MethodsProspective study. History, physical examination, complete blood count, serum biochemistry, abdominal ultrasound examination, and the 4 diagnostic assays for pancreatitis were performed. Intraclass correlation coefficients (ICC) were used to determine the level of agreement between each assay and a clinical suspicion score determined by a panel of 5 board‐certified veterinary internists.ResultsThe ICC between the clinical suspicion score and the 4 assays were SNAP cPL, 0.61; Spec cPL, 0.68; VetScan cPL Rapid Test, 0.68; and Precision PSL, 0.60. The sensitivities of the assays ranged from 73.9 to 100.0%, whereas the specificities were SNAP cPL, 71.1–77.8%; Spec cPL, 74.1–81.1%; VetScan cPL Rapid Test, 76.9–83.8%; and Precision PSL, 64.0–74.3%.Conclusions and Clinical ImportanceA good to excellent level of agreement was demonstrated among the 4 assays. The previously unreported sensitivity and specificity of the VetScan cPL Rapid Test were 73.9–83.3% and 76.9–83.8%, respectively. Results of any of the 4 diagnostic assays alone, in the absence of supporting clinical findings, are insufficient to establish a diagnosis of clinical pancreatitis in dogs.

“…Therefore, the authors recommend that a quantitative pancreatic lipase assay should be performed in addition to an AUS in all dogs being assessed for pancreatitis. One potential explanation for the lower correlation between UPASS and Spec cPL than between UPASS and CDx is that primary nonpancreatic diseases and steroid treatment have been associated with an above reference interval Spec cPL concentration, although the clinical relevance of these increases are often unknown …”

Section: Discussionmentioning

confidence: 99%

“…explanation for the lower correlation between UPASS and Spec cPL than between UPASS and CDx is that primary nonpancreatic diseases and steroid treatment have been associated with an above reference interval Spec cPL concentration, although the clinical relevance of these increases are often unknown. 21,[26][27][28][29][30][31][32] When evaluating individual components of the UPASS, this study . This is likely due to the fact that diseases other than pancreatitis cause pancreatic edema, including hypoalbuminemia and portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis

Cridge

Sullivant

Wills

et al. 2020

Background A clinical diagnosis (CDx) of pancreatitis includes evaluation of clinical signs, abdominal ultrasound (AUS), and pancreatic lipase. However, practitioners are using AUS to diagnose pancreatitis and are using AUS severity to guide decisions. The validity of this is unknown. Objectives To determine whether (1) there is a correlation between AUS, specific canine pancreatic lipase (Spec cPL) assay, and CDx; (2) individual AUS abnormalities correlate more closely with CDx than others; (3) AUS severity mirrors clinical severity indices; (4) changes in AUS can be used as a marker for changes in Spec cPL or CDx; and (5) the sensitivity and specificity of AUS for pancreatitis. Animals One hundred fifty‐seven dogs. Methods In this retrospective case study, inclusion criteria were signs of gastrointestinal, pancreatic disease, or both, in addition to having a Spec cPL and AUS performed within 30 hours. Information extracted from the records included bloodwork, Spec cPL, AUS images/clips, and severity of ultrasonographic findings. Results AUS was weakly correlated with Spec cPL (rs = .0178, P = .03) and moderately correlated with CDx (rs = .379, P = <.001). Pancreatic size (rs = .285, P = <.001), echogenicity (rs = .365, P = <.001), and mesenteric echogenicity (rs = .343, P = <.001) were correlated with CDx. Change in AUS was not correlated with Spec cPL or CDx changes. When pancreatic enlargement, echogenicity, or altered mesenteric echogenicity were required for a diagnosis, the sensitivity and specificity were 89% (95% confidence interval [CI] 71.8, 97.7) and 43% (95% CI 34.0, 51.6). When all 3 criteria were required, the sensitivity and specificity were 43% (95% CI 24.5, 62.8) and 92% (95% CI 85.3, 95.7). Conclusions AUS should not be used in isolation to diagnose pancreatitis and is a poor indicator of severity.