Concurrent hyperadrenocorticism and diabetes mellitus in dogs

Miceli, Diego Daniel; Pignataro, Omar Pedro; Castillo, V.

doi:10.1016/j.rvsc.2017.07.026

Cited by 34 publications

(37 citation statements)

References 48 publications

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“…However, the breeds most reported in our study are also popular in our region, and the fact that they were overrepresented in this population does not absolutely means that they are more prone to HAC. Nevertheless, the breeds reported here are also commonly described in other South America and worldwide studies (Gallelli et al 2010, Nozawa et al, 2014, Fracassi et al, 2015, Caragelasco et al 2017, Miceli et al, 2017, Bennaim et al 2019. Moreover, mongrel dogs may be less represented due to eventual owner´s economic or even social conditions.…”

Section: Discussionmentioning

confidence: 66%

“…It is likely that the condition happens due to chronic glucocorticoid-induced insulin resistance, with a lower lipoprotein lipase activation and greater hormone-sensitive lipase activation. Miceli et al (2017) have observed that dogs with fasting blood glucose levels above 105mg/dL, with dyslipidemia (triglycerides >221.2mg/dL and hypercholesterolemia >350mg/dL), and cortisol:creatinine ratio >100 x 10 -6 , present greater risk of diabetes mellitus developing. The study highlights that 93.7% of the dogs with HAC and DM presented ACTH-dependent HAC, indicating a higher predisposition of this group to develop diabetes mellitus, and even suggests preventive insulin therapy.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014)

et al. 2019

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Diseases’ clinical-epidemiological characterization assists in directing the diagnosis. The objective of this study was to describe epidemiological, clinical and laboratorial aspects of a case series of canine hyperadrenocorticism (HAC). One-hundred fifteen records of dogs diagnosed by the low dose dexamethasone suppression test and/or ACTH stimulation test were evaluated. Of the cases, 81.3% were HAC ACTH-dependent and 18.7% HAC ACTH-independent. Females were more affected, representing 69.3% of the cases. The mean age was 10.3±2.5 years and 64.9% were gonadectomized. Most of the patients were small size dogs, weighting less than 10kg (73.9%). The most frequent breeds were: Poodle (27%), Dachshund (17.4%), and Yorkshire Terrier (10.4%). The most frequent clinical manifestations were polyphagia (86%), polydipsia (82.6%), polyuria (80%), abdominal enlargement (82.6%), thin skin (79.1%), muscular weakness (78.3%) and panting (74.8%). However, eventually unusual HAC-associated signs would be present in some dogs in a more important way compared with the classic disease´s clinical signs. The CBC showed neutrophilia (66%), eosinopenia (58.3%) and lymphopenia (42.6%) as main hematological abnormalities. The most common findings in serum biochemistry were increased alkaline phosphatase activity (81.74%), increased ALT activity (62.6%), hypercholesterolemia (66%) and hypertriglyceridemia (54.7%). Urinalysis revealed hyposthenuria in 14.9% and isostenuria in 13.5%; besides proteinuria in 50% of the cases. Abdominal ultrasound showed bilateral adrenal hyperplasia (92.2%) with adrenal asymmetry in 20.8% of the cases, in addition to hepatomegaly (80.9%), biliary sludge (67.8%) and hepatic hyperechogenicity (47.8%). It was concluded that small size gonadectomized female dogs, mainly Poodles and Dachshunds, presented higher frequency in the population studied, and that the main changes observed in clinical and complementary tests were polyphagia, polyuria, polydipsia, abdominal enlargement, adrenal hyperplasia, increased phosphatase alkaline and hyperlipidemia. These results corroborated to a better disease characterization at Brazil. This work concluded that the population studied resembles the profile describe in European and North American epidemiologic studies, and that the HAC dog´s clinical picture looks similar worldwide.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014)

et al. 2019

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“…In regard to intragroup variation, the HOMAβ-cell function decreased significantly at 3 months in both the control group (P < 0.01) and the metformin group (P < 0.001), with the most pronounced decrease observed in the metformin group. Discussion In both dogs and humans with HAC, the comorbidities associated with hypercortisolism (hypertension, nephropathy, pulmonary thromboembolism, pancreatitis and diabetes mellitus) are the cause of patient death (Nichols, 1997;Ferraú and Korbonits, 2015;Miceli et al, 2017). http://www.openveterinaryjournal.com D.D.…”

Section: Homeostatic Model Assessment (Homa) For Insulin Sensitivity mentioning

confidence: 99%

“…In contrast, some dogs with HAC that were not treated with metformin showed increased levels of glucose and triglycerides, despite having started the treatment for HAC. These increases may be due to individual differences of each dog to either the severity of the disease, resistance to therapy with ketoconazole or cabergoline, or persistence of the adverse effects of hypercortisolism (Vegiopoulos and Herzig, 2007;Castillo et al, 2008;Barahona et al, 2010;Miceli et al, 2012Miceli et al, , 2017. To date, no studies have described the effects of metformin in dogs with HAC, but there have been several reports in diabetic cats.…”

Section: Homeostatic Model Assessment (Homa) For Insulin Sensitivity mentioning

confidence: 99%

“…These metabolic disorders are clinically characterised by fasting hyperglycaemia, hypercholesterolaemia, hypertriglyceridaemia, abdominal obesity, hepatic steatosis and diabetes mellitus (Peterson et al, 1984;Pivonello et al, 2010;Di Dalmazi et al, 2012). Between 5% and 22% of dogs with HAC develop diabetes mellitus (Peterson et al, 1981;Nichols, 1994;Ishino et al, 2010;Gomes Pöppl et al, 2016;Miceli et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Metformin reduces insulin resistance and the tendency toward hyperglycaemia and dyslipidaemia in dogs with hyperadrenocorticism

Miceli¹,

Vidal²,

Batter³

et al. 2018

Open Vet J.

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Hypercortisolism induces a state of insulin resistance that can occur concurrently with fasting hyperglycaemia, dyslipidaemia and diabetes mellitus. Metformin reduces hepatic glucose production and insulin resistance of the skeletal muscle and adipose tissue. The aim of this study was to evaluate the effects of metformin on the control of metabolic disorders of dogs with hyperadrenocorticism (HAC). Twenty-three dogs with HAC were randomly divided into two groups, consisting of a control group and a metformin group (10 mg metformin/kg/12 h). Both groups received the same treatment for HAC. At baseline and 3 months, blood glucose, total cholesterol, triglycerides and insulin concentrations, in addition to urinary cortisol:creatinine ratio, Homeostatic Model Assessment (HOMA) for insulin sensitivity and β-cell function were measured. Dogs treated with metformin showed significantly reduced glycaemia, cholesterolaemia and triglyceridaemia. They also presented reduced hyperinsulinism and insulin resistance, as well as improved pancreatic β-cell function. The implementation of metformin as an adjuvant therapy is effective for the normalisation of metabolic disorders of dogs with HAC.

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Survival of dogs with pituitary‐dependent hyperadrenocorticism treated twice daily with low doses of trilostane

et al. 2022

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Background Twice daily low trilostane doses have proven to be effective to manage canine Cushing's syndrome. However, survival and prognostic factors in dogs treated with this protocol have not been evaluated. The aim of the study was to evaluate survival and prognostic factors, including systolic blood pressure (SBP) at diagnosis, in dogs with pituitary‐dependent hypercortisolism (PDH) treated with low trilostane doses. Methods Medical records of 91 dogs newly diagnosed with PDH initially treated with 0.2–1.1 mg/kg of trilostane twice daily were retrospectively included. Survival times were calculated using the Kaplan–Meier estimator. Univariable and multivariable analysis were performed using the Cox proportional hazard regression analysis. Results Overall, median survival was 998 days (range 26–1832 days, 95% confidence interval = 755–1241 days). In the multivariable analysis, age (hazard ratio [HR] = 1.337, p < 0.001), presence of calcinosis cutis (HR = 5.271, p < 0.001), body condition score (BCS) ≤3/9 (HR = 8.100, p < 0.001) and higher platelet count (HR = 1.002, p = 0.022) were negatively correlated with survival. SBP was not associated with survival. Conclusions Low‐dose trilostane treatment twice daily provides slightly longer survival than previously reported for dogs with PDH treated once or twice daily at higher doses. Older age, presence of calcinosis cutis, low BCS and higher platelet count, but not systemic hypertension, are predictive of poorer prognosis in dogs with PDH.

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Concurrent hyperadrenocorticism and diabetes mellitus in dogs

Cited by 34 publications

References 48 publications

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014)

Epidemiological, clinical, and laboratory aspects in a case series of canine hyperadrenocorticism: 115 cases (2010-2014)

Metformin reduces insulin resistance and the tendency toward hyperglycaemia and dyslipidaemia in dogs with hyperadrenocorticism

Survival of dogs with pituitary‐dependent hyperadrenocorticism treated twice daily with low doses of trilostane

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