Development and internal validation of a prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary‐care practice

Schofield, Imogen; Brodbelt, David; Niessen, Stijn; Church, David; Geddes, Rebecca; Kennedy, Noel; O'Neill, D G

doi:10.1111/jvim.15851

Cited by 10 publications

(12 citation statements)

References 58 publications

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“…Machine learning methods have been applied to a wide range of clinical syndromes in people and veterinary medicine 9‐13 and can detect subtle patterns that allow for the early detection of disease. The gold standard diagnostic test for HA, serum cortisol measurement, has several shortcomings including the need for a clinician to recognize the need for the diagnostic test, prolonged turnaround time in some settings, increased cost to the client, and the need for specialized laboratory equipment to measure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a machine learning tool to screen for hypoadrenocorticism in dogs presenting to a teaching hospital

Reagan

Pires

Quach

et al. 2022

Veterinary Internal Medicne

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Background Dogs with hypoadrenocorticism (HA) have clinical signs and clinicopathologic abnormalities that can be mistaken as other diseases. In dogs with a differential diagnosis of HA, a machine learning model (MLM) has been validated to discriminate between HA and other diseases. This MLM has not been evaluated as a screening tool for a broader group of dogs. Hypothesis An MLM can accurately screen dogs for HA. Animals Dogs (n = 1025) examined at a veterinary hospital. Methods Dogs that presented to a tertiary referral hospital that had a CBC and serum chemistry panel were enrolled. A trained MLM was applied to clinicopathologic data and in dogs that were MLM positive for HA, diagnosis was confirmed by measurement of serum cortisol. Results Twelve dogs were MLM positive for HA and had further cortisol testing. Five had HA confirmed (true positive), 4 of which were treated for mineralocorticoid and glucocorticoid deficiency, and 1 was treated for glucocorticoid deficiency alone. Three MLM positive dogs had baseline cortisol ≤2 μg/dL but were euthanized or administered glucocorticoid treatment without confirming the diagnosis with an ACTH‐stimulation test (classified as “undetermined”), and in 4, HA was ruled out (false positives). The positive likelihood ratio of the MLM was 145 to 254. All dogs diagnosed with HA by attending clinicians tested positive by the MLM. Conclusions and Clinical Importance This MLM can robustly predict HA status when indiscriminately screening all dogs with blood work. In this group of dogs with a low prevalence of HA, the false positive rates were clinically acceptable.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a machine learning tool to screen for hypoadrenocorticism in dogs presenting to a teaching hospital

Reagan

Pires

Quach

et al. 2022

Veterinary Internal Medicne

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“…No hiperadrenocorticismo, os caninos apresentam sintomas variados como polidipsia, poliúria, polifagia, atrofia muscular, hepatomegalia, alterações dermatológicas e alterações laboratoriais (Schofield et al, 2020). Alguns desses sinais clínicos foram observados neste caso como, polidpsia, hepatomegalia, aumento de enzimas hepáticas, além das lesões dermatológicas.…”

Section: Discussionunclassified

“…Os testes diagnósticos específicos, como o teste de estimulação do hormônio adrenocorticotrófico (ACTH) e o teste de supressão com dexametasona em baixa dose são comumente usados para aumentar a confiança no diagnóstico da síndrome de Cushing (Schofield et al, 2020), sendo assim realizou-se o teste de supressão com dexametasona em baixa dose. Uma baixa dose de dexametasona causa feedback negativo suficiente e suprimi a secreção de ACTH hipofisário por até 24 a 48 h, e consequentemente reduz a concentração de cortisol plasmático (Larsson & Lucas, 2016), o que não ocorreu no caso descrito, confirmando o diagnóstico de HAC.…”

Section: Discussionunclassified

Dermatofitose em cão com hipercortisolismo: Relato de caso

Santos¹,

Carvalho²,

Ferreira³

2022

Pubvet

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A dermatofitose é uma doença infecciosa causada principalmente pelos fungos Microsporum canis e Trichophyton mentagrophytes que, geralmente, acometem as camadas superficiais da pele. Trata-se de uma antropozoonose e tem sinais clínicos variáveis como alopecia, eritema, desqueratinização e prurido; este presente somente em 50% dos casos. Para o diagnóstico, pode-se utilizar diversos exames complementares como lâmpada de wood em conjunto com exame citológico da pele, exame direto do pêlo e cultura fúngica. Neste relato, uma fêmea canina da raça Yorkshire apresentava histórico de infecção persistente mesmo com a terapia tópica e sistêmica recomendada. Ao exame físico notou-se alopecia e hipotricose em ponte nasal, bordas de orelhas externas e região de falanges, além de aumento de volume abdominal com telangiectasia. Na avaliação citológica observou-se estruturas compatíveis com artroconideos fúngicos e hifas, ao exame de lâmpada de wood também houve fluorescência, pelos também foram coletados para cultura. Iniciou-se o tratamento com itraconazol, mas houve recidiva após término do uso do antifúngico. Foram feitos exames hormonais e detectou-se o hiperadrenocorticismo (HAC). Assim, iniciou-se o uso do trilostano juntamente com o antifúngico havendo uma melhora significativa no quadro clínico e não foram encontrados, após tratamento, elementos fúngicos na citologia e cultura fúngica.

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“…Naturally occurring Cushing's syndrome or hypercortisolism (HC) is a common endocrinopathy in dogs caused by chronic excessive glucocorticoid activity 1 . Trilostane has been the medical treatment of choice for pituitary and adrenal‐dependent hypercortisolism (ADH) in the past 20 years 2,3 .…”

Section: Introductionmentioning

confidence: 99%

“…Naturally occurring Cushing's syndrome or hypercortisolism (HC) is a common endocrinopathy in dogs caused by chronic excessive glucocorticoid activity. 1 Trilostane has been the medical treatment of choice for pituitary and adrenal‐dependent hypercortisolism (ADH) in the past 20 years. 2 , 3 The drug is a competitive inhibitor of the 3β‐hydroxysteroid dehydrogenase/isomerase system required to synthesize cortisol, aldosterone, and androstenedione.…”

Section: Introductionmentioning

confidence: 99%

Comparison of methods to monitor dogs with hypercortisolism treated with trilostane

Golinelli

Marco²,

Leal

et al. 2021

Veterinary Internal Medicne

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Background The use of adrenocorticotropic hormone stimulation test as method to monitor efficacy of trilostane treatment of hypercortisolism (HC) in dogs has been questioned. Objectives To evaluate and compare 12 methods with which to monitor efficacy of trilostane treatment in dogs with HC. Animals Forty‐five client‐owned dogs with HC treated with trilostane q12h. Methods Prospective cross‐sectional observational study. The dogs were categorized as well‐controlled, undercontrolled, and unwell through a clinical score obtained from an owner questionnaire. The ability to correctly identify trilostane‐treatment control of dogs with HC with the following variables was evaluated: before trilostane serum cortisol (prepill), before‐ACTH serum cortisol, post‐ACTH serum cortisol, plasma endogenous ACTH concentrations, prepill/eACTH ratio, serum haptoglobin (Hp) concentration, serum alanine aminotransferase (ALT), gamma‐glutamyl transferase (γGT) and alkaline phosphatase activity, urine specific gravity, and urinary cortisol : creatinine ratio. Results Ninety‐four re‐evaluations of 44 dogs were included; 5 re‐evaluations of 5 unwell dogs were excluded. Haptoglobin was significantly associated with the clinical score (P < .001) and in the receiver operating characteristic analysis, Hp cutoff of 151 mg/dL correctly identified 90.0% of well‐controlled dogs (specificity) and 65.6% of undercontrolled dogs (sensitivity). Alanine aminotransferase (P = .01) and γGT (P = .009) were significantly higher in undercontrolled dogs. Cutoff of ALT and γGT greater than or equal to 86 U/L and 5.8 U/L, respectively, were significantly associated with poor control of HC by trilostane. Conclusions and Clinical Importance Of all the 12 variables, Hp, and to a lesser degree ALT and γGT, could be considered additional tools to the clinical picture to identify well‐controlled and undercontrolled trilostane‐treated dogs.

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Development and internal validation of a prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary‐care practice

Cited by 10 publications

References 58 publications

Evaluation of a machine learning tool to screen for hypoadrenocorticism in dogs presenting to a teaching hospital

Evaluation of a machine learning tool to screen for hypoadrenocorticism in dogs presenting to a teaching hospital

Dermatofitose em cão com hipercortisolismo: Relato de caso

Comparison of methods to monitor dogs with hypercortisolism treated with trilostane

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