Diagnosis of Spontaneous Canine Hyperadrenocorticism: 2012 ACVIM Consensus Statement (Small Animal)

Abstract

Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited prior to publication. The authors are solely responsible for the content of the statements. This report offers a consensus opinion on the diagnosis of spontaneous canine hyperadrenocorticism. The possibility that a patient has hyperadrenocorticism is based on the history and physical examination. Endocrine tests should be performed only when clinical signs consistent with HAC are present. None of the biochemical screening or differentiating tests for hyperadrenocorticism are perfect. Imaging can also play a role. Awareness of hyperadrenocorticism has heightened over time. Thus, case presentation is more subtle. Due to the changes in manifestations as well as test technology the Panel believes that references ranges should be reestablished. The role of cortisol precursors and sex hormones in causing a syndrome of occult hyperadrenocorticism remains unclear. Diagnosis of Spontaneous

Lack of association between clinical signs and laboratory parameters in dogs with hyperadrenocorticism before and during trilostane treatment

“…This finding was fairly surprising, as one would expect that cases with only mild clinical signs would have a lower degree of cortisol hypersecretion and a less decreased hypothalamic-pituitary-adrenal axis sensitivity than cases with more severe clinical signs (Behrend et al, 2013). On the one hand, the lack of correlation could be due to the subjectivity of the owner questionnaires.…”

Biological Variability in Serum Cortisol Concentration Post‐adrenocorticotropic Hormone Stimulation in Healthy Dogs

“…The intermediate IoI value of 1.1 for the ACTH stimulation test indicates that the ACTH stimulation test is suitable for use with population‐based reference intervals. However, the intermediate value of the IoI also reflects the reported uncertainty in the diagnosis of HC2 as exemplified below.…”

“…Veterinarians base the diagnosis of HC on supportive clinical signs, clinicopathologic changes, and specialized endocrine tests 2. A recent consensus statement from the American College of Veterinary Internal Medicine indicated that the diagnosis of HC depends on the demonstration of either increased cortisol production or decreased sensitivity of the hypothalamic‐pituitary‐adrenal axis to negative glucocorticoid feedback 2. The adrenocorticotropic hormone (ACTH) stimulation test is one of the specialized endocrine screening tests for HC that works by assessment of the adrenocortical reserve 2.…”

Adrenalectomy in dogs: retrospective study of 13 cases performed in Universidade Anhembi Morumbi Veterinary Hospital (2012-2015)

“…Endogenous ACTH levels tend to be normal to elevated in cases of ACTHdependent hypercortisolism and are generally low or undetectable in dogs with adrenal tumors or iatrogenic hyperadrenocorticism (SCHIMMER;PARKER, 2007;BRÖMEL et al, 2013). The reference values vary depending on the technique used; thus, they vary between the levels established by each laboratory (BEHREND et al, 2013).…”

“…Endogenous ACTH concentration test is also recommended to differentiate the origin of hypercortisolemia, as it may be (adrenocorticotropic) primary or (pituitary) ACTH-dependent (NELSON, 2010;BEHREND et al, 2013). Its measurement is a good indication source when hypercortisolism diagnosis has already been established.…”