Use of basal serum or plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000–2005)

Lennon, Elizabeth M.; Boyle, Tonya E; Hutchins, Rae G.; Friedenthal, Arit; Correa, María T.; Bissett, Sally A.; Moses, Lorra S; Papich, Mark G.; Birkenheuer, Adam J.

doi:10.2460/javma.231.3.413

Cited by 69 publications

(109 citation statements)

References 8 publications

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“…Determination of baseline serum cortisol concentration has a high sensitivity (100% if >2 μg/dL) to exclude HA, but a low specificity of only 63.3–78.2% 9, 10. In our study, although having the same sensitivity of 100%, its specificity was only 20%.…”

Section: Discussioncontrasting

confidence: 55%

“…This situation has prompted a need for alternative tests with which to diagnose HA. Measurement of baseline cortisol concentration has been shown to be a useful screening test to rule out HA 9, 10. The disease is unlikely with a baseline serum cortisol >2 μg/dL (>55 nmol/L) 9, 10.…”

mentioning

confidence: 99%

“…The disease is unlikely with a baseline serum cortisol >2 μg/dL (>55 nmol/L) 9, 10. However, due to that test's rather low specificity, an ACTH stimulation test must be performed in dogs with a baseline cortisol ≤2 μg/dL to safely exclude HA 9, 10…”

mentioning

confidence: 99%

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Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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BackgroundThe adrenocorticotropic hormone (ACTH) stimulation test is the gold standard for diagnosing hypoadrenocorticism (HA) in dogs. However, problems with the availability of synthetic ACTH (tetracosactrin/cosyntropin) and increased costs have prompted the need for alternative methods.ObjectivesTo prospectively evaluate the cortisol‐to‐ACTH ratio (CAR) as a screening test for diagnosing canine HA.AnimalsTwenty three dogs with newly diagnosed HA; 79 dogs with diseases mimicking HA; 30 healthy dogs.MethodsPlasma ACTH and baseline cortisol concentrations were measured before IV administration of 5 μg/kg ACTH in all dogs. CAR was calculated and the diagnostic performance of ACTH, baseline cortisol, CAR and sodium‐to‐potassium ratios (SPRs) was assessed based on receiver operating characteristics (ROC) curves calculating the area under the ROC curve.ResultsThe CAR was significantly lower in dogs with HA compared to that in healthy dogs and in those with diseases mimicking HA (P < .0001). There was an overlap between HA dogs and those with HA mimicking diseases, but CAR still was the best parameter for diagnosing HA (ROC AUC 0.998), followed by the ACTH concentration (ROC AUC 0.97), baseline cortisol concentration (ROC AUC 0.96), and SPR (ROC AUC 0.86). With a CAR of >0.01 the diagnostic sensitivity and specificity were 100% and 99%, respectively.Conclusion and Clinical ImportanceCalculation of the CAR is a useful screening test for diagnosing primary HA. As a consequence of the observed overlap between the groups, however, misdiagnosis cannot be completely excluded. Moreover, additional studies are needed to evaluate the diagnostic reliability of CAR in more dogs with secondary HA.

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Section: Discussioncontrasting

confidence: 55%

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confidence: 99%

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Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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“…It was recently shown by (Lennon and others 2007) that a basal serum or plasma cortisol concentration above 55.2 nmol/l eliminates the need for an ACTH stimulation test as concentrations above this value rule out the disease. Aldosterone-to-renin and cortisol-to-ACTH ratios were recently described by (Javadi and others 2006) as an alternative to the traditional stimulation test.…”

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confidence: 99%

Ultrasonographic evaluation of adrenal glands in dogs with primary hypoadrenocorticism or mimicking diseases

et al. 2010

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The adrenal glands of 30 dogs with primary adrenal insufficiency (hypoadrenocorticism) were measured ultrasonographically and compared with those of 14 healthy dogs and those of 10 dogs with diseases mimicking hypoadrenocorticism. Thickness and length of the adrenals were measured on abdominal ultrasonography and the results for each group were compared. Dogs with primary hypoadrenocorticism had significantly thinner adrenals compared with the other two groups, and their left adrenal glands were also significantly shorter than those of healthy dogs. Adrenal ultrasonography may be of diagnostic value in dogs with clinical signs suggestive of primary hypoadrenocorticism, as a left adrenal gland measuring less than 3.2 mm in thickness is strongly suggestive of the disease.

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“…According to Lennon et al (2007), the concentration of plasm cortisol has a high negative predictive value and can be used to rule out the diagnosis of HA. In that same report, the authors say that values ≤ 1µg/dL present an excellent sensitivity (100%) and specificity (98.2%) to detect dogs with HA.…”

Section: Discussionmentioning

confidence: 99%

Primary Hypoadrenocorticism in a Dog

Anjos

Babo-Terra²,

Palumbo³

2016

ArqVet

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This report describes the clinical and laboratorial findings as well as the therapeutic protocol performed in a three-year-old mongrel female intact dog, referred to the Veterinary Hospital of FAMEZ/UFMS. The animal had a previous history of recurrent gastrointestinal signs (such as lethargy, vomiting, loss of appetite, melena and abdominal pain), acute crisis episodes, bradycardia, hypotension, hypothermia and increase of capillary refill time, recognized as addisonian crisis due to primary hypoadrenocorticism. Laboratorial findings included anemia, eosinophilia, neutrophilia, lymphocytosis, sodiumpotassium ratio of 14,02 mEq/L and prerenal azotemia. Based on that, it was confirmed the diagnosis of primary hypoadrenocorcitism. Thus, it was recommended supplementation therapy with mineralocorticoid (aldosterone) and glucocorticoid (cortisol) corresponding respectively, fludrocortisone acetate of 0.2 mg per kg of BW, by mouth, once daily and prednisone 0.2 mg per kg of BW, by mouth, twice daily until further recommendations. The prognostic was excellent, since the animal significantly improved body condition, andclinical signs disappeared after therapy which lead the sodium-potassium ratio to 35.11 mEq/L. Thus, the clinician must always suspect of primary hypoadrenocorticism in dogs with intermittent nonspecific signs that get better with support therapy. Presumably, hypoarenocorticism must be under diagnosed in veterinary medicine, reinforcing the need to require specific exams in patients that show this wax and wane feature of clinical signs. KEYWORDS: Addison's disease. Dogs. Endocrinopathies. Glucocorticoid. Mineralocorticoid. Sodium-potassium ratio. HIPOADRENOCORTICISMO PRIMÁRIO EM UM CÃORESUMO: O presente relato descreve os achados clínicos, laboratoriais e conduta terapêutica de um animal da espécie canina, fêmea, com três anos de idade, inteiro, sem raça definida, diagnosticado com hipoadrenocorticismo primário atendido no Hospital Veterinário da FAMEZ/UFMS. O animal apresentou histórico de recidivas de sinais gastrintestinais (letargia, vômi-tos, perda de apetite, melena e dor abdominal), crise adrenal aguda, bradicardia, hipotensão, hipotermia e aumento do tempo de preenchimento capilar. As alterações laboratoriais compreenderam linfocitose, anemia, eosinofilia, neutrofilia, densidade urinária < 1.030, relação sódio: potássio 14,02 mEq/L e azotemia pré-renal. Baseado nos achados clínicos-laboratoriais confirmou-se o hipoadrenocorticismo primário. Em seguida, foi instituído terapia de suplementação de mineralocorticoide (aldosterona) e glicocorticoide (cortisol), correspondendo respectivamente ao acetato de fludrocortisona na dose de 0,2 mg/ kg por via oral uma vez ao dia e prednisona 0,2 mg/kg por via oral duas vezes por dia até novas recomendações. O prognóstico foi excelente para este caso, já que houve melhora significativa do animal, com o desaparecimento dos sinais clínicos e com nova relação sódio: potássio de 35,11 mEq/L. Assim, deve-se sempre suspeitar de hipoadrenocorticismo primário ...

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Use of basal serum or plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000–2005)

Cited by 69 publications

References 8 publications

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Ultrasonographic evaluation of adrenal glands in dogs with primary hypoadrenocorticism or mimicking diseases

Primary Hypoadrenocorticism in a Dog

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