BACKGROUND:The adrenocorticotropic hormone (ACTH) stimulation test is the gold standard test for diagnosing hypoadrenocorticism. However, basal cortisol is recommended for screening but fails to consider the effect of analytical variation and previous glucocorticoid therapy on test performance and additional information that a stimulation test could provide. HYPOTHESIS/OBJECTIVES:To investigate the effect of varied cut-offs and previous glucocorticoid therapy on the diagnostic performance of basal cortisol and whether ACTH stimulation test results impart additional prognostic information. ANIMALS:Fifty-five and 927 hospitalized dogs with and without hypoadrenocorticism, respectively. METHODS:Retrospective case record analysis of dogs undergoing ACTH stimulation testing. Cortisol concentrations were compared between glucocorticoid-exposed (GS, n = 198) and non-exposed (NGS, n = 729) groups. RESULTS:Basal cortisol concentrations ≤ 2.0 μg/dL were significantly (P < .0001) more common in the GS (n = 91, 46.0%) than in the NGS group (n = 226, 31.0%). False-positive flat-line ACTH stimulation test results occurred in 11 (1.2%) dogs. Basal cortisol ≤ 2.0 μg/dL demonstrated imperfect diagnostic sensitivity (98.2%; 95% CI, 90.3%-100%) and poor specificity (65.8%; 95% CI, 62.7%-68.9%). Increasing the cut-off from 2.0 to 2.4, 2.7, or 3.1 μg/dL improved diagnostic sensitivity at the expense of specificity. In the NGS group, basal > 7.0 μg/dL, post-ACTH > 15.6 μg/dL, and delta < 5.3 μg/dL cortisol concentrations were associated with increased risk of not surviving to discharge. CONCLUSIONS AND CLINICAL IMPORTANCE:Higher basal cortisol concentration cut-offs (>2 μg/dL) maximize test sensitivity to the detriment of specificity. Adrenocorticotropic hormone stimulation test results rule out hypoadrenocorticism in the majority of dogs and can provide prognostic information.

BACKGROUND:C-reactive protein (CRP) concentration in serum or plasma is high in humans during adrenal crisis due to multiple mechanisms, however, the frequency and clinical relevance of high CRP concentrations in dogs with hypoadrenocorticism are unknown. HYPOTHESIS/OBJECTIVES:To determine the frequency of high CRP concentrations in serum or plasma of dogs with hypoadrenocorticism. We hypothesized that CRP concentrations are commonly above reference limit in dogs with hypoadrenocorticism with and without inflammatory comorbidities. ANIMALS:Fifty-one dogs with hypoadrenocorticism presented to 2 referral centers between 2017 and 2023. METHODS:Medical records were retrospectively reviewed for dogs diagnosed with and presenting for illness due to hypoadrenocorticism. Dogs were grouped according to identification of a concurrent inflammatory disease at the time of diagnosis, and whether electrolyte abnormalities were present. C-reactive protein concentrations were compared between groups. RESULTS:Fifty-one dogs were included. C-reactive protein concentration in serum or plasma was above 10 mg/L in 38 of 51 (75%) cases. Median CRP concentration was 52.5 mg/L (range 8-191.4); this was not significantly different between dogs with (n = 14) or without (n = 37) a known inflammatory comorbidity (54.25 [8.0-191.4] and 44.0 [8-180.8] mg/L, respectively, P = .35), or between dogs with (n = 32) or without (n = 13) electrolyte abnormalities (48.25 [8.0-180.8] and 63.0 [8.0-191.4] mg/L, respectively, P = .51). CONCLUSIONS AND CLINICAL IMPORTANCE:High CRP concentrations in serum or plasma were frequently identified in dogs with hypoadrenocorticism, including dogs without recognized inflammatory comorbidities. Hypoadrenocorticism should be considered as a differential diagnosis in cases with high CRP concentrations and vague clinical signs. Extensive investigations for high CRP concentrations in dogs with hypoadrenocorticism might not be necessary without other supporting evidence of an inflammatory comorbidity.

A 4‐year‐old, female, neutered Chihuahua cross was presented with a history of chronic apparent vomiting and coughing. Upon further questioning, regurgitation was suspected rather than vomiting. Conscious thoracic radiographs revealed generalised megaoesophagus. The dog was diagnosed with focal myasthenia gravis based on a positive acetylcholine receptor antibody titre 2.33 nmol/L (<0.6 nmol/L). The dog responded to pyridostigmine treatment (0.5 mg/kg every 12 hours, increasing to 1.6 mg/kg every 12 hours) with reduced frequency of regurgitation episodes. In this case, differentiation between vomiting and regurgitation was crucial for appropriate diagnostic testing and treatment. Pyridostigmine is the treatment of choice for both focal and generalised myasthenia gravis. The dose must be titrated to control clinical signs in both forms of the disease.

Background: Feline primary hyperaldosteronism is a relatively rare endocrine disease of geriatric cats. Main clinical features include those derived from hypertension and hypokalaemia. A high index of suspicion of the disease is required since clinical signs and clinicopathological features can be confused with those of chronic kidney disease. The diagnosis involves the routine clinical pathology, diagnostic imaging and assessment of hormone concentrations, and potentially dynamic functional testing. Treatment could be surgical or medical depending on the cause of the disease. Aim of the article: To review the pathophysiology of primary hyperaldosteronism, summarising the currently available literature about the disease. The article also aims to provide practical suggestions for the diagnostic investigation of cats with suspected primary hyperaldosteronism, and for treatment of the disease.

Sepsis and septic shock are leading causes of morbidity and mortality in both humans and dogs, and early diagnosis is crucial for improving outcomes. This study aimed to evaluate bioactive adrenomedullin (bio-ADM) concentrations in dogs with septic shock (n = 25), dogs with sepsis without evidence of shock (n = 25), and healthy control dogs (n = 25). Plasma bio-ADM concentrations were measured using a human sandwich enzyme-linked immunosorbent assay and reported as median (interquartile range). Plasma bio-ADM concentrations were significantly higher in both septic groups compared to the healthy controls (all <22.4 pg/mL), but not significantly different between the septic shock (75.0 [28.7–115.0] pg/mL) and sepsis (30.7 [22.4–79.7] pg/mL) groups. Dogs with higher illness severity scores had significantly higher bio-ADM concentrations (93.1 [32.2–122.0] pg/mL) than those with lower scores (29.8 [22.4–71.2] pg/mL). However, bio-ADM concentrations did not differ between survivors (33.0 [22.7–76.7] pg/mL) and non-survivors (74.7 [26.1–123.2] pg/mL). Measurement of bio-ADM is a potential marker for canine sepsis, but not for the identification of septic shock, and may provide information on disease severity. Further studies, including those on non-infectious inflammatory conditions, are necessary to better understand the diagnostic utility of bio-ADM measurement and its potential role as a marker of treatment response in dogs with sepsis.

Abstract Background Naturally occurring hypoadrenocorticism is an uncommon endocrine disorder in dogs but has significant morbidity and mortality. Some dogs present with apparent glucocorticoid deficiency alone as evidenced by eunatraemia and eukalaemia. Few studies have compared dogs with hypoadrenocorticism with or without electrolyte disturbances and there are no large case series of affected dogs from Ireland. Methods Retrospective observational study. Results Ninety-two cases diagnosed with hypoadrenocorticism subdivided into those with supportive electrolyte disturbances (Group 1; n = 72) and those without (Group 2; n = 20). Dogs in Group 1 were significantly (p = 0.001) younger (4.0 (3.0–6.0) years) than dogs in Group 2 (6.0 (4.75–8.25) years). Dogs in Group 1 presented significantly more commonly with vomiting (Group 1: 52/71 (73.2%), Group 2: 6/20 (30.0%); p < 0.001), total hyperproteinaemia (Group 1: 21/71 (29.6%), Group 2: 1/20 (5.0%); p = 0.023), increased urea (Group 1: 52/72 (72.2%), Group 2: 5/20 (25.0%); p < 0.001), increased creatinine (Group 1: 31/72 (43.1%), Group 2: 3/20 (15.0%); p = 0.021) and hyperphosphataemia (Group 1: 40/71 (56.3%), Group 2: 2/20 (10.0%); p < 0.001), and significantly less commonly with reticulocytosis (Group 1: 4/38 (10.5%), Group 2: 5/13 (38.5%), p = 0.023). An undetectable basal aldosterone concentration had a positive predictive value of 94.3% for diagnosing undetectable post-ACTH aldosterone concentration. Of the thirteen dogs in Group 2 that had aldosterone concentrations measured and secondary disease excluded, 7 (53.8%) had or subsequently developed evidence of aldosterone deficiency, although not always with electrolyte abnormalities. Conclusions Dogs with hypoadrenocorticism from Ireland are similar to other reported cases. An undetectable basal aldosterone concentration is highly predictive of mineralocorticoid deficiency. Dogs with apparent glucocorticoid deficiency alone can progress to more typical disease and should be monitored appropriately.

Veterinary RecordVolume 194, Issue 11 p. 441-442 Profession Beware restrictive clauses in contracts Stijn Niessen, Corresponding Author Stijn Niessen president elect [email protected] ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorLaura Blackwood, Laura Blackwood members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorRemo Lobetti, Remo Lobetti members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorDaniel Batchelor, Daniel Batchelor members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorJohan Schoeman, Johan Schoeman members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorJo Dukes McEwan, Jo Dukes McEwan members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorDavid Killick, David Killick members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorRobert Shiel, Robert Shiel members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this author Stijn Niessen, Corresponding Author Stijn Niessen president elect [email protected] ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorLaura Blackwood, Laura Blackwood members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorRemo Lobetti, Remo Lobetti members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorDaniel Batchelor, Daniel Batchelor members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorJohan Schoeman, Johan Schoeman members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorJo Dukes McEwan, Jo Dukes McEwan members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorDavid Killick, David Killick members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this authorRobert Shiel, Robert Shiel members of the executive ECVIM–CA, Utrecht, NetherlandsSearch for more papers by this author First published: 31 May 2024 https://doi.org/10.1002/vetr.4366Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume194, Issue111/8 June 2024Pages 441-442 RelatedInformation

Formalin-Fixed Paraffin Embedded (FFPE) biopsies would provide a critical mass of cases to allow investigation of canine liver disease, however their use is often limited by challenges typically associated with transcriptomic analysis. This study evaluates the capability of NanoString® to measure the expression of a broad panel of genes in FFPE liver samples. RNA was isolated from matched histopathologically normal liver samples using FFPE (n = 6) and snap frozen in liquid nitrogen (n = 6) and measured using a custom NanoString® panel. Out of the 40 targets on the panel, 27 and 23 targets were above threshold for non-diseased snap frozen and FFPE tissue respectively. The binding density and total counts were significantly reduced in the FFPE samples relative to the snap frozen samples (p = 0.005, p = 0.01, respectively), confirming a reduction in sensitivity. The concordance between the snap frozen and FFPE samples was high, with correlations (R) ranging between 0.88 and 0.99 between the paired samples. An additional 14 immune-related targets, undetectable the non-diseased FFPE liver, were above threshold when the technique was applied to a series of diseased samples, further supporting their inclusion on this panel. This use of NanoString® based analysis opens up huge opportunity for retrospective evaluation of gene signatures in larger caseloads through harnessing the capacity of archived FFPE samples This information used alongside clinical and histological data will not only afford a way to explore disease etiopathogenesis, it may also offer insight into sub-types of liver disease in dogs, which cannot be discerned using more traditional diagnostic methods.

Objectives:The primary goals of this retrospective study were to describe a population of dogs with portal hypertension secondary to liver disease, and to assess whether prognosis could be inferred from historical, clinical, and clinicopathological data.Animals and procedures:Dogs (N = 76) diagnosed with intrahepatic portal hypertension between 2011 and 2020 were included; dogs with known congenital hepatic anomalies were excluded. Effect on survival was assessed using univariable and multivariable Cox proportional hazards models for historical, clinical, and clinicopathological variables.Results:Dogs survived for a median of 14 d (range: 0 to 2028 d), with 31.6% being euthanized within 2 d of diagnosis and 23.7% surviving longer than 2 mo. Presence of jaundice and duration of clinical signs, expressed in days, were significantly associated with outcome in the univariable analysis (HR = 1.846, 95% CI: 1.094 to 3.117, P = 0.02; HR = 0.995, 95% CI: 0.990 to 1.000, P = 0.033, respectively). However, only presence of jaundice was significantly associated with increased hazard of death in the multivariable analysis.Conclusion:Results of this study show that portal hypertension is associated with a poor prognosis; however, some dogs can show prolonged survival.Clinical relevance:Clinical data can guide decision-making for clinicians and owners.

The syndrome of inappropriate antidiuresis (SIAD) is a condition characterized by increased secretion and/or effects of arginine vasopressin in the absence of appropriate triggers. This chapter discusses the prevalence, pathophysiology and aetiology of SIAD in dogs and cats, with reference to the condition in humans. It explores the clinical features, diagnosis, and treatment options for SIAD, highlighting the importance of water restriction and the potential use of vaptans and other medications. The document emphasizes the need for careful management of hyponatremia to avoid complications such as osmotic demyelination syndrome.

BackgroundUltrasound-determined gallbladder wall thickness is widely used to aid in the diagnosis of gallbladder disease, but no reference values supported by published measurement data are available in dogs. Hypothesis/ObjectiveEstablish normal thickness of the gallbladder wall in dogs. AnimalsFifty-three dogs presented to a referral hospital and required abdominal ultrasound examination for reasons unrelated to primary hepatobiliary disease. MethodsCross-sectional observational study recruiting dogs requiring abdominal ultrasound examination. A standard sequence of gallbladder wall images was recorded for later review. Inclusion criteria were normal ultrasonographic hepatobiliary, pancreatic, and small intestinal findings. Exclusion was determined by 2 European College of Veterinary Internal Medicine (ECVIM)-certified veterinary internists blinded to gallbladder wall thickness data. Dogs were excluded if they had inadequate medical records, a previous history of hepatobiliary, gastrointestinal, or pancreatic disease likely to impact the biliary system (eg, chronic vomiting, nausea, jaundice, diarrhea), unexplained increases in liver enzyme activities, hypoalbuminemia, or ascites. Gallbladder wall thickness was determined by 2 European College of Veterinary Diagnostic Imaging (ECVDI)-certified veterinary radiologists working together to generate a consensus for each dog. The final output was the maximum normal wall thickness for this population of dogs. ResultsThe upper limit for gallbladder wall thickness in 53 fasted (8 hours) dogs <40 kg was 1.30 mm (90% confidence interval, 1.19-1.41). Conclusions and Clinical ImportanceNormal gallbladder wall thickness in dogs is lower than previously reported. Additional studies are required to determine potential effects of body weight and the optimal cut-off to distinguish between healthy and diseased gallbladders.

This chapter discusses the challenges in identifying and quantifying polyuria and polydipsia, and explores the various causes and underlying pathophysiology. The chapter provides an overview of the diagnostic investigation of these conditions, including the use of routine clinicopathological tests, urine culture, tests of endocrine and organ function, and diagnostic imaging. It also discusses the differentials for polyuria and polydipsia based on signalment, history, and physical examination. The chapter concludes with a brief reference to additional tests that may be conducted to differentiate between central diabetes insipidus and primary polyuria.

Hypoadrenocorticism is characterized by a reduction in mineralocorticoid and/or glucocorticoid production by the adrenal glands. Several subtypes have been described with different clinical and clinicopathological consequences. Most affected dogs have vague and non-specific signs that precede an eventual life-threatening crisis. This review aims to appraise classification, the available data on epidemiology and the clinical and laboratory features of naturally occurring canine hypoadrenocorticism.

In collaboration with the American College of Veterinary Pathologists.

OBJECTIVES:Measurement of free T4 by analogue immunoassay (fT4a) is popular but its ability to differentiate hypothyroidism from non-thyroidal illness (NTI) is unclear. The aims were to assess fT4a concentrations in dogs with NTI and to explore diagnostic agreement with total T4 and free T4 measured by equilibrium dialysis (fT4d). METHODS:fT4a was measured in dogs classified with mild, moderate and severe NTI. Total T4 and fT4d were measured in a subgroup of these dogs. RESULTS:146 dogs were included of which 84, 35 and 27 had mild, moderate and severe NTI, respectively. Median (range) fT4a concentrations (pmol/L) were significantly lower (P = 0.023 and P < 0.001) in dogs with severe (3.86 (3.86-23.60)) compared with moderate (11.10 (3.86-34.70)) and mild (15.25 (3.86-48.60)) NTI. Overall, 49 (33.6% [95% CI, 26.4-41.6]) dogs had low fT4a concentration. All thyroid hormones were measured in 74 dogs. Agreement was substantial between total T4 and fT4a (κ=0.79 [95% CI, 0.65-0.92]) and fT4a and fT4d (κ =0.63 [95% CI, 0.47-0.79]) but moderate between total T4 and fT4d (κ=0.49 [95% CI, 0.32-0.66]). Of 42 dogs with low total T4 concentration, five (11.9% [95% CI, 5.19-24.99]) and 18 (42.9% [95% CI, 29.12-57.80]) had fT4a and fT4d within reference interval, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE:fT4a and fT4d cannot be used interchangeably. Measurement of fT4a provides limited further diagnostic information over measurement of total T4 in dogs with NTI. This study raises concerns regarding the ability of fT4a to differentiate NTI from hypothyroidism in dogs with low total T4 concentrations.

The year 2021 marked the centenary of the isolation of a therapeutic form of insulin and its successful use in dogs. This was a landmark moment that subsequently and rapidly led to the commercial manufacture of insulin for use in humans. The impact of insulin was almost miraculous as those destined to die from their diabetes mellitus returned to life. Over the past 100 years, insulin formulations have been modified to attempt to provide a predictable and prolonged duration of action while avoiding the development of hypoglycaemia. This has led to an ever-growing variety of insulin types in human medicine, many of which have subsequently been used in dogs. The purpose of this review article is to provide an overview of available insulin types and their application to the chronic management of canine diabetes mellitus.

OBJECTIVES:The aims of the present study were to describe the prevalence of positive urinary bacterial culture in dogs, to identify the most commonly isolated microorganisms and to analyse changes in antimicrobial susceptibility patterns over time.MATERIAL AND METHODS:A retrospective case series was performed using culture and susceptibility results from canine urine samples collected between January 2010 and December 2017. The presence or absence of infection, identity of the bacterium with heaviest growth, and susceptibility profile were recorded for each sample. Trends in the frequency of positive culture and antimicrobial resistance were assessed by Poisson regression modelling. Prevalence rate ratio and 95% confidence interval were reported for resistance to each antimicrobial.RESULTS:A positive urine culture was documented in 771 (22.5%) of 3420 samples. Escherichia coli was the most commonly isolated microorganism. There was no significant increase in the frequency of positive bacterial culture over the study period (prevalence rate ratio 0.98; 95% confidence interval: 0.92 to 1.0). Overall, there was an increase in antimicrobial resistance within Enterobacteriaceae from 5.2 to 35.6%. The prevalence of multidrug-resistant bacteria varied from year to year throughout the study period. However, the Poisson regression model identified a significant increase in the frequency of multidrug-resistant Enterobacteriaceae over this period, averaging approximately 22% per year (prevalence rate ratio 1.22, 95% confidence interval: 1.06 to 1.42).CLINICAL SIGNIFICANCE:The significant increase in antimicrobial resistance observed in this study is concerning and may have implications for veterinary and public health. Appropriate measures, such as antibiotic stewardship programmes, should be implemented to address increasing antimicrobial resistance.

Total thyroxine (T4) concentrations are lower in healthy greyhounds compared to most other non-sighthound breeds. In humans, variations in the structure or concentration of the major thyroid hormone binding proteins are responsible for most reported differences between total T4 concentrations in healthy individuals from different ethnic groups or other subpopulations. The aim of this study was to determine if such variations are also responsi-ble for the lower total T4 concentrations in greyhounds. The predicted protein sequences of thyroxine-binding globulin (TBG), transthyretin and albumin were determined in liver tissue from a euthyroid greyhound with decreased T4 concentration and a Jack Russell terrier us-ing reverse-transcriptase PCR. Sequences were compared to each other and online reference sequences. Serum proteins from 21 greyhounds and 21 non-sighthound dogs were sepa-rated by denaturing electrophoresis and immunoblots probed with polyclonal antibodies to human TBG and transthyretin. Reactive bands were quantified by densitrometry, expressed relative to the mean of reference samples included in each gel. Serum albumin concentra-tions were measured using a commercially-available assay. Several SNPs were identified but none was thought likely to explain the lower total T4 concentrations in greyhounds. There was no significant difference between the quantity of any of the binding proteins in serum from greyhounds and non-sighthound dogs. However, total T4 and transthyretin concentra-tions were highly correlated in the greyhound group (r = 0.73, P = 0.0 0 02). Variation in the sequence of thyroid hormone binding proteins is not responsible for low greyhound total T4 concentrations. Further evaluation of the role of transthyretin is warranted. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )