CASE #5
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 "Scooter" on the day of presentation |
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History:
Scooter was referred to OSU for a history of excessive drinking and urinating for the past 9 months. The owners have also noticed a gradual progressive hair loss, especially over the trunk. She is not pruritic. Scooter is otherwise active and has a great appetite, although she seems to pant a lot. She is current on vaccinations and the only medication she is receiving is a monthly heartworm preventative (Interceptor).
| Physical Examination: | ||
| Temperature: | 102.2 ºF | |
| Pulse: | 88/min | |
| Respiratory rate: | Panting | |
| Weight: | 38 lbs | |
On physical examination, Scooter’s abdomen seemed distended and hepatomegaly was suspected. No fluid could be balloted. A grade II/VI left apical heart murmur was ausculted. She had mild bilaterally symmetrical alopecia and mild generalized seborrhea sicca, The skin on her ventral abdomen was very thin skin with visible cutaneous vessels.
Questions:
1. What is the maximum water intake per day for a dog? What are your differential diagnoses for Scooter’s PU/PD?
2. List some potential causes of Scooter’s endocrine alopecia
3. What is the most likely cause of the heart murmur?
Diagnostic Evaluation:
Urine C/S = No Growth
Systolic blood pressure = 115 mmHg
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Thoracic
radiographs: showed mild cardiomegaly. |
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Abdominal ultrasound: The liver appeared large and hyperechoic |
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Bilateral adrenomegaly was noted with the left adrenal gland measuring 1.3 cm wide and 3.5 cm long | |
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The right adrenal gland measuring 0.75 cm wide and 2.4 cm long. In normal dogs, the maximum width of the adrenal glands is 0.75 cm. |
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| A fine needle aspirate (FNA) of the liver was performed by ultrasound guidance and cytology revealed large vacuolated hepatocytes consistent with a vacuolar hepatopathy. |
ACTH stimulation test |
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| Scooter | Normal | |||
| Cortisol - Pre | 2.0 | 1.0 – 11.0 ug/dl | ||
| Cortisol – Post 1 hour | 28.0 | 5.0 – 26 ug/dl | ||
More Questions:
4. What are potential causes of an increased ALP/ALP CAP?
5. List 6 causes of hypercholesterolemia in dogs.
6. Results of the urinalysis showed dilute urine but was otherwise unremarkable. Why was a urine culture submitted?
7. Is the ACTH stimulation test consistent with Cushing’s disease? Could a sick, stressed dog without Cushing’s disease have similar ACTH stimulation test results?
8. Putting together the results of the history, physical examination, laboratory and imaging results, do you think Scooter has Cushing’s disease? Do you think it is more likely to be pituitary or adrenal dependant Cushing’s? Be able to defend your answers.
9. If a liver biopsy had been performed, what do you think it would show? Why does this occur with Cushing’s disease? How does it affect liver function?
Scooter was started on Lysodren® (O,P'-DDD) 500 mg tabs: 1 tab orally twice a day for 8 days and then an ACTH stimulation test was repeated.
Recheck ACTH stimulation test |
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| Scooter | Normal | |||
| Cortisol - Pre | 1.7 | 1.0 – 11.0 ug/dl | ||
| Cortisol – Post 1 hour | 3.1 | 5.0 – 26 ug/dl | ||
10. What is your assessment of these test results?
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