Primary hyperaldosteronism in cats – a review

Primary hyperaldosteronism is a disease in which tumors or hyperplasias in the zona glomerulosa of the adrenal gland induce hypersecretion of aldosterone. Effects are thus consistent with the actions of aldosterone in the body: increased sodium retention, increase of blood volume and increased renal excretion of potassium. Clinical signs are systemic hypertension and hypokalemic myopathy with generalized muscle weakness and even paresis. The most common biochemical findings are hypokalemia, elevated urea and creatinine concentration, hypomagnesemia, hypochloremia, and hypophosphatemia. Image of adrenals establishes the unilateral or bilateral involvement and the appropriate treatment for each patient. Medical treatment is symptomatic and consists of potassium supplementation, use of spironolactone and calcium channel blockers. Unilateral adrenalectomy is the treatment of choice, because it is curative and offers good prognosis.

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Diagnóstico y tratamiento de un gato (Felis silvestris catus) con hiperaldosteronismo primario

Clínica veterinaria abordaje diagnóstico y terapéutico ◽

10.22201/fmvz.23958766e.201935 ◽

2019 ◽

Vol 5 ◽

Author(s):

C. Lizzeth Espinosa-Fuentez ◽

Adrián Tinoco-Nájera ◽

Jesús Marín-Heredia

Keyword(s):

Blood Count ◽

Complete Blood Count ◽

Body Condition Score ◽

Clinical Signs ◽

Primary Hyperaldosteronism ◽

Diagnosis And Treatment ◽

Systemic Hypertension ◽

Felis Silvestris ◽

Felis Silvestris Catus ◽

Hypokalemic Myopathy

Descripción del caso. Se presentó a consulta en el Hospital Veterinario de Especialidades (HVE) de la UNAM un paciente felino de 12 años con semiología compatible con miopatía hipocalémica con tres meses de evolución. En el examen físico general se observó condición corporal 2/5, posición plantígrada y ventroflexión cervical. Acudió a consulta con hemograma y bioquímica con valores alterados. Al realizar ultrasonido (US) abdominal, se evidenció proceso neoplásico en glándula adrenal.Hallazgos clínicos e interpretación. Neutrofilia y linfopenia asociadas a estrés, incremento de AST y CK, e hipocalemia, asociados a miopatía hipocalémica, que en conjunto con las alteraciones en el ultrasonido fueron compatibles con hiperaldosteronismo primario, secundario a carcinoma corticoadrenal.Tratamiento y evolución. Se descartaron otras afecciones que generan miopatía hipocalémica y se instauró tratamiento médico con espironolactona y gluconato de potasio, mejorando así su semiología.Pruebas de laboratorio. Como las alteraciones en el hemograma y la bioquímica realizadas fuera del HVE eran compatibles con miopatía hipocalémica, se decartó enfermedad renal crónica debido a que los niveles de creatinina se encontraban dentro de los valores de referencia del laboratorio. La T4T estaba dentro de los intervalos de referencia. La aldosterona fue compatible con hiperaldosteronemia.Discusión y relevancia clínica. El hiperaldosteronismo primario felino parece ser una enfermedad subdiagnosticada, porque los principales diagnósticos diferenciales para este padecimiento son el hipertiroidismo y la enfermedad renal crónica. Asimismo, estos pacientes pueden presentar hipertensión arterial sistémica y, hoy en día, se reconoce que el hiperaldosteronismo es la causa más común de hipertensión endocrina en gatos. Por lo tanto, es importante proporcionar bases y orientación a los médicos veterinarios para diagnosticar y tratar este padecimiento, debido a que en México no se cuenta con la prueba diagnóstica definitiva. Diagnosis and treatment of a cat (Felis silvestris catus) with primary hyperaldosteronism Abstract Case description. A 12 years old feline patient presented to the Hospital Veterinario de Especialidades (HVE) de la UNAM with clinical signs consistent with hypokalemic myopathy of three months duration. The physical exam revealed a body condition score of 2/5, plantigrade stance and cervical ventroflexion. Previous complete blood count and biochemistry revealed abnormal values. Abdominal ultrasound was performed and identified neoplasia in the adrenal gland.Diagnostics and interpretation. A stress leukogram characterized by neutrophilia and lymphopenia, increase in AST and CK, and hypokalemia associated with hypokalemic myopathy. These results along with ultrasonographic findings, were consistent with primary hyperaldosteronism secondary to adrenal carcinoma.Treatment and clinical response. Other causes of hypokalemia and hypokalemic myopathy were ruled out. Treatment was initiated with oral spironolactone and potassium gluconate, with marked improvement of its clinical signs. compatible con hiperaldosteronemia.Laboratory tests. Based on the results of complete blood count and biochemistry performed outside the HVE consistent with hypokalemic myopathy, other etiologies such as renal disease was ruled out as the levels of creatinine were within the reference interval. The T4T was also within reference intervals. Aldosterone levels were consistent with hyperaldosteronemia.Discussion and clinical relevance. Feline primary hyperaldosteronism appears to be an underdiagnosed disease, as diagnostic tests are limited to ruling out hyperthyroidism and chronic kidney disease. Similarly, these patients are likely to present with systemic hypertension and nowadays it is recognized that hyperaldosteronism is the most common cause of endocrine hypertension in cats. Therefore, it is important to educate and guide veterinarians in the diagnosis and treatment of this condition, as a final diagnostic test is not available in Mexico.Keywords: Feline primary hyperaldosteronism, hypertension, hyperaldosteronemia, adreno-cortical hyperplasia, adrenal adenoma or carcinoma, hypokalemic myopathy.

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Primary hyperaldosteronism in the cat: A series of 13 cases

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2004.08.007 ◽

2005 ◽

Vol 7 (3) ◽

pp. 173-182 ◽

Cited By ~ 87

Author(s):

Roderick Andrew ◽

Andrea M Harvey ◽

Séverine Tasker

Keyword(s):

Abdominal Mass ◽

Clinical Signs ◽

Rare Condition ◽

Serum Biochemistry ◽

Plasma Aldosterone ◽

Primary Hyperaldosteronism ◽

Systemic Hypertension ◽

Plasma Aldosterone Concentration ◽

Adrenal Imaging ◽

Stabilisation Period

Thirteen cases of feline primary hyperaldosteronism were diagnosed based on clinical signs, serum biochemistry, plasma aldosterone concentration, adrenal imaging and histopathology of adrenal tissue. Two cases presented with blindness caused by systemic hypertension, whilst the remaining 11 cases showed weakness resulting from hypokalaemic polymyopathy. Elevated concentrations of plasma aldosterone and adrenocortical neoplasia were documented in all cases. Seven cases had adrenal adenomas (unilateral in five and bilateral in two) and six had unilateral adrenal carcinomas. Three cases underwent medical treatment only with amlodipine, spironolactone and potassium gluconate; two cases survived for 304 and 984 days until they were euthanased because of chronic renal failure, whilst the third case was euthanased at 50 days following failure of the owner to medicate the cat. Ten cases underwent surgical adrenalectomy following a successful stabilisation period on medical management. Five cases remain alive at the time of writing with follow-up periods of between 240 and 1803 days. Three cases were euthanased during or immediately following surgery because of surgical-induced haemorrhage. One cat was euthanased 14 days after surgery because of generalised sepsis, whilst the remaining cat was euthanased 1045 days after surgery because of anorexia and the development of a cranial abdominal mass. It is recommended that primary hyperaldosteronism should be considered as a differential diagnosis in middle-aged and older cats with hypokalaemic polymyopathy and/or systemic hypertension and should no longer be considered a rare condition.

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Severe hypoaldosteronism after unilateral adrenalectomy for primary hyperaldosteronism

Endocrine Abstracts ◽

10.1530/endoabs.49.ep30 ◽

2017 ◽

Author(s):

Joao Ananias Goncalves ◽

Rui Barrros ◽

Betania Ferreira ◽

Claudia Amaral

Keyword(s):

Primary Hyperaldosteronism ◽

Unilateral Adrenalectomy

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An afebrile heartwater-like syndrome in goats

Journal of the South African Veterinary Association ◽

10.4102/jsava.v84i1.955 ◽

2013 ◽

Vol 84 (1) ◽

Author(s):

Rhoda Leask ◽

Kenneth P. Pettey ◽

Gareth F. Bath

Keyword(s):

Clinical Signs ◽

Control Measures ◽

Sub Saharan Africa ◽

Limiting Factor ◽

Febrile Reaction ◽

Presumptive Diagnosis ◽

Appropriate Treatment ◽

Sub Saharan ◽

Characteristic Features ◽

And Control

Heartwater is a serious limiting factor for sheep and goat production in the major endemic area of sub-Saharan Africa and therefore most knowledge, research and control methods originate from this region. Whilst the usual or common clinical presentations can be used to make a presumptive diagnosis of heartwater with a good measure of confidence, this is not always the case, and animals suffering from heartwater may be misdiagnosed because their cases do not conform to the expected syndrome, signs and lesions. One aberrant form found occasionally in the Channel Island breeds of cattle and some goats is an afebrile heartwaterlike syndrome. The most constant and characteristic features of this heartwater-like syndrome comprise normal temperature, clinical signs associated with generalised oedema, and nervous signs, especially hypersensitivity. The presumption that the disease under investigation is the afebrile heartwater-like syndrome entails a tentative diagnosis based on history and clinical signs and the response to presumed appropriate treatment (metadiagnosis). The afebrile heartwater-like syndrome presents similarly to peracute heartwater but without the febrile reaction. Peracute cases of heartwater have a high mortality rate, enabling confirmation of the disease on post-mortem examination. Recognition of the afebrile heartwater-like syndrome is important to prevent deaths and identify the need for appropriate control measures.

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Resolution of congenital nasolacrimal duct obstruction with conservative management

Journal of Chitwan Medical College ◽

10.3126/jcmc.v6i1.16573 ◽

2017 ◽

Vol 6 (1) ◽

pp. 12-15

Author(s):

J B Shrestha

Keyword(s):

Congenital Anomaly ◽

Conservative Management ◽

Pediatric Population ◽

Clinical Signs ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Topical Antibiotics ◽

Appropriate Treatment

Congenital nasolacrimal duct obstruction is the commonly encountered congenital anomaly in pediatric population occurring in as many as 30% of new borns. Conservative management of such condition with topical antibiotics and properly performed massage of the nasolacrimal sac is appropriate treatment during the first few months of age. The purpose of this study was to determine the rate of resolution of nasolacrimal duct obstruction with conservative management in infants up to 10 months of age. A total of 181 infants of age up to 10 months old with the diagnosis of Congenital nasolacrimal duct obstruction were advised nasolacrimal duct massage with or without the prescription of topical antibiotics. Resolution of nasolacrimal duct obstruction was assessed at 3 month and 6 month and was defined as the absence of all clinical signs of nasolacrimal duct obstruction. At the 6-month examination, 163 eyes (83%) of 181 children showed resolution with conservative management. The overall success rate of Congenital nasolacrimal duct obstruction with conservative management was high and this form of management can be considered as one of the best options in infants.

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Detectability of the peripheral and axial manifestations of psoriatic arthritis in patients with psoriasis in dermatological practice

Modern Rheumatology Journal ◽

10.14412/1996-7012-2019-4-48-54 ◽

2019 ◽

Vol 13 (4) ◽

pp. 48-54

Author(s):

M. N. Chamurlieva ◽

E. Yu. Loginova ◽

T. V. Korotaeva

Keyword(s):

Back Pain ◽

Psoriatic Arthritis ◽

Early Diagnosis ◽

Clinical Signs ◽

Severity Index ◽

The Body ◽

Inflammatory Back Pain ◽

Patient Complaints ◽

Asas Criteria ◽

Mechanical Back Pain

Psoriatic arthritis (PsA) is a heterogeneous disease manifested by peripheral arthritis, dactylitis, spondylitis, and enthesitis. PsA is often undiagnosed by dermatovenerologists because of the difficulty in identifying a variety of clinical signs. The early diagnosis of PsA and the accurate assessment of all its symptoms are necessary for the timely choice of optimal therapy.Objective: to assess the detectability of clinical signs of PsA in patients with psoriasis in dermatological practice.Patients and methods. The investigation enrolled 103 patients (47 men and 56 women) (mean age, 44.0±13.7 years) with psoriasis (its mean duration, 10.7±10.2 years), the average prevalence and severity according to the Body Surface Area (BSA) and the Psoriasis Area and Severity Index (PASI) were 9.3±13.6% and 15.4±12.5 scores, respectively. All the patients completed the Psoriasis Epidemiology Screening Tool (mPEST) and were examined by a dermatovenerologist and a rheumatologist. The diagnosis of PsA was based on the Classification Criteria for Psoriatic Arthritis (CASPAR). The investigators evaluated arthritis, dactylitis, enthesitis, and inflammatory back pain (IBP) according to the rheumatological standards: IBP by the Assessment of SpondyloArthritis International Society (ASAS) criteria, and enthesitis by the Leeds Enthesitis Index (LEI).Results and discussion. Sixty-one (59.2%) of the 103 patients with psoriasis were found to have PsA on the basis of the CASPAR criteria and the rheumatologist's examination. The dermatovenerologist diagnosed arthritis in a significantly smaller number of cases than did the rheumatologist: in 15 (24.6%) and 35 (57.4%) of the 61 patients (p<0.001), respectively. The dermatovenerologist and the rheumatologist demonstrated no significant differences in their clinical evaluation of dactylitis: it was detected in 37 (60.7%) and 40 (65.6%) of the 61 patients, respectively (p=0.32). Based on patient complaints and mPEST findings, the dermatovenerologist recorded pain in the calcaneal region in 32 (52.5%) patients. The rheumatologist identified ulnar, knee, and calcaneus enthesitis in 11 (18%), 8 (13.1%), and 25 (41%) patients, respectively. Based on complaints and mPEST findings, the dermatovenerologist detected back pain in 30 (49.2%) of the 61 patients. The rheumatologist diagnosed IBP in 21 (70%) of these 30 patients and mechanical back pain in 9 (30%). Thus, IBP was noted in 34.4% of PsA patients. Tendonitis was undiagnosed by the dermatovenerologist; the rheumatologist identified wrist tendonitis in 13 (21.3%) of the 61 patients with PsA.Conclusion. Dermatovenerologists frequently underestimate damage to the spine and entheses in patients with psoriasis. The introduction of the ASAS criteria for IBP and methods for assessing enthesitis in dermatological practice can improve the early diagnosis of axial lesion in PsA in patients with psoriasis.

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Drug-Induced Heart Failure (Part 2: Mechanisms of Development, Clinical Signs, Differential Diagnosis, Risk Factors, Treatment and Prevention)

Safety and Risk of Pharmacotherapy ◽

10.30895/2312-7821-2020-8-2-57-65 ◽

2020 ◽

Vol 8 (2) ◽

pp. 57-65

Author(s):

O. D. Ostroumova ◽

I. V. Goloborodova

Keyword(s):

Heart Failure ◽

Beta Blockers ◽

Clinical Signs ◽

Clinical Manifestations ◽

Left Ventricular ◽

Clinical Syndrome ◽

Channel Blockers ◽

Drug Induced ◽

Treatment And Prevention ◽

Developing Heart

Heart failure is a complex clinical syndrome caused by an impaired pumping function of the heart muscle, etiologically associated with cardiovascular disease and, in the vast majority of cases, requiring complex therapeutic regimens and simultaneous prescription of several drugs. To date, we know several classes of drugs (including those used for heart failure) which can induce development/progression of heart failure in both patients with left ventricular dysfunction, and in patients who do not have cardiovascular diseases. The aim of the study was to analyse and systematize data on development mechanisms, as well as methods of prevention and treatment of drug-induced heart failure when using diff erent groups of drugs. It has been established that drug-induced heart failure is most often associated with the use of calcium channel blockers (verapamil, diltiazem, nifedipine), beta-blockers, antiarrhythmic drugs (disopyramide, fl ecainide, propafenone, amiodarone, ibutilide, dofetilide, dronedarone), anthracyclines (doxorubicin) and other antitumor drugs (trastuzumab, bevacizumab, infl iximab), hypoglycemic drugs (thiazolidinediones, saxagliptin, alogliptin), and nonsteroidal anti-infl ammatory drugs, including selective cyclooxygenase-2 inhibitors. The study revealed various mechanisms of heart failure development following drug treatment. In some patients, heart failure development is associated with the cardiotoxic eff ect of a particular drug, in others with adverse eff ects on hemodynamics. Much depends on risks of developing heart failure, including specifi c risks attributable to groups of drugs and individual drugs. The identifi cation of drugs that can contribute to the development/ progression of heart failure, and possible clinical manifestations of drug-induced heart failure, as well as provision of timely information to physicians, and engagement of clinical pharmacologists with the aim of optimizing treatment of patients can facilitate timely diagnosis, treatment and prevention of drug-induced heart failure.

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Novel Nanoparticle-Based Cancer Treatment, Effectively Inhibits Lung Metastases and Improves Survival in a Murine Breast Cancer Model

Frontiers in Oncology ◽

10.3389/fonc.2021.761045 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sarah Kraus ◽

Raz Khandadash ◽

Raphael Hof ◽

Abraham Nyska ◽

Ekaterina Sigalov ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Field ◽

Lung Metastases ◽

Metastatic Cancer ◽

Relative Size ◽

Clinical Signs ◽

Metastatic Breast ◽

The Body ◽

Alternating Magnetic Field ◽

Therapeutic Modality

Sarah Nanoparticles (SaNPs) are unique multicore iron oxide-based nanoparticles, developed for the treatment of advanced cancer, following standard care, through the selective delivery of thermal energy to malignant cells upon exposure to an alternating magnetic field. For their therapeutic effect, SaNPs need to accumulate in the tumor. Since the potential accumulation and associated toxicity in normal tissues are an important risk consideration, biodistribution and toxicity were assessed in naïve BALB/c mice. Therapeutic efficacy and the effect on survival were investigated in the 4T1 murine model of metastatic breast cancer. Toxicity evaluation at various timepoints did not reveal any abnormal clinical signs, evidence of alterations in organ function, nor histopathologic adverse target organ toxicity, even after a follow up period of 25 weeks, confirming the safety of SaNP use. The biodistribution evaluation, following SaNP administration, indicated that SaNPs accumulate mainly in the liver and spleen. A comprehensive pharmacokinetics evaluation, demonstrated that the total percentage of SaNPs that accumulated in the blood and vital organs was ~78%, 46%, and 36% after 4, 13, and 25 weeks, respectively, suggesting a time-dependent clearance from the body. Efficacy studies in mice bearing 4T1 metastatic tumors revealed a 49.6% and 70% reduction in the number of lung metastases and their relative size, respectively, in treated vs. control mice, accompanied by a decrease in tumor cell viability in response to treatment. Moreover, SaNP treatment followed by alternating magnetic field exposure significantly improved the survival rate of treated mice compared to the controls. The median survival time was 29 ± 3.8 days in the treated group vs. 21.6 ± 4.9 days in the control, p-value 0.029. These assessments open new avenues for generating SaNPs and alternating magnetic field application as a potential novel therapeutic modality for metastatic cancer patients.

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Diagnostic significance of clinical and para-clinical signs of community-acquired pneumonia in children

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(2)-08 ◽

2020 ◽

Vol 24 (2) ◽

pp. 244-249

Author(s):

V.Yu. Pasik

Keyword(s):

Young Children ◽

Sensitivity And Specificity ◽

Clinical Symptoms ◽

Clinical Signs ◽

The Body ◽

Diagnostic Methods ◽

Statistical Hypothesis ◽

Diagnostic Significance ◽

Operational Characteristics ◽

Gallbladder Dyskinesia

Annotation. Respiratory diseases are relevant in pediatric practice, which is associated with its widespread and frequent complications, especially in young children. The aim of the study was to assess the diagnostic value of clinical symptoms, laboratory and ultra-sonographic parameters in pneumonia in children of the first 3 years of life. A retrospective study of medical records of 218 children who were hospitalized in the department for young children diagnosed with pneumonia for the period from 2016 to 2018. The average age of children was 11.67±9.97 months and it was within the range from 1 month to 3 years. The ration of boys and girls was practically identical (51.8% and 48.2% accordingly). The first group included children aged under one year (the average age is 4.57±0.84 months; n=88). The second group included children aged from 1 to 3 years (the average age is 18.2±4.25 months; n=130). To characterize the information content of clinical and laboratory symptoms the study has used objective parameters defined as the operational characteristics of tests. The most important operational characteristics of diagnostic methods included: sensitivity (Se, sensitivity) and specificity (Sp, specificity). To check the statistical hypothesis on differences of absolute and relative frequencies, fractions, and ratios in two independent samples, the criteria of хі-square (χ2) was used. While detailing an anamnesis, the disease was more often related to untimely treatment and outpatient care. Various data were obtained on the absolute and relative risk, as well as the sensitivity and specificity of the localization of pneumonia depending on age. Therefore, the incidence of bilateral pneumonia was considered an indicator of risk. On admission to hospital, the body temperature of patients was 38.2±0.66°С. Most of the complaints were on the unproductive or productive cough. Besides, in some cases, shortness of breath and runny nose were mentioned. Thus, in young children with pneumonia, a diagnostically significant clinical symptom is a bilateral lung impression (82.6%), compared with right-handed (15.1%) and left-handed (2.3%), which is significantly more common in children under 1-th year of life compared with patients 1–3 years; laboratory features are probably higher levels of liver-specific enzymes – ALT and AST in children under 1 year; ultrasonographic indicators associated with the presence of pneumonia in young children include increased liver size, gallbladder deformity, the presence of sediment in the gallbladder, dyskinesia of the biliary tract, thickening of the gallbladder wall; children under 1 year of age have a risk of liver enlargement and biliary dyskinesia.

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In an Adult Horse With Severe Asthma (Previously Recurrent Airway Obstruction) Does Using Inhaled Corticosteroids Result in an Equal Improvement in Clinical Signs When Compared to Systemic Corticosteroids?

Veterinary Evidence ◽

10.18849/ve.v3i2.139 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Natasha A Jocelyn

Keyword(s):

Open Access ◽

Airway Obstruction ◽

Severe Asthma ◽

Inhaled Corticosteroids ◽

Clinical Signs ◽

The Body ◽

Recurrent Airway Obstruction ◽

Bottom Line ◽

Systemic Corticosteroids ◽

Equine Asthma

PICO question In an adult horse with severe asthma (previously recurrent airway obstruction (RAO)) does using inhaled corticosteroids result in an equal improvement in clinical signs when compared to systemic corticosteroids?Clinical bottom line The level of confidence in the outcomes from the body of evidence in the 4 papers identified is high. This suggests inhaled corticosteroids (fluticasone and beclomethasone) when used at an appropriate dose can have equivalent effects on severe equine asthma as systemic intravenous dexamethasone. Inhaled corticosteroids can take longer to have the desired effects. <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

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