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Diagnosis of hyperadrenocorticism in dogs: a survey of internists and dermatologists

Ellen N. BehrendDepartment of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, AL 36849.
Present address is Department of Clinical Sciences, Hoerlein Hall, Auburn University, Auburn, AL 36849.

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 VMD, PhD, DACVIM
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Robert J. KemppainenDepartment of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, AL 36849.

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Terrence P. ClarkDepartment of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, AL 36849.
Present address is Pfizer Global Research and Development, Veterinary Medicine Clinical Development, Eastern Point Road, Groton, CT 06340.

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M. D. SalmanDepartment of Environmental Health, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

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Mark E. PetersonCaspary Research Institute and the Bobst Hospital of the Animal Medical Center, 510 East 62nd St, New York, NY 10021.

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 DVM, DACVIM

Abstract

Objective—To determine testing protocols used by board-certified internists and dermatologists for diagnosis of hyperadrenocorticism (HAC) in dogs.

Design—Survey.

Study Population—Board-certified internists and dermatologists.

Procedure—A questionnaire was mailed to 501 specialists to gather information pertaining to diagnosis of HAC.

Results—206 surveys were returned. Only 26% of respondents indicated they would screen a dog for HAC if the dog had only a few laboratory abnormalities consistent with HAC and no clinical signs consistent with the disease; 31% indicated they would not, and 43% indicated they would sometimes. Overall, 55% of respondents indicated they preferred to use the lowdose dexamethasone suppression test for routine screening of dogs suspected to have HAC. However, many respondents indicated they would use a different screening test than usual in particular circumstances. Sixty-eight percent of respondents indicated they would perform a second screening test for confirmation if results of an initial screening test were positive but there were few clinical or laboratory abnormalities consistent with HAC. Most respondents used some sort of test to differentiate pituitary-dependent HAC from HAC secondary to an adrenal tumor (AT), but no 1 test was clearly preferred. Ultrasonography was commonly used, whereas computed tomography and magnetic resonance imaging were not, even if available.

Conclusions and Clinical Relevance—Results suggest that the low-dose dexamethasone suppression test is the test most commonly used to screen dogs for HAC but that other tests may be used in certain circumstances. A variety of tests were used to differentiate pituitary-dependent HAC from HAC secondary to an AT. (J Am Vet Med Assoc 2002;220:1643–1649)

Abstract

Objective—To determine testing protocols used by board-certified internists and dermatologists for diagnosis of hyperadrenocorticism (HAC) in dogs.

Design—Survey.

Study Population—Board-certified internists and dermatologists.

Procedure—A questionnaire was mailed to 501 specialists to gather information pertaining to diagnosis of HAC.

Results—206 surveys were returned. Only 26% of respondents indicated they would screen a dog for HAC if the dog had only a few laboratory abnormalities consistent with HAC and no clinical signs consistent with the disease; 31% indicated they would not, and 43% indicated they would sometimes. Overall, 55% of respondents indicated they preferred to use the lowdose dexamethasone suppression test for routine screening of dogs suspected to have HAC. However, many respondents indicated they would use a different screening test than usual in particular circumstances. Sixty-eight percent of respondents indicated they would perform a second screening test for confirmation if results of an initial screening test were positive but there were few clinical or laboratory abnormalities consistent with HAC. Most respondents used some sort of test to differentiate pituitary-dependent HAC from HAC secondary to an adrenal tumor (AT), but no 1 test was clearly preferred. Ultrasonography was commonly used, whereas computed tomography and magnetic resonance imaging were not, even if available.

Conclusions and Clinical Relevance—Results suggest that the low-dose dexamethasone suppression test is the test most commonly used to screen dogs for HAC but that other tests may be used in certain circumstances. A variety of tests were used to differentiate pituitary-dependent HAC from HAC secondary to an AT. (J Am Vet Med Assoc 2002;220:1643–1649)