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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)

Elizabeth M. LennonDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Tonya E. BoyleDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Rae Grace HutchinsDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Arit FriedenthalDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Maria T. CorreaPopulation Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Sally A. BissettDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Lorra S. MosesDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Adam J. BirkenheuerDepartments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Abstract

Objective—To determine whether basal serum or plasma cortisol concentration can be used as a screening test to rule out hypoadrenocorticism in dogs.

Design—Retrospective case-control study.

Animals—110 dogs with nonadrenal gland illnesses and 13 dogs with hypoadrenocorticism.

Procedures—Sensitivity and specificity of basal serum or plasma cortisol concentrations of either ≤ 1 μg/dL or ≤ 2 μg/dL to detect dogs with hypoadrenocorticism were estimated by use of the ACTH stimulation test as the gold standard.

Results—Basal cortisol concentrations of ≤ 1 μg/dL had excellent sensitivity (100%) and specificity (98.2%) for detecting dogs with hypoadrenocorticism. For basal cortisol concentrations of ≤ 2 μg/dL, sensitivity was 100% but specificity was 78.2%.

Conclusions and Clinical Relevance—On the basis of sensitivity and specificity, basal serum or plasma cortisol concentrations had high negative predictive values over a wide range of prevalence rates and can be used to rule out a diagnosis of hypoadrenocorticism. Dogs with basal cortisol concentrations > 2 μg/dL that are not receiving corticosteroids, mitotane, or ketoconazole are highly unlikely to have hypoadrenocorticism. However, if the basal cortisol concentration is ≤ 2 μg/dL, little to no information regarding adrenal gland function can be obtained and an ACTH stimulation test should be performed.

Abstract

Objective—To determine whether basal serum or plasma cortisol concentration can be used as a screening test to rule out hypoadrenocorticism in dogs.

Design—Retrospective case-control study.

Animals—110 dogs with nonadrenal gland illnesses and 13 dogs with hypoadrenocorticism.

Procedures—Sensitivity and specificity of basal serum or plasma cortisol concentrations of either ≤ 1 μg/dL or ≤ 2 μg/dL to detect dogs with hypoadrenocorticism were estimated by use of the ACTH stimulation test as the gold standard.

Results—Basal cortisol concentrations of ≤ 1 μg/dL had excellent sensitivity (100%) and specificity (98.2%) for detecting dogs with hypoadrenocorticism. For basal cortisol concentrations of ≤ 2 μg/dL, sensitivity was 100% but specificity was 78.2%.

Conclusions and Clinical Relevance—On the basis of sensitivity and specificity, basal serum or plasma cortisol concentrations had high negative predictive values over a wide range of prevalence rates and can be used to rule out a diagnosis of hypoadrenocorticism. Dogs with basal cortisol concentrations > 2 μg/dL that are not receiving corticosteroids, mitotane, or ketoconazole are highly unlikely to have hypoadrenocorticism. However, if the basal cortisol concentration is ≤ 2 μg/dL, little to no information regarding adrenal gland function can be obtained and an ACTH stimulation test should be performed.

Contributor Notes

Presented in part at the 2006 American College of Veterinary Internal Medicine Forum, Louisville, June 2006.

Address correspondence to Dr. Birkenheuer.