Diagnosis and management of hypoaldosteronism without hypoadrenocorticism in an alpaca

Kelly A. Butterworth Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.

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Alessandra M. Pellegrini-Masini Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.

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Michelle H. Barton Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.

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Abstract

Case Description—Primary hypoaldosteronism without concurrent hypoadrenocorticism was diagnosed in an 8-year-old female alpaca with acute onset of weakness progressing to recumbency within 6 hours after onset.

Clinical Findings—Hematologic testing at admission revealed profound hyponatremia, hypochloremia, and acidemia with a normal blood potassium concentration. Further diagnostic testing, including an ACTH stimulation test, led to a diagnosis of hypoaldosteronism in conjunction with normal cortisol production.

Treatment and Outcome—The hembra responded well to IV polyionic fluid therapy with sodium supplementation and was managed successfully long term with free access to saline (0.9% NaCl) solution in addition to water ad libitum.

Clinical Relevance—To our knowledge, this is the first reported case of hypoaldosteronism in an alpaca. Hypoaldosteronism should be considered in alpacas as a possible differential diagnosis for refractory hyponatremia or for hyponatremia in which an underlying etiology is not determined.

Abstract

Case Description—Primary hypoaldosteronism without concurrent hypoadrenocorticism was diagnosed in an 8-year-old female alpaca with acute onset of weakness progressing to recumbency within 6 hours after onset.

Clinical Findings—Hematologic testing at admission revealed profound hyponatremia, hypochloremia, and acidemia with a normal blood potassium concentration. Further diagnostic testing, including an ACTH stimulation test, led to a diagnosis of hypoaldosteronism in conjunction with normal cortisol production.

Treatment and Outcome—The hembra responded well to IV polyionic fluid therapy with sodium supplementation and was managed successfully long term with free access to saline (0.9% NaCl) solution in addition to water ad libitum.

Clinical Relevance—To our knowledge, this is the first reported case of hypoaldosteronism in an alpaca. Hypoaldosteronism should be considered in alpacas as a possible differential diagnosis for refractory hyponatremia or for hyponatremia in which an underlying etiology is not determined.

Contributor Notes

Supported by the Southeastern Alpaca Association. Crooked Pines Hollow Alpaca Farm provided healthy control alpacas for comparison testing.

Address correspondence to Dr. Butterworth (kelly.butterworth@gmail.com).
  • 1.

    Fowler ME. Medicine and surgery of South American camelids. Ames, Iowa: Iowa State University Press, 1989.

  • 2.

    Lefebvre HP, Olivier D, Trumel C, et al. Fractional excretion tests: a critical review of methods and applications in domestic animals. Vet Clin Pathol 2008; 37:420.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Leon JB, Smith BB, Timm KI, et al. Endocrine changes during pregnancy, parturition, and early post partum period in the llama (Llama glama). J Reprod Fertil 1990; 88:503511.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Anderson DE, Grubb T, Fernando S. The effect of short duration transport on serum cortisol response in alpacas. Vet J 1999; 157:189191.

  • 5.

    Bonacic C, Macdonald DW, Villouta G. Adrenocorticotrophin-induced stress response in captive vicunas (Vicugna vicugna) in the Andes of Chile. Anim Welf 2003; 12:369385.

    • Search Google Scholar
    • Export Citation
  • 6.

    Norton F, Nadler JL. Hypoaldosteronism. Curr Ther Endocrinol Metab 1997; 6:164167.

  • 7.

    Peterson ME, Kintzer PP, Kass PH. Pretreatment clinical and laboratory findings in dogs with hypoadrenocorticism: 225 cases (1979–1993). J Am Vet Med Assoc 1996; 208:8591.

    • Search Google Scholar
    • Export Citation
  • 8.

    White PC. Disorders of aldosterone biosynthesis and action. N Engl J Med 1994; 314:250258.

  • 9.

    Kayes-Wandover KM, Tannin GM, Shulman D, et al. Congenital hyperreninemic hypoaldosteronism unlinked to the aldosterone synthase (CYP11B2) gene. J Clin Endocrinol Metab 2001; 86:53795382.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Kayes-Wandover KM, Lee Schindler RE, Taylor HC, et al. Type 1 aldosterone synthase deficiency presenting in a middle-aged man. J Clin Endocrinol Metab 2001; 86:10081012.

    • Search Google Scholar
    • Export Citation
  • 11.

    Schaer MS, Riley WJ, Buergelt CD, et al. Autoimmunity and Addison's disease in the dog. J Am Anim Hosp Assoc 1986; 22:789794.

  • 12.

    Oberbauer AM, Bell JS, Belanger JM, et al. Genetic evaluation of Addison's disease in the Portuguese water dog. BMC Vet Res 2006; 15:111117.

    • Search Google Scholar
    • Export Citation
  • 13.

    Maclaren NK, Riley WJ. Inherited susceptibility to autoimmune Addison's disease is linked to human leukocyte antigen-DR3 and/or DR4, except when associated with type 1 autoimmune poly-glandular syndrome. J Clin Endocrinol Metab 1986; 22:789794.

    • Search Google Scholar
    • Export Citation
  • 14.

    Du Cheyron D, Bouchet B, Cauquelin B, et al. Hyperreninemic hypoaldosteronism syndrome plasma concentrations of interleukin-6 and outcome in critically ill patients. Intensive Care Med 2008; 34:116124.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Raff H, Findling JW, Diaz SJ, et al. Aldosterone control in critically ill patients: ACTH, metoclopramide, and natriuretic peptide. Crit Care Med 1990; 18:915920.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Lobetti RG. Hyperreninaemic hypoaldosteronism in a dog. J S Afr Vet Assoc 1998; 68:3335.

  • 17.

    Knochel JP. The syndrome of hyporeninemic hypoaldosteronism. Ann Rev Med 1979; 30:145153.

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