Hyperadrenocorticism - what should we be doing?

Squires, Richard (2020) Hyperadrenocorticism - what should we be doing? In: Proceedings of the World Congress of Veterinary Dermatology. pp. 84-91. From: 9th World Congress on Veterinary Dermatology, October 2020 - April 2021, Online.

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This article is intended as a brief refresher on current approaches to the diagnosis of canine hyperadrenocorticism (HAC). Some areas of debate and apparent controversy will be highlighted. Spontaneously-occurring canine HAC will be the focus. Dr Harvey Cushing first described HAC in human beings approximately 80 years ago although he discovered it much earlier. The earliest publication on canine HAC currently listed in Medline was published in 1953. Cushing’s syndrome is synonymous with HAC. The term “Cushing’s disease” is best reserved for cases of pituitary-dependent HAC (PDH). There is a remarkably large body of peer-reviewed scientific literature dealing with HAC in dogs. A search of Medline for articles on “dogs AND hyperadrenocorticism” on May 18th 2020 resulted in 823 hits, including 22 articles from 2019 and (already) 5 from 2020. This large amount of work has been done because HAC is one of the most prevalent and therefore important endocrine diseases of dogs. Diagnosis and treatment are reasonably complex. Despite a considerable amount of intense study over the last six to seven decades, many cases of HAC in dogs remain challenging to diagnose and some cases are difficult to treat satisfactorily. HAC is considerably less common in cats and people. It is not known why HAC is so common in dogs. A major difficulty with diagnosis of HAC in dogs is the lack of a single “gold standard” or “reference standard” diagnostic test. As with some other diagnostically-challenging diseases (such as systemic lupus erythematosus), a diagnosis must be based on a combination of compatible clinical findings. In the case of HAC, these findings derive from signalment, history, physical examination, routine clinicopathological testing, diagnostic imaging and adrenal function testing. None of these tests is 100% reliable, the combination must be considered. Compatible history and physical examination findings are particularly important. It is distinctly possible that the subset of all HAC dogs examined and diagnostically investigated by veterinary dermatologists is subtly different from the subset examined and investigated by internists. Many case series and suggested diagnostic and therapeutic approaches have been published by internists, based on their own clinical caseloads. Therefore caution and perhaps some scepticism should be exercised by veterinary dermatologists if published advice and findings do not seem coherent with their own experiences and clinical findings. In addition, many of the descriptions of canine HAC are decades old. It has been suggested that greater familiarity with the syndrome may have led to earlier diagnoses, perhaps altering the prevalence of some diagnostic features.

Item ID: 65342
Item Type: Conference Item (Presentation)
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Date Deposited: 11 Mar 2021 01:16
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