59.3 MAY/JUN 2023
Veterinary Practice Guidelines
2023 AAHA Selected Endocrinopathies of Dogs and
Cats Guidelines
Andrew Bugbee, Renee Rucinsky, Sarah Cazabon, Heather Kvitko-White, Patty Lathan, Amy Nichelason, Liza Rudolph
Canine and feline endocrinopathies reflect an endocrine gland disease or dysfunction with resulting hormonal abnormalities that can variably affect the patient’s wellbeing, quality of life, and life expectancy. These guidelines provide consensus recommendations for diagnosis and treatment of four canine and feline endocrinopathies commonly encountered in clinical practice: canine hypothyroidism, canine hypercortisolism (Cushing’s syndrome), canine hypoadrenocorticism (Addison’s disease), and feline hyperthyroidism. To aid the general practitioner in navigating these common diseases, a stepwise diagnosis and treatment algorithm and relevant background information is provided for managing each of these diseases. The guidelines also describe, in lesser detail, the diagnosis and treatment of three relatively less common endocrinopathies of cats: feline hyperaldosteronism, feline hypothyroidism, and feline hyperadrenocorticism. Additionally, the guidelines present tips on effective veterinary team utilization and client communication when discussing endocrine cases.
Case Reports
Microchip Implantation Within the Cervical Spine, a Neurologic Evaluation, and Surgical Correction
Breanne Morrell, Charlotte E. Gillis, Katheryn C. Wolfe, James T. Giles, III
A 5 mo old male Japanese chin was examined 1 mo following the sudden onset of pelvic limb weakness and ataxia immediately after microchip placement. Neurological examination revealed an ambulatory paraparesis, which was worse on the right side, with additional weakness noted in the right thoracic limb. Lesion localization was C6–T2 spinal cord segments, worse on the right. Radiographic imaging of the cervical spine revealed a microchip at the location of the C7–T1 intervertebral space. Computed tomography revealed a microchip within the spinal canal causing spinal cord compression at the level of the C7–T1 intervertebral disc space. Surgical removal of the microchip was performed, and the patient recovered well. A 6 wk follow-up neurologic examination showed persistent mild ataxia in the pelvic limbs. This case supports previously reported cases of permanent spinal cord damage caused by microchip placement. Surgical removal of the microchip resulted in the improvement of neurologic signs. Although extraction of the microchip did not resolve all neurologic deficits, surgery prevented further migration and possible damage to the spinal cord.
Case Reports
Successful Management of Severe Manganese Toxicosis in Two Dogs
Jacob Wolf, Levi Hoffman, Carl Southern
Manganese is a common component of human joint supplements and may be a source of ingestion and subsequent toxicosis in dogs. Although hepatotoxicity secondary to manganese toxicosis has been reported in dogs before, no descriptions of successful management of manganese toxicosis has been reported in veterinary literature. A 5 yr old spayed female Shetland sheepdog and a 5 yr old female Shetland sheepdog were evaluated following accidental ingestion of a joint supplement. Consultation with a toxicologist revealed concern for manganese toxicosis resulting in hepatic injury. Both dogs developed subsequent acute liver injury, despite decontamination and initial management with N-acetylcysteine and cholestyramine. The patients were managed with calcium ethylenediaminetetraacetic acid, paraaminosalicylic acid, allopurinol, Vitamin E, ginkgo biloba, and S-adenosylmethionine/silybin. Liver values returned to normal in both dogs. Manganese exposure was confirmed with urine manganese analysis in one dog and fecal examination in the other dog. A previous case report detailed the fatal manganese toxicosis in a dog; this case report describes the successful management of severe acute hepatic injury secondary to manganese toxicosis. The combination of medications used above may be used for successful treatment of manganese toxicosis in dogs.
Case Reports
Successful Medical Management of an Acute Traumatic Sternal Luxation in a Cat
Jesse Grady, Shanna Marroquin, Alison Lee
A 5 yr old indoor–outdoor domestic longhair red tabby cat presented for evaluation of a 1 day history of hiding, urinating and defecating outside the litterbox, and vocalizing when picked up. Physical examination revealed significant pain on palpation of the caudal sternum where an approximately 8 × 6 cm contusion was noted. Sedated thoracic radiographs revealed a luxated fifth intersternebral joint with the sixth sternebra being cranioventrally displaced (along with the seventh and eight sternebrae) to the level of the mid fourth sternebra. There were sharply marginated, short oblique fractures of the distal sixth costal cartilages bilaterally with mild dorsal displacement of the distal segment. The sternal luxation was palpated more aggressively once the patient was sedated and deemed to be stable. Because of the stability of the luxation and absence of sternebral fractures, conservative medical management in the form of analgesics and rest was instituted. Repeat thoracic radiographs 2 wk after presentation revealed an unchanged sternal luxation. Twelve months after presentation, the patient presented for an unrelated lameness and, in that timeframe, has exhibited no sequelae to the sternal luxation, which still palpates stable and is radiographically unchanged.
Case Reports
Uterus Masculinus with a Patent Urethral Communication Documented with Positive Contrast Computed Tomography
Jilli Crosby, Alexandros Hardas, Karla Lee, Lynda Rutherford
A 9 mo old male Labrador retriever presented for investigation into persistent urinary incontinence. Abdominal ultrasound and retrograde urethrocystogram with computed tomography documented a uterus masculinus (UM), which was confirmed on histopathology after surgical removal. A connection between the UM and the urethra was present, documented by positive contrast retrograde urethrocystography and confirmed with surgery.
Typically, in the literature, UM are blind ending, and there are only a few case reports that demonstrate an assumed connection. This case has demonstrated a patent connection between the UM and the urethra, which should be considered a differential diagnosis for persistent urinary incontinence and urinary tract infection in juvenile male dogs.
Original Studies
Agreement Between Tongue-Based Oscillometric and Invasive Blood Pressure in Anesthetized Dogs of Various Weights
Dalhae Kim, Jiyoung Kim, Donghwi Shin, Inhyung Lee, Won-gyun Son
This study aimed to evaluate the agreement between oscillometric blood pressure (OBP) measured from the tongue and invasive blood pressure (IBP) measured from the dorsal pedal artery in anesthetized dogs of various body weights. Forty-five client-owned dogs undergoing general anesthesia for surgery or imaging scan were included; weights ranged from 2.5 to 42.6 kg. Agreement between paired IBP and OBP during normotension was verified with reference standards used in small animals and humans. The data were stratified by body weight (≤5 kg versus >5 kg). In the >5 kg group (n = 29), the bias ± standard deviation for mean (2.1 ± 7.9 mm Hg) and diastolic pressure (−2.7 ± 7.9 mm Hg) exhibited reliability that met human standards (<5 ± 8 mm Hg). However, in the ≤5 kg group (n = 16), the bias ± standard deviation met only veterinary standards (≤10 ± 15 mm Hg) for mean (3.1 ± 10.2 mm Hg) and diastolic pressure (−2.5 ± 12.6 mm Hg). Agreement for systolic pressure did not meet either standard for both groups. This study demonstrates that tongue-based OBP is a close estimate of mean/diastolic blood pressure in anesthetized dogs (>5 kg) during normotension by small-animal and human criteria.
