Prevalence of inflammatory versus neoplastic lesions in dogs with chronic gastrointestinal signs undergoing gastroduodenoscopy: 195 cases (2007-2015).

OBJECTIVES: Prevalence of inflammatory enteropathy versus lymphoma in dogs undergoing gastroduodenoscopy has not been evaluated. This retrospective study assessed outcome from 195 client-owned dogs scheduled to undergo upper gastrointestinal endoscopy as the next diagnostic step. MATERIAL AND METHODS: Cases were grouped into the following diagnoses according to WSAVA guidelines: lymphoplasmacytic enteritis (LPE), eosinophilic enteritis (EE), mixed-cell enteritis (ME), histologically normal biopsies (N), and lymphoma (L). Clinical signs, and preendoscopic results from laboratory and ultrasonography examinations, were compared among groups. RESULTS: LPE was diagnosed in 133 (68%), EE in 17 (9%), ME in 9 (5%), 32 (16%) dogs had histologically normal biopsies. Four (2%) dogs were diagnosed with lymphoma. Vomiting was the most frequent clinical sign (61%), followed by weight loss (43%), and diarrhea (39%). Vomiting also predominated when looking at individual histological disease categories, however clinical signs did not differ significantly between groups. Dogs with lymphoma were more likely to have ultrasonographic abnormalities, had significantly lower haematocrit, albumin and total protein concentrations compared to dogs with LPE and histologically normal biopsies. CLINICAL SIGNIFICANCE: Lymphoma was rarely found in this group of dogs with nonspecific results of pre-endoscopic work-up. Our results provide first reference for clinicians when discussing the possibility of a step-up therapeutic approach (such as multiple dietary trials) with owners before pursuing endoscopy. Understanding the likelihood of finding lymphoma is important in that histologic documentation of inflammatory enteropathy alone has limited therapeutic consequences. Future studies are needed to validate these findings in dogs undergoing combined upper and lower gastrointestinal endoscopy and biopsies.

Systemic Scedosporium prolificans infection in an 11-month-old Border collie with cobalamin deficiency secondary to selective cobalamin malabsorption (canine Imerslund-Gräsbeck syndrome).

An 11-month-old Border collie presented collapsed and continued to deteriorate rapidly despite supportive treatment. The dog had a history of failure to thrive and recurring respiratory infection. Laboratory abnormalities included neutrophilic leucocytosis, Heinz body anaemia, hyperammonaemia, hyperbilirubinaemia, proteinuria and hypocobalaminaemia. Post-mortem examination revealed multi-focal necrosis within the heart, kidneys, pancreas, liver, meninges and cerebral cortex. Fungal hyphae in lesions were identified as Scedosporium prolificans following culture. Subsequent genotyping confirmed that the dog carried the CUBN:c.8392delC mutation in a homozygous state, verifying hereditary cobalamin deficiency (a.k.a. Imerslund-Gräsbeck syndrome). Cobalamin deficiency may have been a predisposing factor for the development of systemic fungal infection in this dog.

Effects of 6 Weeks of Parenteral Cobalamin Supplementation on Clinical and Biochemical Variables in Cats with Gastrointestinal Disease.

BACKGROUND: Effects and duration of commonly used protocols for cobalamin (Cbl) supplementation on cellular Cbl deficiency have not been determined in hypocobalaminemic cats. HYPOTHESIS/OBJECTIVES: To evaluate effect of Cbl supplementation on clinical signs, serum and urine methylmalonic acid (MMA) concentrations over 16 weeks. ANIMALS: Twenty client-owned hypocobalaminemic cats with enteropathy. METHODS: Prospective study. Serum Cbl and serum and urine MMA concentrations were determined prospectively in cats at enrollment (t0), immediately before (t6), and 4 (t10) and 10 weeks (t16) after 6th Cbl injection (250 µg, IM q 7 days). Clinical signs severity (activity, appetite, vomiting, diarrhea, body weight) graded at each time point and expressed as clinical disease activity score. RESULTS: Clinical disease activity score decreased during supplementation and increased after treatment discontinuation. Median serum Cbl concentration increased significantly from t0 (111 pmol/L, range 111-212) to t6 (2,332.5 pmol/L, range 123-22,730) (P < 0.01). Values at t10 were 610.5 pmol/L (range, 111-2,527) and 180.5 pmol/L (range, 111-2,262) at t16 (P < 0.01). Median baseline serum MMA concentration (372 µmol/L, range 0.39-147,000) decreased significantly to 1.62 µmol/L (range, 0.18-806) at t6 (P < 0.01) and gradually increased to 5.34 µmol/L (range, 0.13-1,730) at t10 and 189 µmol/L (range, 0.4-983) at t16. Similar, nonsignificant, pattern observed for urine MMA concentration. Serum and urine MMA concentrations had not normalized in 12 and 6 cats, respectively, at t6. CONCLUSION AND CLINICAL IMPORTANCE: The Cbl supplementation protocol used here did not lead to complete normalization of cellular Cbl deficiency in all examined cats, and biochemical improvements were transient.

Comparison of Serum Spec fPL(™) and 1,2-o-Dilauryl-Rac-Glycero-3-Glutaric Acid-(6'-Methylresorufin) Ester Assay in 60 Cats Using Standardized Assessment of Pancreatic Histology.

BACKGROUND: Feline pancreas-specific lipase (Spec fPL) is considered a useful test for the antemortem diagnosis of pancreatitis in cats. A recent study found good agreement between the results of the Spec fPL and catalytic 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase assay. Prospective studies evaluating their sensitivity and specificity are lacking. OBJECTIVES: To compare the results of the Spec fPL and the DGGR assays with a standardized histologic assessment of the pancreas. ANIMALS: Sixty client-owned cats presented for necropsy. PROSPECTIVE STUDY: Spec fPL concentrations and serum DGGR lipase activity were measured from the same blood sample. The pancreas was removed within 3 hours after euthanasia; serial transverse sections were made every 0.5 cm throughout the entire pancreas and reviewed using a histologic grading scheme. Sensitivity and specificity for the Spec fPL and DGGR assay results were determined. RESULTS: The sensitivity and specificity for the Spec fPL assay (cutoff value ≥5.4 µg/L) was 42.1 [95% confidence interval (95% CI), 29.4-55.9%] and 100% (95% CI, 31.0-100.0%). The sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 36.8 (95% CI, 24.7-50.7%) and 100% (95% CI, 31.0-100.0%). When lymphocytic inflammation up to 10% of a section was considered normal, the sensitivity and specificity for Spec fPL assay (cutoff value ≥5.4 µg/L) was 61.1 (95% CI, 36.1-81.7%) and 69.0% (95% CI, 52.8-81.9%) and the sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 66.7 (95% CI, 41.2-85.6%) and 78.6% (95% CI, 62.8-89.2%). CONCLUSIONS AND CLINICAL IMPORTANCE: Both lipase assays performed similarly well, but their agreement with histologic pancreatic inflammation was limited.

The effect of orally administered ranitidine and once-daily or twice-daily orally administered omeprazole on intragastric pH in cats.

BACKGROUND: Gastric acid suppressants frequently are used in cats with acid-related gastric disorders. However, it is not known if these drugs effectively increase intragastric pH in cats. OBJECTIVES: To examine the effects of PO administered ranitidine and omeprazole on intragastric pH in cats and to compare the efficacy of once-daily versus twice-daily dosage regimens for omeprazole. ANIMALS: Eight domestic shorthair cats. METHODS: Using a randomized 4-way cross-over design, cats were given enteric-coated omeprazole granules (1.1-1.3 mg/kg q24h and q12h), ranitidine (1.5-2.3 mg/kg q12h), and placebo. Intragastric pH was monitored continuously for 96 hours using the Bravo(™) system, starting on day 4 of treatment, followed by a median washout period of 12 days. Mean percentage of time pH was ≥3 and ≥4 was compared among groups using repeated measures ANOVA. RESULTS: Mean ± SD percentage of time intragastric pH was ≥3 and ≥4 was 67.0 ± 24.0% and 54.6 ± 26.4% for twice-daily omeprazole, 24.4 ± 22.8% and 16.8 ± 19.3% for once-daily omeprazole, 16.5 ± 9.0% and 9.6 ± 5.9% for ranitidine, and 9.4 ± 8.0% and 7.0 ± 6.6% for placebo administration. Twice-daily omeprazole treatment significantly increased intragastric pH, whereas pH after once-daily omeprazole and ranitidine treatments did not differ from that of placebo-treated cats. CONCLUSION AND CLINICAL IMPORTANCE: Only twice-daily PO administered omeprazole significantly suppressed gastric acidity in healthy cats, whereas once-daily omeprazole and standard dosages of ranitidine were not effective acid suppressants in cats.

Hepatic fungal infection in a young beagle with unrecognised hereditary cobalamin deficiency (Imerslund-Gräsbeck syndrome).

A 12-month-old beagle presented for anorexia, pyrexia and vomiting. The dog had been treated intermittently with antibiotics and corticosteroids for inappetence and lethargy since five months of age. Previous laboratory abnormalities included macrocytosis and neutropenia. At presentation, the dog was lethargic, febrile and thin. Laboratory examination findings included anaemia, a left shift, thrombocytopenia, hypoglycaemia and hyperbilirubinaemia. Multiple, small, hypoechoic, round hepatic lesions were observed on abdominal ultrasound. Cytological examination of hepatic fine needle aspirates revealed a fungal infection and associated pyogranulomatous inflammation. The dog's general condition deteriorated despite supportive measures and treatment with fluconazole, and owners opted for euthanasia before hypocobalaminaemia was identified. Subsequent genomic analysis revealed a CUBN:c.786delC mutation in a homozygous state, confirming hereditary cobalamin malabsorption (Imerslund-Gräsbeck syndrome). Similar to human infants, dogs with Imerslund-Gräsbeck syndrome may rarely be presented for infectious diseases, distracting focus from the underlying primary disorder.

Wireless ambulatory esophageal pH monitoring in dogs with clinical signs interpreted as gastroesophageal reflux.

BACKGROUND: Although gastroesophageal reflux (GER) often is assumed to be causative for upper gastrointestinal and respiratory signs in dogs, no attempts have been made to verify this assumption. OBJECTIVES: To monitor esophageal pH with the Bravo pH system in healthy dogs and client-owned dogs displaying signs commonly attributed to GER. ANIMALS: Seven healthy and 22 client-owned dogs. METHODS: After routine esophagogastroduodenoscopy, radiotelemetric pH capsules were placed in distal esophagus for continuous pH recording. Reflux was defined as single pH measurement <4. At discharge, owners were instructed to press individually predefined clinical sign-buttons on the receiver whenever indicated. Results between groups were compared using Mann-Whitney U-test. RESULTS: The median (range) number of refluxes in client-owned and healthy dogs, respectively, was 17 (1-205) and 10 (1-65), the number of refluxes >5 minutes in duration was 1 (0-14), and 1 (0-4), duration of longest reflux (min) was 10 (0-65) and 8 (0-27), and fractional time pH <4 (%) was 0.76% (0.01-6.28), and 0.3% (0-3.1). No differences were found between groups. The median of 7 (1-35) clinical sign-button pushes were recorded in 21 dogs. Median of 12.5% (2.8% [1/35]-50% [2/4]) reflux-positive clinical sign-button pushes was found in 10 dogs with reflux-positive pushes. Five (22.7%) dogs had increased esophageal acid exposure, and mild esophagitis was noted in 1 dog. CONCLUSION AND CLINICAL IMPORTANCE: Despite evidence of increased GER in some dogs, the clinical sign-reflux association remained poor. Future investigation should focus on dogs with esophagitis.

Agreement of serum Spec cPL with the 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester (DGGR) lipase assay and with pancreatic ultrasonography in dogs with suspected pancreatitis.

BACKGROUND: Spec cPL is the most sensitive and specific test for diagnosing pancreatitis in dogs. Its results have not been compared to those of the 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase assay or those of abdominal ultrasonography. OBJECTIVES: To investigate agreement of Spec cPL with DGGR lipase activity and pancreatic ultrasonography in dogs with suspected pancreatitis. ANIMALS: One hundred and forty-two dogs. METHODS: DGGR lipase activity (reference range, 24-108 U/L) and Spec cPL were measured using the same sample. The time interval between ultrasonography and lipase determinations was <24 hours. The agreement of the 2 lipase assays at different cutoffs and the agreement between pancreatic ultrasonography and the 2 tests were assessed using Cohen's kappa coefficient (κ). RESULTS: DGGR lipase (>108, >216 U/L) and Spec cPL (>200 µg/L) had κ values of 0.79 (95% confidence interval [CI], 0.69-0.9) and 0.70 (CI, 0.58-0.82). DGGR lipase (>108, >216 U/L) and Spec cPL (>400 µg/L) had κ values of 0.55 (CI, 0.43-0.67) and κ of 0.80 (CI, 0.71-0.9). An ultrasonographic diagnosis of pancreatitis and DGGR lipase (>108, >216 U/L) had κ values of 0.29 (CI, 0.14-0.44) and 0.35 (CI, 0.18-0.52). Ultrasonographically diagnosed pancreatitis and Spec cPL (>200, >400 µg/L) had κ values of 0.25 (CI, 0.08-0.41) and 0.27 (CI, 0.09-0.45). CONCLUSIONS AND CLINICAL IMPORTANCE: Although both lipase assays showed high agreement, agreement between ultrasonography and lipase assays results was only fair. Because lipase results are deemed more accurate, ultrasonography results should be interpreted carefully.

Agreement of the serum Spec fPL™ and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester lipase assay for the determination of serum lipase in cats with suspicion of pancreatitis.

BACKGROUND: Serum lipase activities measured by catalytic assays are claimed to be of limited utility for diagnosing pancreatitis in cats. The Spec fPL assay currently is believed the most sensitive test; however, studies comparing different lipase assays are lacking. 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) assay for the determination of lipase activity has been evaluated in dogs, but no information is available in cats. OBJECTIVES: To investigate the agreement of DGGR-lipase activity and Spec fPL concentration in cats with clinical signs consistent with pancreatitis. ANIMALS: Two hundred fifty-one client-owned cats. METHODS: DGGR-lipase activity and Spec fPL concentration measured from the same blood sample in cats undergoing investigation for pancreatitis. The agreement between DGGR-lipase and Spec fPL at different cutoffs was assessed using Cohen's kappa coefficient (κ). Sensitivity and specificity were calculated for 31 cases where pancreatic histopathology was available. RESULTS: DGGR-lipase (cutoff, 26 U/L) and Spec fPL (cutoff, >5.3 µg/L) had a κ of 0.68 (standard error [SE] 0.046). DGGR-lipase (cutoff, 26 U/L) and Spec fPL (cutoff, >3.5 µg/L) had a κ of 0.60 (SE, 0.05). The maximum κ at a Spec fPL cutoff >5.3 µg/L was found when the DGGR-lipase cutoff was set >34 U/L and calculated as 0.755 (SE, 0.042). Sensitivity and specificity were 48% and 63% for DGGR-lipase (cut-off, 26 U/L) and 57% and 63% for Spec fPL (>5.3 µg/L), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Both lipase assays agreed substantially. DGGR assay seems a useful and cost-efficient method compared to the Spec fPL test.

[Primary hyperaldosteronism in cats]. / Primärer Hyperaldosteronismus bei Katzen.

Primary hyperaldosteronism is a clinical syndrome characterized by an elevated aldosterone secretion by the adrenals. The present case series describes 7 cats with primary hyperaldosteronism, which were presented between 2002 and 2011. Common clinical symptoms were weakness, anorexia, cervical ventroflexion and blindness. All cats showed hypokalemia. In 6 cats, blood pressure was determined: 5 cats showed hypertension, of which 4 animals exhibited retinal detachment and blindness. In the ultrasonographic examination, unilateral adrenomegaly was present in 6 cats whereas one animal showed normal adrenals. In 4 cats, the serum aldosterone concentration was above the reference range. Five cats underwent unilateral adrenalectomy, which was accomplished uneventfully and returned the electrolytes back to normal. Histopathological examination of the adrenals revealed 2 carcinomas and 4 adenomas; one cat with ultrasonographic normal adrenals exhibited bilateral nodular hyperplasia.

[Evaluation of serum cobalamin concentration in cats with clinical signs of gastrointestinal disease]. / Untersuchungen zur Serumcobalaminkonzentration bei Katzen mit gastrointestinaler Symptomatik.

Medical records of 261 cats presenting with gastrointestinal disease that had a serum cobalamin concentration measured were reviewed. In addition, a reference range for cobalamin (305 - 1.967ng/L) was established using 22 healthy adult cats with undetectable levels of urinary methylmalonic acid. A total of 108 of 261 cats (41.4 %) had hypocobalaminemia; 69 cats (26.4 %) had cobalamin concentrations below the detection limit of the assay (< 150ng/L, group A) and 39 (15 %) had concentrations between 150 - 304ng/L (group B). The remaining 153 (58.6 %) cats had normal cobalamin concentrations (group C). Diarrhea was the most common clinical sign in hypocobalaminemic cats and vomiting or anorexia was the most common sign in normocobalaminemic cats. Only cats with both, vomiting and diarrhea were more likely to have hypocobalaminemia than cats with other clinical signs (odds ratio, 2.879; 95 % CI, 1.313 - 6.310). Serum cobalamin concentration was negatively correlated with age of the patient and positively correlated with body condition score. Cats of group A had a significantly higher neutrophil count (p = 0.0009) and higher MCV (p = 0.0064) and significantly lower hematocrit (p = 0.0018) and albumin concentration (p = 0.0037) than cats in other groups. There was no difference between cats of groups B and C with respect to complete blood cell counts and metabolic profiles. Among the diagnoses made in 125 cats (A 69.6 %, B 59 %, C 35.3 %), lymphoma and inflammatory enteropathy were most common. Lymphoma was diagnosed in 31.2 % (A 53.8 %, B 15.4 %, C 30.8 %) and inflammatory enteropathy in 22.4 % (A 35.7 %, B 7.1 %, C 57.2 %) of cats. Hypocobalaminemia is a frequent problem in cats with gastrointestinal disease. Presenting clinical signs as well as laboratory results may already indicate its probability and severity. However, only values below the detection limit of the assay seem to affect routine bloodwork results. Cobalamin should be routinely measured in feline gastrointestinal disease, as its serum concentration may influence the choice of further diagnostics.

Feasibility and safety of endoscopic ultrasound-guided fine needle aspiration of the pancreas in dogs.

BACKGROUND: Endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) has proven a useful and safe diagnostic tool for assessing pancreatic disease in human medicine. No information about pancreatic EUS-FNA is available in dogs. OBJECTIVES: To assess the feasibility and safety of pancreatic EUS-FNA in healthy dogs. ANIMALS: Thirteen beagles with a median body weight of 13.4 kg. METHODS: Experimental study. An ultrasound endoscope (insertion tube outer diameter 11.8 mm) was used, and FNA was carried out with 19 G needles. The optimal puncture site was chosen with the aid of Doppler imaging. Complete clinicopathologic assessments including pain scoring and pancreas-specific lipase measurements were obtained before EUS as well as on day 1 and day 2 after EUS-FNA. RESULTS: The pancreatic body was identified in all dogs, the left lobe was clearly identified in 9/13 and appeared indistinctly marginated in 4/13 dogs, and the distal third of the right lobe could not be identified in 7/13 dogs. EUS-FNA was carried out in 12/13 dogs. Cellularity of smears was adequate for evaluation in 8/12 cases, in which samples were obtained transgastrically (n = 4) or transduodenally (n = 4). All dogs recovered uneventfully and no clinical and laboratory abnormalities occurred during the 48 hour monitoring period after the procedure. CONCLUSION AND CLINICAL IMPORTANCE: Although the healthy canine pancreas is difficult to visualize in its entirety with EUS, pancreatic EUS-FNA with a 19 G needle is feasible in medium-sized dogs and can be considered a safe procedure. Its diagnostic usefulness should be evaluated in dogs with pancreatic disease.

Effects of iatrogenic hypercortisolism on gallbladder sludge formation and biochemical bile constituents in dogs.

An association between gallbladder mucoceles and hypercortisolism (HC) was recently described in dogs. Because the formation of a mucocele from clear bile without the transitional formation of microprecipitates appears unlikely, the aim of this study was to investigate the effects of iatrogenic HC on sludge formation and changes in the biochemical composition of bile. Bile samples from 6 dogs obtained by percutaneous ultrasound-guided cholecystocentesis before (day 0), during (days 28, 56, and 84), and after (days 28p, 56p, and 84p) oral administration of hydrocortisone (8 mg/kg every 12 h) were analysed for calcium, cholesterol and bilirubin concentrations and pH. In addition the gallbladder was examined ultrasonographically for sludge. Six dogs receiving a placebo served as controls. Although gallbladder sludge was observed in all treated dogs at day 56, it was also noted in 50% of control dogs, and no significant differences were seen between groups at any sampling time. Bilirubin and cholesterol concentrations decreased significantly and reversibly during treatment, and calcium concentration showed a similar trend. Bile pH was consistently slightly alkaline during iatrogenic HC, whereas it was slightly acidic in control animals. A 3-month period of iatrogenic HC does not lead to ultrasonographically detectable gallbladder sludge or to an increase in bile constituents that are commonly implicated in sludge formation in humans.

[Severe gastrointestinal bleeding secondary to lornoxicam in the dog]. / Lornoxicam-assoziierte schwere gastrointestinale Blutungen beim Hund.

Six dogs with lornoxicam induced severe gastrointestinal bleeding are described. The ingested dose ranged between 0.5 - 5.1 mg/kg BW (median 0.63 mg/kg BW). The severity of the bloodloss anemia was moderate to severe with PCV values ranging between 12 - 27 % (median 16 %) and serum albumin concentrations between 12 - 22 g/l (median 16 g/l). One dog had evidence of chronic thrombocytopathia over 13 days and clinicopathologic findings of gastrointestinal bleeding over 55 days. None of the dogs developed kidney injuries. The clinical condition required transfusion of blood products in 5 of 6 cases. One dog with a perforated duodenal ulcer and septic peritonitis survived until discharge but had to be euthanized later on due to recrudescent clinical signs (hematemesis, melena). The median length of hospitalisation was 12 days (5 - 14). No correlation was seen between the ingested dose and severity of clinical signs. Lornoxicam ingestion leads to severe and longlasting gastrointestinal bleeding in the dog and requires immediate intensive therapy.

[Exocrine pancreatic insufficiency in the cat]. / Exokrine Pankreasinsuffizienz bei der Katze.

While exocrine pancreatic insufficiency (EPI) is a well-documented functional disease of the pancreas in dogs, only a few reports characterize EPI in cats and no information is available on cats diagnosed with a function test from Europe. The present case series describes and discusses the clinicopathologic findings, diagnostics and therapy in 5 cats (18 months to 16 years) with EPI from Switzerland.

[Generalized metastatic intestinal and cutaneous calcinosis in a Hovawart puppy with leptospirosis]. / Generalisierte metastatische intestinale und kutane Kalzinosis bei einem Hovawart-Welpen mit Leptospirose.

A 10-week old male Hovawart presented with acute renal failure. Based on clinical symptoms, blood analysis results and serology, a diagnosis of leptospirosis was made. Besides being acotemic, the puppy was initially also severely hypercalcemic. The dog was treated successfully, but developed widespread cutaneous and visceral calcifications. Severe pyloric calcification resulted in functional pyloric obstruction, which was successfully treated by pyloromyotomy. All skin lesions were cured with topical therapy within a few weeks. To the authors' knowledge, this is the first report of generalized intestinal and cutaneous calcification associated with acute renal failure due to Leptospirosis.

Ultrasonographic evaluation of adrenal glands in dogs with primary hypoadrenocorticism or mimicking diseases.

The adrenal glands of 30 dogs with primary adrenal insufficiency (hypoadrenocorticism) were measured ultrasonographically and compared with those of 14 healthy dogs and those of 10 dogs with diseases mimicking hypoadrenocorticism. Thickness and length of the adrenals were measured on abdominal ultrasonography and the results for each group were compared. Dogs with primary hypoadrenocorticism had significantly thinner adrenals compared with the other two groups, and their left adrenal glands were also significantly shorter than those of healthy dogs. Adrenal ultrasonography may be of diagnostic value in dogs with clinical signs suggestive of primary hypoadrenocorticism, as a left adrenal gland measuring less than 3.2 mm in thickness is strongly suggestive of the disease.

Urinary catecholamine and metanephrine to creatinine ratios in dogs with hyperadrenocorticism or pheochromocytoma, and in healthy dogs.

BACKGROUND: Urinary catecholamines and metanephrines are used for the diagnosis of pheochromocytoma (PHEO) in dogs. Hyperadrenocorticism (HAC) is an important differential diagnosis for PHEO. OBJECTIVES: To measure urinary catecholamines and metanephrines in dogs with HAC. ANIMALS: Fourteen dogs with HAC, 7 dogs with PHEO, and 10 healthy dogs. METHODS: Prospective clinical trial. Urine was collected during initial work-up in the hospital; in dogs with HAC an additional sample was taken at home 1 week after discharge. Parameters were measured using high-pressure liquid chromatography and expressed as ratios to urinary creatinine concentration. RESULTS: Dogs with HAC had significantly higher urinary epinephrine, norepinephrine and normetanephrine to creatinine ratios than healthy dogs. Urinary epinephrine, norepinephrine, and metanephrine to creatinine ratios did not differ between dogs with HAC and dogs with PHEO, whereas the urinary normetanephrine to creatinine ratio was significantly higher (P= .011) in dogs with PHEO (414, 157.0-925.0, median, range versus (117.5, 53.0-323.0). Using a cut-off ratio of 4 times the highest normetanephrine to creatinine ratio measured in controls, there was no overlap between dogs with HAC and dogs with PHEO. The variables determined in urine samples collected at home did not differ from those collected in the hospital. CONCLUSION AND CLINICAL IMPORTANCE: Dogs with HAC might have increased concentrations of urinary catecholamines and normetanephrine. A high concentration of urinary normetanephrine (4 times normal), is highly suggestive of PHEO.