Hiperadrenocorticismo canino : revisão de literatura e relato de 7 casos clínicos
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2024
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Esta dissertação foi realizada no âmbito da conclusão do Mestrado Integrado em Medicina Veterinária da Universidade Lusófona de Humanidades e Tecnologias e teve como objetivo o desenvolvimento do tema Hiperadrenocorticismo Canino. Inclui uma revisão bibliográfica extensa sobre esta doença e uma apresentação, bem como uma discussão de sete casos clínicos acompanhados durante o período de estágio curricular. O Hiperadrenocorticismo é a terceira endocrinopatia mais prevalente no cão, particularmente na idade adulta a geriátrica, e ocorre devido à presença de níveis elevados da concentração de cortisol no sangue durante um longo período de tempo. A sua etiologia pode ser espontânea devido a uma hipertrofia corticotrófica ou uma neoplasia hipofisária, resultando no hiperadrenocorticismo hipófise-dependente ou devido a neoplasias das glândulas adrenais que, por sua vez, dão origem ao hiperadrenocorticismo adrenal-dependente. Pode, ainda, ocorrer de forma iatrogénica, nomeadamente devido à administração exógena excessiva e prolongada de glucocorticoides. O diagnóstico desta patologia deve ter em consideração a história clínica do animal, bem como os achados clínicos no exame físico e nos exames complementares de diagnóstico, particularmente análises sanguíneas (hemograma, bioquímicas e ionograma), urianálise, meios imagiológicos (ecografia abdominal, tomografia computorizada e ressonância magnética) e testes da função endócrina. Por sua vez, o tratamento médico, nomeadamente o trilostano, é mais utilizado comparativamente ao tratamento cirúrgico. O prognóstico nestes animais é favorável quando diagnosticados atempadamente e devidamente tratados. Neste relatório de casos clínicos, são descritos sete casos com apresentações clínicas diferentes. Desta forma, nos casos que foi possível acompanhar o seguimento após o diagnóstico definitivo, verificou-se que todos apresentaram melhorias significativas da sintomatologia, bem como da qualidade de vida. O grande desafio destes animais estará relacionado com a possibilidade e capacidade dos tutores em cumprirem as recomendações médico-veterinárias quer ao nível de tratamentos crónicos, quer ao nível das consultas de seguimento, pois é economicamente dispendioso. Palavras-chave: Endocrinopatia; Hiperadrenocorticismo canino; Síndrome de Cusinhg; Glândula adrenal; Glucocorticoides; Mineralocorticoides; Cortisol; Trilostano
This dissertation was written in order to complete the Integrated Master’s Degree in Veterinary Medicine of Universidade Lusófona de Humanidades e Tecnologias and aimed to develop the theme of canine Hyperadrenocorticism. It includes an extensive bibliographic review about this disease, as well as presentation and discussion of seven case-studies followed during the curricular internship period. Hyperadrenocorticism is the third most prevalent endocrinopathy in dogs, particularly at an adult or geriatric age, and occur due to high levels of cortisol concentration in blood during a long period of time. The etiology can be spontaneous due to a corticotrophic hypertrophy or a pituitary neoplasm, resulting in pituitary dependent hyperadrenocorticism or due to an adrenal gland neoplasm which, in turn, give rise to adrenal dependent hyperadrenocorticism. This disease can also be iatrogenic, namely due to the excessive and prolonged exogenous administrations of glucocorticoids. The diagnosis of this pathology must take into consideration the clinical history of the animal, as well as the clinical findings on the physical exam and the complementary diagnostic tests, particularly blood work (complete blood count, biochemistry and ionogram), urinalysis, diagnostic imaging(abdominal ultrasound, computed tomography and magnetic resonance imaging) and endocrine function tests. On the other hand, the medical treatment, namely trilostano, is most used comparatively to surgical treatment. The prognosis in this animals is favorable when they are diagnosed in time and properly treated. In this report, seven cases with different clinical presentations are described. So, in cases that it was possible to follow up after the definitive diagnosis, we report that all of them had significant improvements in symptoms, as well as in quality of life. The big challenge of these animals will be related to the possibility and capacity of the owners to comply with veterinary recommendations both in terms of chronic treatments and in terms of follow-up appointments, because all of this is economically expensive. Keywords: Endocrinopathy; Canine hyperadrenocorticism; Cushing disease; Adrenal gland; Glucocorticoids; Mineralocorticoids; Cortisol; Trilostane
This dissertation was written in order to complete the Integrated Master’s Degree in Veterinary Medicine of Universidade Lusófona de Humanidades e Tecnologias and aimed to develop the theme of canine Hyperadrenocorticism. It includes an extensive bibliographic review about this disease, as well as presentation and discussion of seven case-studies followed during the curricular internship period. Hyperadrenocorticism is the third most prevalent endocrinopathy in dogs, particularly at an adult or geriatric age, and occur due to high levels of cortisol concentration in blood during a long period of time. The etiology can be spontaneous due to a corticotrophic hypertrophy or a pituitary neoplasm, resulting in pituitary dependent hyperadrenocorticism or due to an adrenal gland neoplasm which, in turn, give rise to adrenal dependent hyperadrenocorticism. This disease can also be iatrogenic, namely due to the excessive and prolonged exogenous administrations of glucocorticoids. The diagnosis of this pathology must take into consideration the clinical history of the animal, as well as the clinical findings on the physical exam and the complementary diagnostic tests, particularly blood work (complete blood count, biochemistry and ionogram), urinalysis, diagnostic imaging(abdominal ultrasound, computed tomography and magnetic resonance imaging) and endocrine function tests. On the other hand, the medical treatment, namely trilostano, is most used comparatively to surgical treatment. The prognosis in this animals is favorable when they are diagnosed in time and properly treated. In this report, seven cases with different clinical presentations are described. So, in cases that it was possible to follow up after the definitive diagnosis, we report that all of them had significant improvements in symptoms, as well as in quality of life. The big challenge of these animals will be related to the possibility and capacity of the owners to comply with veterinary recommendations both in terms of chronic treatments and in terms of follow-up appointments, because all of this is economically expensive. Keywords: Endocrinopathy; Canine hyperadrenocorticism; Cushing disease; Adrenal gland; Glucocorticoids; Mineralocorticoids; Cortisol; Trilostane
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VETERINARY MEDICINE, ENDOCRINE SYSTEM DISEASES, HYPERADRENOCORTICISM, DOGS, ADRENAL GLANDS, GLUCOCORTICOIDS, HYDROCORTISONE, TRILOSTANE, MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, DOENÇAS DO SISTEMA ENDÓCRINO, HIPERADRENOCORTICISMO, CÃES, GLÂNDULAS SUPRARRENAIS, GLUCOCORTICOIDES, HIDROCORTISONA, TRILOSTANO, Mestrado Integrado em Medicina Veterinária