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. 2022 Nov;36(6):1947-1957.
doi: 10.1111/jvim.16564. Epub 2022 Nov 3.

Characterization of clinicopathologic and abdominal ultrasound findings in dogs with glucocorticoid deficient hypoadrenocorticism

Krystle L Reagan  1 , Ehren McLarty  2 , Stanley L Marks  1 , Jamie Sebastian  3 , Jennifer McGill  3 , Chen Gilor  4
Affiliations

Characterization of clinicopathologic and abdominal ultrasound findings in dogs with glucocorticoid deficient hypoadrenocorticism

Krystle L Reagan et al. J Vet Intern Med. 2022 Nov.

Abstract

Background: Clinical findings of glucocorticoid-deficient hypoadrenocorticism (GDH) can overlap with other diseases, presenting a diagnostic challenge.

Objectives: Describe clinicopathologic and ultrasonographic features of dogs with GDH and those suspected of having GDH that had the disease ruled out.

Animals: Six hundred twenty-three dogs.

Methods: Records from dogs with suspected GDH between 2003 and 2018 were reviewed. Dogs with hyperkalemia or hyponatremia were excluded. Dogs were categorized as controls when the resting serum cortisol or post-ACTH cortisol concentration were > 2 μg/dL. Clinicopathologic and ultrasonographic features were compared between groups. The optimal cut-point, area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for individual features used to detect GDH.

Results: Dogs were categorized as GDH (n = 29) or controls (n = 594). Lymphocyte count (>1750 cells/L; sensitivity, 96.6%; 95% confidence interval [CI], 82.8%-99.8%; specificity, 60.3%; 95% CI, 56.3%-64.1%; AUC, 0.828; 95% CI, 0.762-0.894) and albumin/globulin ratio (<1.081; sensitivity, 86.2%; 95% CI, 69.4%-94.5%; specificity, 78.8%; 95% CI, 75.3%-81.9%; AUC, 0.886; 95% CI, 0.827-0.944) had the highest discriminatory power between groups. Left adrenal gland width <0.39 cm was 80% (95% CI, 58.4%-91.9%) sensitive and 82.4% (95% CI, 74.2-88.4) specific for GDH. Serum cobalamin concentrations and ultrasonographic abnormalities of the GI tract were not different between groups.

Conclusion and clinical importance: No single variable could be used to confidently rule out GDH and obviate the need for cortisol testing in dogs with a clinical presentation consistent with GDH.

Keywords: Addison's disease; adrenal gland; atypical Addison's; cortisol.

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Conflict of interest statement

Authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Hematologic variables that differed between a cohort of dogs with GDH versus a cohort of control dogs. Violin plots compare hematologic variables (A, hematocrit; B, hemoglobin concentration; C, eosinophil count; D, lymphocyte count; E, neutrophil/lymphocyte ratio) for the control population (red) and GDH population (blue). The bold vertical line represents the population median and thin vertical lines represent the lower and upper quartiles
FIGURE 2
FIGURE 2
Receiver operator characteristic curves of hematologic variables discriminating between a cohort of dogs with GDH and a cohort of control dogs as compared to serum cortisol concentration measurement. Hemoglobin (gray), hematocrit (orange), lymphocyte count (green), and eosinophil count (blue), neutrophil/lymphocyte ratio (purple)
FIGURE 3
FIGURE 3
Biochemical variables that differed between a cohort of dogs with GDH versus a cohort of control dogs. Violin plots compare variables (A, chloride; B, creatinine; C, albumin; D, globulins; E, AST; F, cholesterol; G, glucose; H, albumin/globulin ratio) in the control population (red) and GDH groups (blue). The bold vertical line represents the population median and thin vertical lines represent the lower and upper quartiles
FIGURE 4
FIGURE 4
Receiver operator characteristic curves of biochemical variables discriminating between a cohort of dogs with GDH and a cohort of control dogs as compared to serum cortisol concentration measurement. Glucose (gray), cholesterol (blue), AST (brown), globulins (light blue), albumin (green), creatinine (purple), albumin/globulin ratio (red)
FIGURE 5
FIGURE 5
Comparison of serum cobalamin concentrations between a cohort of dogs with GDH and a cohort of control dogs. Violin plots compare the control population (red) and GDH population (blue). The bold vertical line represents the population median and thin vertical lines represent the lower and upper quartiles
FIGURE 6
FIGURE 6
Comparison of adrenal gland width measured ultrasonographically between a cohort of dogs with GDH and a cohort of control dogs. Violin plots compare the control population (red) and GDH population (blue) for the left (A) and right (B) adrenal glands. The bold vertical line represents the population median and thin vertical lines represent the lower and upper quartiles
See this image and copyright information in PMC

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