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Background: Canine hyperadrenocorticism (or Cushing’s syndrome) occurs due to a functional pituitary or adrenal tumour, resulting in excessive circulatory glucocorticoids, which produce the classical clinical signs in affected dogs. Although management of the disease traditionally focuses on treating these endocrine consequences, the pathology reflects an oncological disease with the possibility of progression of the underlying neoplasia. Surgical options for these tumours are now becoming increasingly available and successful. Aim of the article: This article covers how to distinguish between pituitary and adrenal hyperadrenocorticism as well as outlining the treatment options for this important disease in dogs.

Introduction Dogs treated for hypoadrenocorticism are monitored through analysis of their blood electrolytes. This is routinely performed with point-of-care analysers and doses of medications are adjusted based on the results. Objectives To investigate the performance of two point-of-care analysers (IDEXX Catalyst Dx and IDEXX VetStat) against a reference laboratory method for the measurement of blood sodium, potassium and chloride concentrations, as well as sodium: potassium ratios, in dogs diagnosed with and treated for hypoadrenocorticism. Methods Forty-eight dogs were enrolled into a prospective cross-sectional study. Paired blood samples were taken and tested on two point-of-care analysers and at a reference laboratory. Statistical analysis was then performed with Bland-Altman analysis and Passing-Bablok regression. The clinical effects of inaccurate electrolyte analysis were investigated. Results In total, 329 samples were tested on the Catalyst analyser, while another 72 samples were tested on the VetStat. Passing-Bablok regression identified both proportional and constant bias for some analytes. There was poor agreement between sodium and chloride concentrations on both analysers. Both analysers tended to give higher results than the reference method for all analytes, except for potassium when measured on the VetStat. Clinical significance There are inherent differences between the electrolyte concentrations measured by these two point-of-care analysers and reference laboratory methods in dogs with hypoadrenocorticism.

Objectives: The main aim of the study was to describe the features and diagnoses of a population of cats referred with pyrexia. Other aims were to report and evaluate the utility of clinical investigations performed, and describe any effect of treatment before referral on temperature at presentation and ability to make a diagnosis. Methods: Clinical records of cats with pyrexia (⩾39.2°C) documented at least twice were retrospectively reviewed. Cases were assigned to disease categories (infectious, inflammatory, immune-mediated, neoplastic, miscellaneous and no diagnosis [pyrexia of unknown origin, PUO]) based on diagnosis. The overall value of clinical investigations was assessed by classifying them as ‘enabling’, ‘assisting’ or ‘no assistance’ in achieving each diagnosis. The effect of treatment before referral was assessed for any association with temperature at presentation and ability to make a diagnosis (PUO vs other disease categories). Results: One hundred and six cases were identified. The most common cause of pyrexia was feline infectious peritonitis (22 cats, 20.8%) and the largest disease category was infectious (41/106, 38.7%). Inflammatory conditions were found in 19 (17.9%) cats, neoplasia in 13 (12.3%), miscellaneous causes in 11 (10.4%) and immune-mediated disease in six (5.7%). No diagnosis was reached in 16 (15.0%) cats, often despite extensive diagnostic investigations. Cytology and histopathology most often ‘enabled’ or ‘assisted’ in obtaining a diagnosis. Most cats (91, 85.8%) received treatment before referral, with antimicrobial treatment given to 87 (82.1%). Prior treatment before referral was not associated with temperature at presentation nor with success in establishing a diagnosis. Conclusions and relevance: This is the first study investigating causes of pyrexia in cats. Infectious diseases were most common and immune-mediated diseases were comparatively rare.

We are a mixture of volunteers and paid professionals who give our time to lead and support the veterinary professions, and we are extremely honoured to be able to do so. But we are increasingly concerned about the tone of some of the debates that are taking place in the veterinary world, particularly by the disparaging and demeaning language used against us or our colleagues. As leaders in the professions, representing various …

Blood glucose is maintained within a narrow range by the balance between intestinal absorption, glucose synthesis and glucose release from glycogen stores. Many diseases can affect this balance and result in hypoglycaemia; this can result in dramatic clinical signs due to neuroglycopenia. This article summarises the physiology of glucose regulation and the clinical signs of hypoglycaemia, its emergency treatment and its causes.

Background: Trilostane is a recognized treatment for canine pituitary-dependent hyperadrenocorticism (PDH); however, its efficacy in dogs with adrenal-dependent hyperadrenocorticism (ADH) is unknown. Objectives: To examine factors that might influence survival in the medical management of ADH, with particular emphasis on treatment selection. Animals: Thirty-seven animals referred to 4 centers over a period of 12 years that had been diagnosed with ADH and treated with either trilostane (22/37), mitotane (13/37), or both (2/37). Methods: Retrospective analysis of clinical records. Results: There was no statistically significant difference between the survival times of 13 dogs treated only with mitotane when compared with 22 dogs treated only with trilostane. The median survival time for animals treated with trilostane was 353 days (95% confidence interval [CI] 95–528 days), whereas it was 102 days (95% CI 43–277 days) for mitotane. Metastatic disease was detected in 8 of 37 dogs. There was a significantly lower probability of survival for dogs with metastatic disease when compared with those without metastatic disease (P < .001). Conclusions and Clinical Importance: The choice of medical treatment for ADH may not have a major effect on survival times. However, the presence of metastatic disease considerably decreases survival time regardless of the choice of medical treatment.

Objectives: To describe the effect of trilostane on insulin requirements and serum fructosamine in dogs with diabetes mellitus (DM) and hyperadrenocorticism (HAC). Methods: Observational retrospective study of eight dogs. Results: Median fructosamine concentration at presentation was 401 μmol/L (range 244 to 554 μmol/L). Median insulin dose at presentation was 1·1 IU/kg/dose (0·4 to 2·1 IU/kg/dose) administered twice daily in five animals and once in three. Four dogs had their insulin dose prospectively reduced at the start of trilostane therapy. The HAC was controlled within 28 days in seven dogs. The remaining case was controlled by 17 weeks. Two dogs died within 40 days of starting trilostane. The median fructosamine concentration was 438 μmol/L (range 325 to 600 μmol/L) after stabilisation of the HAC. One case had a consistent reduction in serum fructosamine concentration over the first four months. The median insulin dose after stabilisation of HAC was 1·5 IU/kg dose (range 0·25 to 3·0 IU/kg/dose). Insulin requirements were reduced in two cases after treatment with trilostane. Four dogs required increased insulin doses. Clinical Significance: Insulin requirements and fructosamine concentrations do not consistently reduce during trilostane treatment for HAC. Prospective studies are required to provide recommendations regarding reductions in insulin doses with trilostane treatment.

Polyuria (PU) and polydipsia (PD) are common presenting signs in dogs but less common in cats. Compensatory mechanisms that regulate water homeostasis mean that PU and PD always occur together. Most causes of PU/PD cause a primary PU with a secondary PD. There are a number of causes with some difference in the relative frequencies in dogs and cats (see Tables 1 and 2). LOGICAL APPROACH Most causes of PU/PD are serious diseases that require specific therapy. Therefore ‘symptomatic’ treatment is rarely appropriate and a logical series of investigative steps, if necessary undertaken over a series of veterinary consultations, is appropriate. The approach to PU/PD should be in this general order (which can be modified at any stage depending on the results) : 1. History 2. Physical examination 3. Urinalysis 4. Biochemistry (including T4 in cats) 5. Haematology 6. Hyperadrenocorticism screening test (less so in cats)

A 12-year-old male neutered Miniature Poodle with confirmed pituitary-dependent hyperadrenocorticism was treated with trilostane. After three doses, it developed clinical and laboratory changes suggestive of isolated hypocortisolism ('atypical hypoadrenocorticism'), which persisted and progressed for more than 3 months despite immediate withdrawal of the trilostane. The clinical signs of hyperadrenocorticism resolved without further trilostane. After 3 months, prednisolone treatment was started and the clinical signs of hypocortisolism resolved. Prednisolone therapy was required for more than 1 year. Ultrasonography initially demonstrated large hypoechoic adrenal cortices, typical of dogs with hyperadrenocorticism, which then became small and heteroechoic, consistent with the development of adrenal necrosis. Persistent isolated hypocortisolism has not been reported previously as a complication of trilostane therapy. The case is also remarkable for the very short duration of trilostane therapy that elicited this complication. Clinicians should be aware that trilostane therapy may result in adrenal necrosis, even in the very earliest stages of therapy, but prompt action can prevent a life-threatening situation.

Once it has been determined that a mating did take place and that the bitch was in heat then owners should be advised that pregnancy is possible (though by no means certain). Unless the client has a valid reason for keeping the animal intact then ovariohysterectomy performed two to three weeks after the end of vulval bleeding is the best recommendation. If the animal will potentially be used for breeding then several drugs are available that can terminate the pregnancy, however none is perfect. Many of the drugs that can be used to induce pregnancy termination have potentially serious side effects.

This article provides an overview of the management of canine obesity, with particular reference to the recent introduction of anti-obesity drugs and their role in weight management programmes. Obesity is best defined as an accumulation of excessive amounts of adipose tissue in the body. The term obese should be reserved for those cases whose current weight is 30% above their ideal (animals are termed overweight if they are 15 to 30% above their ideal). In most animals, obesity is the result of a simple imbalance between energy intake and energy expenditure. Numerous factors may influence the relative ease with which weight is gained, and these include genetics, age, neuter status, amount of physical activity, and the caloric content of the diet. In comparison with ‘simple’ obesity, medical causes such as hypothyroidism and hyperadrenocorticism, are comparatively rare (typically

Serum sodium:potassium (Na:K) ratios are often reported in biochemical studies of dogs, although their value has not been assessed. The aims of this study were to identify diseases associated with a low Na:K ratio in dogs and to compare their prevalence with the prevalence in dogs from the same referral hospital with normal Na:K ratios. A total of 238 dogs with a Na:K ratio less than 27 were identified from medical records. Sample contamination with edta was suspected in 74 cases (31 per cent) and these and two cases that had been supplemented with potassium were removed from the analysis. The remaining 162 cases and 147 control dogs were divided into five categories depending on the organ system affected. Among the cases there were significantly more in the endocrine category than among the control dogs. Hypoadrenocorticism was the most single common cause of a low Na:K ratio and affected 27 (16.7 per cent) of the cases. Other clinical problems associated with low Na:K ratios included different urogenital, cardiorespiratory and gastrointestinal diseases.

THE methods used to diagnose hyperadrenocorticism and distinguish the two forms of disease – pituitary-dependent versus adrenal-dependent – were described in the last issue of In Practice (September 2007, volume 29, pp 446-454). This article focuses on the treatment of the condition. Before treating any dog with hyperadrenocorticism, it is worthwhile having a detailed discussion with the owner about the costs, benefits and potential complications of the available therapies.

HYPERADRENOCORTICISM, or Cushing9s syndrome, is one of the most common canine endocrinopathies seen in small animal practice. Although in many cases the clinical signs are fairly characteristic, the chronic course of the disease and some unusual clinical manifestations can make it hard to recognise. In addition, the diagnostic tests that are available can be difficult to interpret. This article summarises the current knowledge of the presentation and diagnosis of this disease. An article in the next issue will focus on the treatment options.

A continuous monitoring system (MGP DM2000X) was assessed for monitoring γ radiation emissions and determining appropriate isolation times for hyperthyroid cats treated with radioactive iodine (I(131)). Daily radiation emitted by 12 cats who had received a range of doses of I(131) (80-200 MBq) was measured and average background radiation readings deducted. The effective half-lives of the I(131) in the cats were found to have a median of 2.54 days (range 1.40-3.24 days). Cats treated with 200 MBq emitted 5 µGy/day more exposure than cats treated with lower doses throughout the study period (P=0.032). All cats were found to emit a total radiation dose exposure less than 100 µGy (range 0-43 µGy) during days 18-21 of isolation. The potential additional dose exposure to owners was calculated at various days that might be considered for the cats to be returned to their owners. Using this provisional data, maximum isolation periods at this institution could be safely reduced to 17 days as long as certain precautions are followed. This preliminary study demonstrated that this novel cage-side monitoring system can be used to calculate the effective half-life of I(131) and to measure γ radiation exposure from treated cats, which may assist other institutions in determining appropriate isolation times for individual cats.

Haematuria in a dog occurred secondarily to a unilateral ureteral fibroepithelial polyp. The diagnostic techniques, gross pathology and histopathological findings of this unusual benign tumour are reported. Complete resolution of clinical signs occurred following ureteronephrectomy.

HYPERADRENOCORTICISM, or Cushing’s syndrome, is one of the most common canine endocrinopathies seen in small animal practice. Although in many cases the clinical signs are fairly characteristic, the chronic course of the disease and some unusual clinical manifestations can make it hard to recognise. In addition, the diagnostic tests that are available can be difficult to interpret. This article summarises the current knowledge of the presentation and diagnosis of this disease. An article in the next issue will focus on the treatment options. Diagnosis of canine

Objectives: To assess the effect of canine hyperadrenocorticism (HAC) on parathyroid hormone (PTH), phosphate and calcium concentrations. Methods: PTH concentrations and routine biochemical parameters were measured in 68 dogs with HAC. Ionised calcium was measured in 28 of these dogs. The results obtained were compared with an age- and weight-matched group of 20 hospital patients that did not show signs of HAC. Results: There were significant differences between the PTH, phosphate, alkaline phosphatase, creatinine and albumin concentrations between the two groups. Total and ionised calcium concentrations were not significantly different. Most of the dogs (92 per cent) with HAC had PTH concentrations that were greater than the reference range (10 to 60 pg/ml), and in 23 dogs they were greater than 180 pg/ml. There were significant positive correlations between the PTH and basal cortisol, post-adrenocorticotropic hormone (ACTH) cortisol and alkaline phosphatase concentrations, and also the phosphate and post-ACTH cortisol concentrations. Clinical Significance: Adrenal secondary hyperparathyroidism is a cause of increased PTH concentrations and may be associated with abnormalities in calcium and phosphate metabolism in dogs with HAC. The findings of this study could explain why canine HAC may cause clinical signs such as calcinosis cutis that are associated with altered calcium metabolism.

Background: Increased concentrations of haptoglobin (Hp), a moderate acute phase protein, have been demonstrated in dogs with hyperadrenocorticism (HAC). Monitoring serum concentrations of Hp in hyperadrenocorticoid dogs before and after trilostane administration may provide valuable information on the response to therapy. Objective: The aim of this study was to measure Hp concentrations in dogs with spontaneously occurring HAC at the time of diagnosis and after treatment with trilostane. Methods: Serum Hp concentration was measured using an automatic biochemical assay based on Hp-hemoglobin binding and utilizing SB-7 reagent in 12 dogs with spontaneous HAC before and after treatment with trilostane (30 or 60 mg PO q 12–24 h). Post-treatment Hp concentrations were measured at the time the owner reported an improvement in clinical signs. Pretreatment and post-treatment Hp values were compared with reference values and with values from 4 healthy control dogs. Results: Two dogs with HAC had pretreatment Hp values within the reference interval; 10 dogs had moderate (n = 8) or marked (n = 2) increases in Hp concentration. After treatment with trilostane, Hp concentration remained within the reference interval (n = 2), decreased to within the reference interval (n = 3), or remained moderately increased (n = 7; 3–10 g/L). Overall, a significant decrease was observed in Hp concentration after trilostane treatment compared with pretreatment values (P < .005). Both untreated and treated dogs with HAC had significantly higher Hp concentrations (P < .001) when compared with control dogs. Conclusions: Clinical control of HAC did not closely relate to serum Hp concentration. Further studies are required to assess whether this is because of inadequate control of disease or because a build-up of cortisol precursors or secondary effects of HAC affect Hp concentration.

A one-year-old, neutered female Skye terrier presented with anorexia, vomiting, seizures and ascites. Portal venography demonstrated the presence of multiple acquired portosystemic shunts. Hepatic biopsy confirmed the presence of copper accumulation and fibrosis. Treatment included ursodeoxycholic acid therapy, colchicine and oral zinc. To the authors' knowledge, this is the first case report detailing successful management of Skye terrier hepatopathy.

The presence of anti-insulin antibodies was determined by ELISA in serum samples from 30 diabetic dogs receiving bovine insulin therapy and 30 normoglycaemic dogs. Twenty of the diabetic dogs had significant reactivity to both bovine (heterologous) and porcine (homologous) insulin compared to control dogs. In contrast there was no significant difference between the two populations in reactivity to canine distemper virus (CDV) or canine thyroglobulin. The high degree of correlation between anti-bovine insulin and anti-porcine insulin antibodies suggested cross-reactivity which was confirmed by performing a competition ELISA, with antibody binding to bovine insulin inhibited by pre-incubating serum with porcine insulin. The insulin B-chain, rather than the A-chain was the most reactive component of the insulin molecule although in some cases, diabetics with antibody reactivity to whole insulin protein showed minimal reactivity to the individual subunits. The data suggest that treatment of diabetic dogs with bovine insulin can lead to anti-insulin antibody production. These antibodies cross-react with homologous insulin and recognise conformational as well as linear epitopes.

POLYURIA and polydipsia are two common presenting signs in dogs seen in practice. There are a number of causes and these can be divided into two groups: primary polyuria/secondary polydipsia and primary polydipsia/secondary polyuria. Some causes may produce clinical signs by more than one mechanism. Compensatory mechanisms that regulate water homeostasis mean that polyuria and polydipsia always occur together. Careful history taking and hospital monitoring are required to demonstrate polyuria or polydipsia. This article describes the approach to the investigation of canine polyuria and polydipsia, and discusses some of the procedures which may aid diagnosis.

IN this, the second of two articles, the underlying causes of feline anaemia are discussed. The first article, published in the September issue of In Practice (pp 411-415), described the presentation and outlined general principles in the investigation of feline anaemia. Readers are advised to refer to the previous article before consulting this article.

ANAEMIA is a decrease in the number of erythrocytes, concentration of haemoglobin or haematocrit volume and, as such, should be regarded as a clinical sign rather than a disease. The haematocrit of normal adult cats is greater than 0-25 litre/litre. Although normal kittens have lower numbers of erythrocytes and haemoglobin concentrations compared to adult cats their haematocrit is still rarely less than 0-25 litre/litre. Anaemia is a common presentation in feline practice and is caused by many different underlying pathologica,l mechanisms. The aims of this article are to describe the clinical signs and discuss general principles in the investigation of feline anaemia. A second article, to be published in the next issue, will deal with the differential diagnoses of feline anaemia.

Benign prostatic hyperplasia (BPH) is the most common prostatic abnormality of entire male dogs. It has been estimated to occur (either grossly or microscopically) in over 80% of entire males over the age of five years. There are no known breed predispositions. The condition is characterised by an increase in prostatic epithelial cell numbers (hyperplasia) and also epithelial cell size (hypertrophy) (Johnston et al. 2000). Although the exact cause of BPH has not been determined, it is known that the age of the dog and hormonal influences play a major role; especially testosterone, dihydrotestosterone and circulating oestrogen levels.

HYPOTHYROIDISM is usually caused by immune-mediated destruction or idiopathic atrophy of the thyroid gland. Diagnosis is initially based on historical and clinical findings consistent with the condition. If the history or clinical examination are inconsistent with the diagnosis, then other differential diagnoses should be thoroughly investigated before any investigations are conducted on the thyroid gland. Unfortunately, many dogs present with a history that is at least suggestive of hypothyroidism (for example, lethargy and poor coat condition), but clinical examination proves unrewarding. In these cases further tests are indicated. This article discusses the interpretation - and limitations - of specific tests of thyroid function and sets out a diagnostic protocol.

Malignant histiocytosis is a rare disease which is characterised by the neoplastic proliferation of tissue macrophages (histiocytes) leading to excessive phagocytosis of erythrocytes. The clinical signs and pathological findings in three Bernese mountain dogs are described. Two of the dogs had the same sire. The disease has been established as a familial problem in Bernese mountain dogs in other countries, although it has not been previously recorded in the United Kingdom.

A litter of five 14-week-old papillon puppies was referred for investigation of pelvic limb ataxia. Clinical examination revealed signs of ataxia, hypermetria and depressed postural reflexes affecting all four limbs. The severity of these signs varied between members of the litter. The condition became progressively worse and by 19 weeks of age all but the least severely affected pup (the single male of the litter) had deteriorated to the point that euthanasia was indicated on humane grounds. Pathological examination revealed widespread changes in both white and grey matter of the neuraxis caudal to the fore-brain, particularly involving the dorsolateral white matter of the spinal cord, which were characterised by axonal swellings typical of neuroaxonal dystrophy.

CENTRAL diabetes insipidus is an uncommon condition characterised by polyuria due to a deficiency in the secretion of antidiuretic hormone from the posterior pituitary gland. The causes of central diabetes insipidus in dogs include intracranial tumours, such as craniopharyngioma, meningioma

When hyperthyroidism is treated with radioiodine, up to 75 per cent of the injected dose is excreted in the faeces and urine, which poses hazards to handlers. Three groups of hyperthyroid cats were treated with 120, 150 and 200 megabecquerel (MBq) of radioiodine, and samples of faeces and urine-soaked litter (USL) were collected over a 24-hour period, once a week, for four weeks. The amount of radioactivity in each homogenised sample was then measured using a sodium iodide detector. Radioactivity significantly decreased in both the faecal and USL samples over the first three weeks. Regardless of dose, there was no significant difference in faecal and USL samples between weeks 3 and 4. Faecal radioactivity was generally higher than the USL, but both were variable between cats at each time point. There were some significant differences in radioactivity between doses at various time points, but these were very small compared with the differences between time points. From the results, the maximum likely exposure to a worker or owner handling the waste was calculated. For cats treated with up to 200 MBq, radioactivity levels after two weeks were such that the waste could be designated as 'very low level waste' (a UK statutory definition) for disposal purposes.

IDIOPATHIC pulmonary fibrosis is a respiratory illness that results in exercise intolerance, coughing and breathing difficulties. ‘Crackles’ are often heard on auscultation. It is usually diagnosed in terrier dogs, especially the West Highland white terrier, but also exists in other breeds such

Infectious Diseases of the Dog and Cat Craig E. Greene Published by Elsevier, 2006, 3rd edition, hardback, 1424 pages, Price £73.99, ISBN-10: 1416036008, ISBN-13: 978-1416036005

In this paper I would like to consider Hell as a concept around which there cluster various different difficulties, and to see how and on what conditions some of these difficulties could be overcome, the whole paper illustrating, albeit by reference to a particular topic, and so with obvious restrictions, the character of theological argument, the nature of theological assertions, and the kind of empirical grounding that must be given to them.