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Diagnosis of adrenal-cortisol insufficiency is often misleading in hospitalized patients, as clinical and biochemical features overlap with comorbidities. We analyzed clinical determinants associated with a biochemical diagnosis of adrenal-cortisol insufficiency in non-intensive care unit (ICU) hospitalized patients.In a retrospective cohort study we reviewed 4668 inpatients with random morning cortisol levels ≤15 μg/dL hospitalized in our center between 2003 and 2010. Using serum cortisol threshold level of 18 μg/dL 30 or 60 minutes after Cortrosyn (250 μg; Amphastar Pharmaceuticals, Inc., Rancho Cucamonga, Calif) injection to define biochemical adrenal-cortisol status, we characterized and compared insufficient (n = 108, serum cortisol ≤18 μg/dL) and sufficient (n = 394; serum cortisol18 μg/dL) non-ICU hospitalized patients.Commonly reported clinical and routine biochemical adrenal-cortisol insufficiency features were similar between insufficient and sufficient inpatients. Biochemical adrenal-cortisol insufficiency was associated with increased frequency of liver disease, specifically hepatitis C (P = .01) and prior orthotopic liver transplantation (P.001), human immunodeficiency virus (HIV; P = .005), and reported pre-existing male hypogonadism (P.001), as compared with the biochemical adrenal-cortisol sufficiency group. Forty percent of insufficient inpatients were not treated with glucocorticoids after diagnosis. Multivariable logistic analysis demonstrated that inpatients with higher cortisol levels (P = .0001) and higher diastolic blood pressure (P = .05), and females (P = .009) were more likely not to be treated, while those with previous short-term glucocorticoid treatment (P = .002), other coexisting endocrine diseases (P = .005), or who received an in-hospital endocrinology consultation (P.0001), were more likely to be replaced with glucocorticoids.Commonly reported adrenal-cortisol insufficiency features do not reliably identify hospitalized patients biochemically confirmed to have this disorder. Comorbidities including hepatitis C, prior orthotopic liver transplantation, HIV, and reported pre-existing male hypogonadism may help identify hospitalized non-ICU patients for more rigorous adrenal insufficiency assessment.

Glaucoma in the beagle is an inherited disease that is exhibited clinically in dogs of 6 to 18 months of age. The genealogy, clinical signs, gonioscopy, tonometry, tonography, water provocative response, and scanning electron microscopy of the iridocorneal angle of the glaucomatous beagle are summarized.

Ophthalmic nodular fasciitis in 5 dogs was often manifested as subconjunctival masses of variable growth rate. Each mass was raised, pink, and hyperemic. Five masses involved the bulbar conjunctiva, and 2 masses involved the eyelids. Local excision of each mass successfully resolved the condition.

Lipid infiltration of the corneal stroma, sclera, and uvea occurred in a 2-year-old cottontail rabbit that had been fed an all-milk diet for 20 months. Superficial keratectomy was performed on the left eye but the rabbit died. Histologically, lipid deposits were most extensive in the anterior corneal stroma and posterior iridal epithelium.

Topical 1, 2, and 4 percent pilocarpine were evaluated in the normotensive and glaucomatous beagles, comparing intraocular pressure (IOP), pupillary size, and time. In normotensive beagles pilocarpine produced maximal decreases of 25 percent (5.5 mm. Hg) at 1 percent concentration; 34 percent (7.26 mm. Hg) at 2 percent concentration; and 25 percent (6.9 mm. Hg) at 4 percent concentration. The maximum reductions in IOP after pilocarpine instillation in the glaucomatous beagle were 30 percent (9.1 mm. Hg) at 1 percent concentration; 44 percent (14.92 mm. Hg) at 2 percent concentration; and 31 percent (10.89 mm. Hg) at 4 percent concentration. The glaucomatous beagles responded with a greater reduction of IOP than did the normotensive beagles.

In two cases of naturally occurring disseminated histoplasmosis, multifocal inflammatory lesions were seen in the posterior segment of the eyes. Histologic examination of both animals revealed lesions of active choroiditis (cat) and retinitis (dog) in association with numerous Histoplasma capsulatum.