Primary hypoaldosteronism in a dog with concurrent suspected chronic hepatitis

Marina Hernández Perelló, Carolina Albuquerque
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Abstract

A 3-year-old female spayed English Cocker Spaniel presented with a 2-month history of lethargy. The owner reported a single tonic-clonic seizure 7 months before presentation and intermittent mild gastrointestinal signs for the past 18 months. Initial investigations revealed hyponatraemia, hyperkalaemia and increased levels of liver enzymes. An adrenocorticotropic hormone stimulation test excluded hypocortisolism. The gastrointestinal signs resolved following a dietary change, suggesting that chronic enteropathy and most primary and secondary causes of hepatic disease were excluded, leaving idiopathic chronic hepatitis as the most likely cause of increased levels of liver enzymes. Liver parameters reduced to levels just above reference range after immunosuppressive doses of prednisolone. Aldosterone levels pre- and post-adrenocorticotrophic hormone stimulation were <20 pmol/litre, consistent with mineralocorticoid deficiency. The mineralocorticoid deficiency was treated with desoxycorticosterone pivalate at 1–1.3 mg/kg subcutaneously every 48–87 days, which resulted in immediate and complete resolution of the clinical signs and electrolyte imbalance. Given the dog's signalment and results from clinical investigations, the isolated hypoaldosteronism is speculated to be caused by immune-mediated adrenal gland destruction. Isolated hypoaldosteronism should be considered a differential diagnosis for hyponatraemia in dogs, when an adrenocorticotrophic hormone stimulation test excludes hypocortisolism.
疑似慢性肝炎犬的原发性醛固酮过少症
一只 3 岁的雌性去势英国可卡犬因嗜睡 2 个月而就诊。犬主报告说,该犬在发病前 7 个月曾有过一次强直阵挛发作,在过去 18 个月中曾间歇性出现轻微胃肠道症状。初步检查结果显示,它患有低钠血症、高钾血症和肝酶水平升高。促肾上腺皮质激素刺激试验排除了皮质醇功能减退症。改变饮食后,胃肠道症状缓解,这表明慢性肠病和大多数原发性和继发性肝病的病因已被排除,因此特发性慢性肝炎最有可能是导致肝酶水平升高的原因。使用泼尼松龙免疫抑制剂量后,肝脏参数降低到略高于参考范围的水平。肾上腺皮质激素刺激前后的醛固酮水平均小于 20 pmol/升,与矿质皮质激素缺乏一致。矿质皮质激素缺乏症用去氧皮质酮特戊酸盐治疗,每 48-87 天皮下注射 1-1.3 毫克/千克,临床症状和电解质失衡立即得到完全缓解。鉴于该犬的体征和临床检查结果,推测该孤立性醛固酮过多症是由免疫介导的肾上腺破坏引起的。当肾上腺皮质激素刺激试验排除了皮质醇过少症的可能性时,孤立性醛固酮过少症应被视为犬低钠血症的鉴别诊断之一。
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