Hypoadrenocorticism in dogs underUKprimary veterinary care: frequency, clinical approaches and risk factors

Abstract

Objectives To estimate the frequency, clinical approaches and risk factors of hypoadrenocorticism in dogs under UK primary veterinary care. Materials and Methods Dogs diagnosed with hypoadrenocorticism were identified from the UK VetCompass™ programme by searching anonymised electronic patient records. Pre‐existing and newly diagnosed cases of disease during 2016 were included. Cases were further sub‐categorised as having a laboratory‐confirmed or presumed diagnosis of hypoadrenocorticism based on the information recorded in the electronic patient records. Descriptive data were manually extracted. Multivariable logistic regression methods were used to identify demographic risk factors. Results There were 177 hypoadrenocorticism cases identified from 905,543 dogs in 2016; 72 laboratory‐confirmed and 105 presumed. The 1‐year period prevalence for hypoadrenocorticism in all dogs was 0.06% (95% confidence interval: 0.05‐0.07%). The most common presenting clinical signs in laboratory‐confirmed dogs were lethargy (51/66, 77.3%), anorexia (48/66, 66.7%) and vomiting (48/66, 66.7%). Hyperkalaemia was reported in 47 of 53 (88.7%), hyponatraemia in 46 of 53 (86.8%). Median sodium: potassium ratio was 19.00 (interquartile range: 16.20‐20.60). Breed, age, neuter status and insurance status were associated with a laboratory‐confirmed diagnosis of hypoadrenocorticism. No sex association with hypoadrenocorticism was observed in the multivariable model. The standard poodle had 51.38 times the odds (95% CI: 14.49‐182.18) of hypoadrenocorticism compared with crossbreeds. The labradoodle and West Highland white terrier also had increased odds. Clinical Significance This is the first epidemiological study to report on hypoadrenocorticism in dogs within the UK primary‐care population. These results provide benchmark data of current veterinary activity relating to hypoadrenocorticism in primary‐care practices.

Evaluation of resting cortisol concentration testing in dogs with chronic gastrointestinal signs

“…We believe this possibility seems unlikely, with prevalence in other geographically diverse populations reportedly being similar. 2 , 3 , 4 , 5 A further possibility is that referring practitioners in the United Kingdom are more likely than those in Germany to screen for hypoadrenocorticism before referral. This possible bias is intrinsic to studying a referral population of animals because the population is dependent on the referring veterinarians' routine practices.…”

“…The prevalence estimate in our study more closely corresponds with the overall prevalence of hypoadrenocorticism in the general dog population, which has been estimated by previous studies as being between 0.06% and 1.1%. 2 , 3 , 4 , 5 …”

“…The prevalence estimate in our study more closely corresponds with the overall prevalence of hypoadrenocorticism in the general dog population, which has been estimated by previous studies as being between 0.06% and 1.1%. [2][3][4][5] Hypoadrenocorticism and other nongastrointestinal diseases (including pancreatic diseases, endocrinopathies, diseases of the liver and kidneys and neoplasia) can present clinically with chronic gastrointestinal signs and 23.4% (66/282) of the patients in our study had nongastrointestinal disease as the final diagnosis. Our findings are in agreement with those of a recent German study that assessed resting cortisol concentrations, with primary inflammatory enteropathy as the final diagnosis in more than half of the patients, both with resting cortisol concentrations higher and lower than 55 nmol/L.…”

“… 1 The estimated cross‐sectional prevalence of hypoadrenocorticism is between 0.06% and 1.1%. 2 , 3 , 4 , 5 Predisposed breeds have higher prevalence estimates, including bearded collies (3.4%), standard poodles (10%), Portuguese water dogs (1.5%) 6 and Nova Scotia duck tolling retrievers (1.4%), 1 and it is considered to be an inherited disease in these breeds. 1 Primary hypoadrenocorticism, a lack of both glucocorticoid and mineralocorticoid secretion caused by immune‐mediated adrenal gland damage is most common.…”

“…Clinical signs of hypoadrenocorticism can be vague and nonspecific, mimicking other diseases, and making diagnosis challenging. 1 The most common clinical signs reported are lethargy, anorexia, vomiting, diarrhea, weakness, and weight loss 1 , 5 , which may be gradual in onset and commonly wax and wane. 1 , 11 , 12 …”