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Appearance of the fundus of a cat with hypertensive retinopathy, characterised by the presence of a large sub-hyaloid (pre-retinal) haemorrhage, multifocal dot and blot (intra-retinal) haemorrhages, sub-retinal exudate (flat retinal detachment), and hypertensive vasculopathy. (Image courtesy of Jane Sansom)
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Primary hyperaldosteronism, also known as Conn's syndrome, is probably the most common adrenocortical disease in cats. As in humans, this disease is suspected to be underdiagnosed in cats. Cats presenting with systemic arterial hypertension and/or hypokalaemia are erroneously presumed to have chronic kidney disease, and further investigations are n...
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... manifestations of arterial hypertension include acute onset of blindness due to retinal detachment and/or intraocular haemorrhage (Figure 2). Subtle signs of hypertensive retinopathy observed on fundic examination (such as retinal and intravitreal haemorrhages and/ or retinal oedema) are more commonly observed (Refsal and Harvey, 2014) (Figure 3). ...
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BACKGROUND
Anaemia is highly prevalent in Indian population. While most studies focus on
children and women of reproductive age, there are relatively few studies of
anaemia in older adults. This age group is also a highly vulnerable group which is
commonly represented in medical ward admissions due to infections, diabetes,
hypertension, etc. When a...
Citations
... ). Bei der Katze gehören klinische Befunde wie zervikale Ventroflexion, plantigrade Fußung in den Hinterextremitäten, Schwierigkeiten beim Springen, plötzliches Erblinden infolge von Retinaablösungen und intraokuläre Blutungen zu den häufigsten Symptomen(Fernandez et al. 2016).Die vorliegende Fallserie beschreibt die klinischen und pathologischen Veränderungen zweier ungewöhnlicher Fälle des primären Hyperaldosteronismus mit tödlichen Komplikationen. Eine Katze mit bilateraler nodulären Hyperplasie der NNR und daraus fol-gendem Hirninfarkt sowie Niereninsuffizienz wurde aufgrund der schlechten Prognose euthanasiert. ...
Primary hyperaldosteronism (Conn syndrome) is a rarely diagnosed endocrine disorder of the cat, clinically characterized predominantly by cervical ventroflexion and generalized muscle weakness due to hypokalemia and end organ damage following hypertension. Causes of the disease are aldosterone-secreting hyperplasia, adenomas and adenocarcinomas of the adrenal cortex. The present case series describes two cases with unusual and fatal complications. The first case describes a 13 years old European shorthair cat presented for progressive central nervous and neuromuscular disorders. The cat was under medical treatment due to hyperaldosteronemia and hypokalemia. In the post anesthetic phase – as part of an MRI scan – the cat was euthanized due to severe shock and acute renal failure. Pathological examination revealed bilateral nodular adrenocortical hyperplasia, multiple cerebral infarctions, hypertrophy and fibrosis of the heart and blood vessels, and bilateral chronic renal inflammation and fibrosis. The pathological findings are sufficiently compatible with chronic hypertension. The second cat – a 10 years old Maine Coon – was presented for cervical ventroflexion, hypokalemia, hypertension and left adrenal gland enlargement and an adrenalectomy was performed. The pathological examination could detect an adenoma in the adrenal cortex. Post-operatively, the cat developed a perforated gastric ulcer and consequent pyoabdomen. The reasons for the unusual gastric ulceration could not be clarified, but a relation to the primary tumor or the therapy performed should be considered. For the first time, increased aldosterone production within the adrenocortical pathology could be confirmed by immunohistological examination in these two cats.
... No obstante, en pacientes con hipertensión sistémica, uno de los principales motivos de consulta puede ser la pérdida de visión secundaria a desprendimiento de retina, la cual se ha asociado más en pacientes con hiperplasia suprarrenal bilateral. 10 Para planear adecuadamente la cirugía es necesario realizar estudios de imagen. En pacientes con neoplasias suprarrenales, el US y la TC poseen especificidad del 80 y 100 % respectivamente, y sensibilidad del 90 y 92 % para la detección de invasión vascular. ...
... Los pacientes sometidos a cirugía pueden alcanzar tiempos de sobrevida de hasta 3.5 a 5 años, pero en aquellos que solo fueron tratados medicamente, la sobrevida reportada es de hasta 984 días. 10 La muerte se asocia normalmente con enfermedad renal crónica progresiva o hipertensión refractaria. El pronóstico a largo plazo de los gatos con hiperaldosteronismo primario, secundario a hiperplasia bilateral de la zona glomerulosa no está bien documentado. ...
Descripción del caso. Se presentó a consulta en el Hospital Veterinario de Especialidades (HVE) de la UNAM un paciente felino de 12 años con semiología compatible con miopatía hipocalémica con tres meses de evolución. En el examen físico general se observó condición corporal 2/5, posición plantígrada y ventroflexión cervical. Acudió a consulta con hemograma y bioquímica con valores alterados. Al realizar ultrasonido (US) abdominal, se evidenció proceso neoplásico en glándula adrenal. Hallazgos clínicos e interpretación. Neutrofilia y linfopenia asociadas a estrés, incremento de AST y CK, e hipocalemia, asociados a miopatía hipocalémica, que en conjunto con las alteraciones en el ultrasonido fueron compatibles con hiperaldosteronismo primario, secundario a carcinoma corticoadrenal. Tratamiento y evolución. Se descartaron otras afecciones que generan miopatía hipocalémica y se instauró tratamiento médico con espironolactona y gluconato de potasio, mejorando así su semiología. Pruebas de laboratorio. Como las alteraciones en el hemograma y la bioquímica realizadas fuera del HVE eran compatibles con miopatía hipocalémica, se decartó enfermedad renal crónica debido a que los niveles de creatinina se encontraban dentro de los valores de referencia del laboratorio. La T4T estaba dentro de los intervalos de referencia. La aldosterona fue compatible con hiperaldosteronemia. Discusión y relevancia clínica. El hiperaldosteronismo primario felino parece ser una enfermedad subdiagnosticada, porque los principales diagnósticos diferenciales para este padecimiento son el hipertiroidismo y la enfermedad renal crónica. Asimismo, estos pacientes pueden presentar hipertensión arterial sistémica y, hoy en día, se reconoce que el hiperaldosteronismo es la causa más común de hipertensión endocrina en gatos. Por lo tanto, es importante proporcionar bases y orientación a los médicos veterinarios para diagnosticar y tratar este padecimiento, debido a que en México no se cuenta con la prueba diagnóstica definitiva. Diagnosis and treatment of a cat (Felis silvestris catus) with primary hyperaldosteronism. Abstract. Case description. A 12 years old feline patient presented to the Hospital Veterinario de Especialidades (HVE) de la UNAM with clinical signs consistent with hypokalemic myopathy of three months duration. The physical exam revealed a body condition score of 2/5, plantigrade stance and cervical ventroflexion. Previous complete blood count and biochemistry revealed abnormal values. Abdominal ultrasound was performed and identified neoplasia in the adrenal gland. Diagnostics and interpretation. A stress leukogram characterized by neutrophilia and lymphopenia, increase in AST and CK, and hypokalemia associated with hypokalemic myopathy. These results along with ultrasonographic findings, were consistent with primary hyperaldosteronism secondary to adrenal carcinoma. Treatment and clinical response. Other causes of hypokalemia and hypokalemic myopathy were ruled out. Treatment was initiated with oral spironolactone and potassium gluconate, with marked improvement of its clinical signs compatible con hiperaldosteronemia. Laboratory tests. Based on the results of complete blood count and biochemistry performed outside the HVE consistent with hypokalemic myopathy, other etiologies such as renal disease was ruled out as the levels of creatinine were within the reference interval. The T4T was also within reference intervals. Aldosterone levels were consistent with hyperaldosteronemia. Discussion and clinical relevance. Feline primary hyperaldosteronism appears to be an underdiagnosed disease, as diagnostic tests are limited to ruling out hyperthyroidism and chronic kidney disease. Similarly, these patients are likely to present with systemic hypertension and nowadays it is recognized that hyperaldosteronism is the most common cause of endocrine hypertension in cats. Therefore, it is important to educate and guide veterinarians in the diagnosis and treatment of this condition, as a final diagnostic test is not available in Mexico. Keywords: Feline primary hyperaldosteronism, hypertension, hyperaldosteronemia, adreno-cortical hyperplasia, adrenal adenoma or carcinoma, hypokalemic myopathy.
