| Sažetak | Hipoadrenokorticizam (Addisonova bolest) je rijedak endokrinološki poremećaj koji nastaje zbog djelomičnog ili potpunog gubitka funkcije kore nadbubrežne žlijezde. Klinička slika hipoadrenokorticizma je promjenjiva i karakterizirana oscilacijama u pojavnosti i jačini simptoma koji su nespecifični a mogu uključivati znakove od strane gotovo svih organskih sustava. Upravo zbog toga Addisonova bolest se često i lako može previdjeti od strane kliničara, odnosno biti pogrešno protumačena nekom drugom bolešću zbog čega se u literaturi često naziva «the great pretender» (veliki varalica).
Cilj ovog istraživanja bio je analizirati arhivske podatke pasa kojima je dijagnosticiran hipoadrenokorticizam na Klinici za unutarnje bolesti Veterinarskog fakulteta Sveučilišta u Zagrebu, te utvrditi pojavnost, metode dijagnostike, liječenja te ishod bolesti.
Detaljnom analizom arhivskih podataka «Vef. Protokola» od 30. studenog 2005. do 24. kolovoza 2018. godine izdvojeno je ukupno četrnaest pasa s hipoadrenokorticizmom od kojih je u 13 (93%) dijagnosticiran primarni, a u jednog pasa (7%) sekundarni oblik.
Istraživanu skupinu činilo je 8 ženki (57%) i 6 (43%) mužjaka, a najučestalija pasmina su bili pudli (29%). U 93% pasa zabilježeni su različiti recidivirajući gastrointestinalni simptomi, od kojih su najčešći bili povraćanje i inapetencija s učestalosti od 78%. Nalazi hematoloških parametara bili su nespecifični, dok su najčešća odstupanja u biokemijskim nalazima bila su povišena koncentracija ureje (86%) i kreatinina (57%), te hiponatremija i hiperkalemija (79%), a većina pacijenata (79%) imala je Na/K omjer <27:1. U svih je pasa nakon uvođenja terapije ishod bio povoljan. Zabilježeni rezultati u suglasnosti su sa dosadašnjim literaturnim podatcima o Addisonovoj bolesti u pasa.
Trajanje simptoma do provedbe ACTH-stimulacijskog testa pokazalo se izrazito varijabilnim (2–2190 dana) i prosječno prilično dugim (10±1195,5), dok je vremenski period od postavljanja sumnje na hipoadrenokorticizam do postavljanja dijagnoze i početka adekvatne terapije iznosio od 0 - 11 dana (3,5±8,3). Iz navedenog proizlazi da se hipoadrenokorticizam, usprkos relativno jednostavnim i brzim dijagnostičkim mogućnostima, i dalje prerijetko uvrštava u listu mogućih diferencijalnih dijagnoza te je broj pacijenata koji bivaju dijagnosticirani tek po razvoju dramatičnih simptoma od strane hipovolemičnog šoka uslijed Adisonijanske krize razmjerno velik (43%). Stoga je kod svih pasa s recidivirajućim probavnim poremećajima nužno prvenstveno provesti pretrage koje će pobuditi sumnju na hipoadrenokorticizam (pr. određivanje koncentracija natrija i kalija). Također, kako dio pasa s hipoadrenokorticizmom ne pokazuje odstupanja u koncentraciji elektrolita, preporučuje se češće provođenje ACTH-stimulacijskog testiranja u pasa s gastrointestinalnim simptomima kako bi se na vrijeme potvrdila dijagnoza i započelo promptno liječenje koje osigurava povoljni ishod. |
| Sažetak (engleski) | Hypoadrenocorticism (also known as Addison's disease) is a rare endocrine disorder which occurs because of the partial or total loss of function of the cortex of the adrenal gland. The clinical manifestation of hypoadrenocorticism is varied and is characterized by oscillations in the incidence and strength of symptoms which are non-specific, and can include simptoms caused by almost every organ system in the body. As a result of this, Addison's disease is easily overlooked by clinicians, that is, it can be wrongly interpreted as another disease, which is why it is known in literature as 'the Great Pretender'.
The goal of this study was to analize arhived data about dogs who have been diagnosed with hypoadrenocorticism at the Clinic of Internal Diseases of the Veterinary Faculty in Zagreb, and determine the incidence, methods of diagnosis, therapy and outcome of the disease.
With the detailed analysis of arhived data 'Vef. protokoli' from the 30th of December 2005 to the 24th of August 2018, there have been isolated 14 dogs in total with hypoadrenocorticism, of which 13 (93%) dogs have been diagnosed with the primary form and 1 (7%) dog with the secondary form.
The researched group is made up of 8 (57%) females and 6 (43%) males, with the most common breed being poodles (29%). In 93% of dogs, there have been various recurrent gastrointestinal symptoms noted, of which vomiting and inappetence have been the most common with a prevalence of 78%.
The results of haematological findings have been non-specific, while the most common deviations in biochemical findings have been a higher level of urea (86%) and creatinine (57%), hyponitraemia and hyperkalemia (79%), and most patients (79%) had a Na/K ratio of <27:1. In all of the dogs , after the administration of therapy, the outcome was postive. These recorded results are in agreement with literature data about Addison's disease in dogs thus far.
The length of time from the duration of symptoms to the execution of the ACTH-stimulation test has shown to be pronouncedly variable (2-2190 days), and rather long on average (10±1195,5), while the time period from the moment of suspicion that it could be hypoadrenocorticism to the moment of concrete diagnosis and the beginning of adequate therapy, was 0-11 days (3,5±8,3). From this we can assume that hypoadrenocorticism, notwithstanding its relatively quick and easy diagnostic potential, is still too rarely included in the list of potential differential diagnoses. The number of patients who are diagnosed only when they are showing dramatic symptoms such as hypovolemic shock while in Addisionian crisis is rather large (43%). Therefore, in all dogs with recurrent digestive disorders it is necessary to first conduct tests that will awaken a suspicion that it could be hypoadrenocorticism (such as determining the concentrations of sodium and potassium). In addition to this, as a percentage of dogs with hypoadrenocorticism don't show deviations in electrolites, it is recommended that the ACTH-stimulation test is done more frequently in dogs with gastrointestinal problems so that a diagnosis can be established on time and so that therapy can start promptly, which ensures a better outcome. |
