1. Aldosteronoma in a dog with polyuria as the leading symptom
- Author
-
Peter Boer, Jan A. Mol, Ad Rijnberk, I.K van Vonderen, F.J. van Sluijs, Hans S. Kooistra, T.S.G.A.M. van den Ingh, George Voorhout, W.H. Boer, and Jooske IJzer
- Subjects
Male ,Vasopressin ,medicine.medical_specialty ,Vasopressins ,medicine.drug_class ,Urine ,Plasma renin activity ,chemistry.chemical_compound ,Dogs ,Endocrinology ,Food Animals ,Polyuria ,Internal medicine ,Hyperaldosteronism ,Renin ,medicine ,Animals ,Dog Diseases ,Aldosterone ,Saline Solution, Hypertonic ,business.industry ,Osmolar Concentration ,Adrenalectomy ,medicine.disease ,Hypertonic saline ,chemistry ,Urine osmolality ,Animal Science and Zoology ,Vasopressin Analogue ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
In a 10-year-old castrated male shorthaired German pointer polyuria was associated with slight hypokalemia, hypophosphatemia and alkalosis, as well as elevated plasma concentrations of a glucocorticoid-inducible iso-enzyme of alkaline phosphatase. Repeated measurements of urinary corticoids and normal suppressibility of the hypothalamus-pituitary-adrenocorticial axis excluded glucocorticoid excess. Urine osmolality (Uosm) did not increase during administration of the vasopressin analogue desmopressin. At the time water deprivation had caused Uosm to rise from 300 to 788 mOsm/kg, there was also plasma hypertonicity. During hypertonic saline infusion the osmotic threshold for vasopressin release was increased. The combination of elevated plasma aldosterone concentrations and unmeasurably low plasma renin activity pointed to primary hyperaldosteronism. As initially computed tomography (CT) did not reveal an adrenocortical lesion, the dog was treated with the aldosterone antagonist spironolactone. This caused Uosm to rise in a dose-dependent manner. However, well-concentrated urine was only achieved with doses that gave rise to adverse effects. Once repeated CT, using 2-mm-thick slices, had revealed a small nodule in the cranial pole of the left adrenal, unilateral adrenalectomy was performed which resolved the polyuria completely. Also the plasma concentrations of kalium, aldosterone and renin activity returned to within their respective reference ranges. The adrenocortical nodule had the histological characteristics of an aldosteronoma, with the non-affected zona glomerulosa being atrophic. In this dog with primary hyperaldosteronism the polyuria was characterized by vasopressin resistance and increased osmotic threshold of vasopressin release, similar to the polyuria of glucocorticoid excess. The possibility is discussed that the polyuria of glucocorticoid excess is actually a mineralocorticoid effect.
- Published
- 2001
- Full Text
- View/download PDF