Table Of Content

BSAVA Manual of BSAVA Manual of Canine and Feline Endocrinology B Fourth edition S Canine and Feline A Edited by Carmel T. Mooney and Mark E. Peterson V A Endocrinology M a n Since publication of the third edition in 2004 there u have been many signifi cant advances. Several a l endocrine disorders, such as feline acromegaly and o fourth edition hyperaldosteronism, have risen in importance. The use f of diet and novel insulins in diabetic cats, and new drugs C such as trilostane and methimazole, which were briefl y a mentioned in previous editions, are now considered n routine. In addition, the genetic risks associated with many i n disorders have been elucidated. e • A new chapter presents the principles of interpreting a n endocrine test results and discusses how test d performance can be assessed to help improve diagnostic confi dence. • The central section on glands and their diseases is presented in a standard format F to aid information retrieval – detailing physiology, aetiology, clinical features, e l diagnosis and treatment. i n • The fi nal section has been rewritten to focus on solving clinical and e clinicopathological abnormalities with an endocrine dimension. E n CONTENTS: Hormone assays and collection of samples; Principles of interpreting endocrine d test results; The pituitary gland: Disorders of vasopressin production; Pituitary dwarfi sm; o Acromegaly; The parathyroid gland: Hyperparathyroidism; Hypoparathyroidism; The thyroid c gland: Canine hypothyroidism; Canine hyperthyroidism; Feline hyperthyroidism; Feline r hypothyroidism; The pancreas: Canine diabetes mellitus; Feline diabetes mellitus; Insulinoma i n and other gastrointestinal tract tumours; The adrenal gland: Canine hypoadrenocorticism; Canine hyperadrenocorticism; Feline hyperadrenocorticism; Feline hypoadrenocorticism; Feline o hyperaldosteronism; Presenting complaints and their investigation: Investigation of polyuria l o and polydipsia; Investigation of hypercalcaemia and hypocalcaemia; Investigation of unstable g canine diabetes mellitus; Investigation of unstable feline diabetes mellitus; Ketoacidosis; y Investigation of hypoglycaemia; Investigation of symmetrical alopecia in dogs; Investigation of adrenal masses; Investigation of hyperlipidaemia; Index 4 t h Carmel T. Mooney MVB MPhil PhD DipECVIM-CA MRCVS e Carmel is a University College Dublin graduate who spent several years in d Scotland where she completed both MPhil (The University of Edinburgh) and PhD (The University of Glasgow) theses on feline hyperthyroidism. n Following this she returned to UCD where she is currently Senior Lecturer in Small Animal Internal Medicine. Carmel obtained the European Diploma in Veterinary Internal Medicine (Companion Animals) in 1998 and is also an RCVS Recognized Specialist in Small Animal Medicine (Endocrinology), awarded in recognition of her clinical and research work. She is a Past President of the BSAVA (2005–2006) and was founding Secretary of the European Society of Veterinary Endocrinology. Mark E. Peterson DVM DipACVIM Mark graduated from the University of Minnesota in 1976, moved to NYC to do an internship and medical residency at The Animal Medical Center, and then completed a post-doctoral fellowship in endocrinology and nuclear medicine at The New York Hospital–Cornell Medical Center and the AMC, staying on there for over 30 years. In 2009 Mark opened the Animal Endocrine Clinic, a specialty referral hospital. Mark’s clinical and research efforts have mainly been directed toward advancing the understanding of canine and feline endocrine disorders, especially diabetes mellitus and Edited by thyroid and adrenal disease. He has published more than 450 journal articles, book chapters and research abstracts, and is a frequent speaker Carmel T. Mooney at veterinary colleges and scientifi c seminars. and Mark E. Peterson 1354 Endo Cover Spread.indd 1 08/02/2012 15:21 BSAVA Manual of Canine and Feline Endocrinology Fourth edition Editors: Carmel T. Mooney MVB MPhil PhD DipECVIM-CA MRCVS Veterinary Clinical Studies Section, School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Republic of Ireland and Mark E. Peterson DVM DipACVIM Director of Endocrinology and Nuclear Medicine, Animal Endocrine Clinic, New York, NY 10025, USA Published by: British Small Animal Veterinary Association Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB A Company Limited by Guarantee in England. Registered Company No. 2837793. Registered as a Charity. Copyright © 2012 BSAVA First published 1990 Second edition 1998 Third edition 2004 Fourth edition 2012 Reprinted 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder. A catalogue record for this book is available from the British Library. ISBN 978 1 905319 28 2 e-ISBN 978 1 905319 89 3 The publishers, editors and contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned or referred to in this publication. Details of this kind must be verified in each case by individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded that in each case they must follow all appropriate national legislation and regulations (for example, in the United Kingdom, the prescribing cascade) from time to time in force. Printed in India by Imprint Digital 3200PUBS15 Printed on ECF paper made from sustainable forests i Page i Endocrinology.indd 1 02/05/2017 14:55 Other titles in the BSAVA Manuals series: Manual of Canine & Feline Abdominal Imaging Manual of Canine & Feline Abdominal Surgery Manual of Canine & Feline Advanced Veterinary Nursing Manual of Canine & Feline Anaesthesia and Analgesia Manual of Canine & Feline Behavioural Medicine Manual of Canine & Feline Cardiorespiratory Medicine Manual of Canine & Feline Clinical Pathology Manual of Canine & Feline Dentistry Manual of Canine & Feline Dermatology Manual of Canine & Feline Emergency and Critical Care Manual of Canine & Feline Endoscopy and Endosurgery Manual of Canine & Feline Fracture Repair and Management Manual of Canine & Feline Gastroenterology Manual of Canine & Feline Haematology and Transfusion Medicine Manual of Canine & Feline Head, Neck and Thoracic Surgery Manual of Canine & Feline Musculoskeletal Disorders Manual of Canine & Feline Musculoskeletal Imaging Manual of Canine & Feline Nephrology and Urology Manual of Canine & Feline Neurology Manual of Canine & Feline Oncology Manual of Canine & Feline Ophthalmology Manual of Canine & Feline Radiography and Radiology: A Foundation Manual Manual of Canine & Feline Rehabilitation, Supportive and Palliative Care: Case Studies in Patient Management Manual of Canine & Feline Reproduction and Neonatology Manual of Canine & Feline Surgical Principles: A Foundation Manual Manual of Canine & Feline Thoracic Imaging Manual of Canine & Feline Ultrasonography Manual of Canine & Feline Wound Management and Reconstruction Manual of Canine Practice: A Foundation Manual Manual of Exotic Pet and Wildlife Nursing Manual of Exotic Pets: A Foundation Manual Manual of Feline Practice: A Foundation Manual Manual of Ornamental Fish Manual of Practical Animal Care Manual of Practical Veterinary Nursing Manual of Psittacine Birds Manual of Rabbit Medicine Manual of Rabbit Surgery, Dentistry and Imaging Manual of Raptors, Pigeons and Passerine Birds Manual of Reptiles Manual of Rodents and Ferrets Manual of Small Animal Practice Management and Development Manual of Wildlife Casualties For further information on these and all BSAVA publications, please visit our website: www.bsava.com ii Prelims Endocrinology.indd 2 01/06/2015 13:15 Contents List of contributors v Foreword viii Preface ix Part 1: Introduction 1 Hormone assays and collection of samples 1 Kent R. Refsal and Raymond F. Nachreiner 2 Principles of interpreting endocrine test results 8 Peter A. Graham Part 2: The pituitary gland 3 Disorders of vasopressin production 15 Robert E. Shiel 4 Pituitary dwarfism 28 Annemarie M. W. Y. Voorbij and Hans. S. Kooistra 5 Acromegaly 35 Stijn J. M. Niessen, Mark E. Peterson and David B. Church Part 3: The parathyroid gland 6 Hyperparathyroidism 43 Barbara J. Skelly 7 Hypoparathyroidism 56 Barbara J. Skelly Part 4: The thyroid gland 8 Canine hypothyroidism 63 Carmel T. Mooney and Robert E. Shiel 9 Canine hyperthyroidism 86 Carmel T. Mooney 10 Feline hyperthyroidism 92 Carmel T. Mooney and Mark E. Peterson 11 Feline hypothyroidism 111 Sylvie Daminet Part 5: The pancreas 12 Canine diabetes mellitus 116 Lucy J. Davison iii Prelims Endocrinology.indd 3 19/01/2012 08:28 13 Feline diabetes mellitus 133 Jacquie Rand 14 Insulinoma and other gastrointestinal tract tumours 148 Peter P. Kintzer Part 6: The adrenal gland 15 Canine hypoadrenocorticism 156 David B. Church 16 Canine hyperadrenocorticism 167 Michael E. Herrtage and Ian K. Ramsey 17 Feline hyperadrenocorticism 190 Mark E. Peterson 18 Feline hypoadrenocorticism 199 Mark E. Peterson 19 Feline hyperaldosteronism 204 Andrea M. Harvey and Kent R. Refsal Part 7: Presenting complaints and their investigation 20 Investigation of polyuria and polydipsia 215 Rhett Nichols and Mark E. Peterson 21 Investigation of hypercalcaemia and hypocalcaemia 221 Patricia A. Schenck and Dennis J. Chew 22 Investigation of unstable canine diabetes mellitus 234 Lucy J. Davison 23 Investigation of unstable feline diabetes mellitus 243 Danièlle Gunn-Moore and Nicki Reed 24 Ketoacidosis 251 Amanda K. Boag 25 Investigation of hypoglycaemia 259 Johan P. Schoeman 26 Investigation of symmetrical alopecia in dogs 265 Rosario Cerundolo 27 Investigation of adrenal masses 272 Carlos Melian 28 Investigation of hyperlipidaemia 278 Steve Dodkin and Kostas Papasouliotis Index 284 iv Prelims Endocrinology.indd 4 19/01/2012 08:28 Contributors Amanda K. Boag MA VetMB DipACVIM DipACVECC FHEA MRCVS Clinical Director, Vets Now, Penguin House, Castle Riggs, Dunfermline KY11 8SG Rosario Cerundolo DVM CertVD DipECVD MRCVS European and RCVS Recognized Specialist in Veterinary Dermatology Honorary Associate Professor of Veterinary Dermatology, University of Nottingham Consultant in Dermatology, Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk CB8 0UH Dennis J. Chew DVM DipACVIM The Ohio State University College of Veterinary Medicine, Columbus, OH 43210, USA David B. Church BVSc PhD MACVSc ILTM MRCVS Professor of Small Animal Studies, Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA Sylvie Daminet DMV PhD DipACVIM DipECVIM-CA Companion Animal Clinic, University of Ghent, Salisburylane 133, 9820, Belgium Lucy J. Davison MA VetMB PhD DSAM DipECVIM-CA The Queen’s Veterinary School Hospital, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES Steve Dodkin BSc MSc Diagnostic Laboratories, Langford Veterinary Services, University of Bristol, Langford, Bristol BS40 5DU Peter A. Graham BVMS PhD CertVR DipECVCP MRCVS Cambridge Specialist Laboratory Services, Unit 2 Sawston Park, London Road, Pampisford, Sawston, Cambridgeshire CB22 3EE Danièlle Gunn-Moore BSc BVM&S PhD FHEA MACVSc MRCVS RCVS Recognized Specialist in Feline Medicine Professor of Feline Medicine and Head of Companion Animal Sciences, Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG Andrea M. Harvey BVSc DSAM(Feline) DipECVIM-CA MRCVS RCVS Recognized Specialist in Feline Medicine International Society of Feline Medicine, Taeselbury, High Street, Tisbury, Wiltshire SP3 6LD Michael E. Herrtage MA BVSc DVSc DVR DVD DSAM DipECVIM-CA DipECVDI MRCVS European and RCVS Recognized Specialist in Veterinary Internal Medicine Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES Peter P. Kintzer DVM DipACVIM Bost Road Animal Hospital, Springfield, MA 01119, USA v Prelims Endocrinology.indd 5 19/01/2012 08:28 Hans S. Kooistra DVM PhD DipECVIM-CA Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands Carlos Melian DVM PhD Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Trasmontana s/n, 35416 Arucas, Las Palmas, Gran Canaria, Spain Carmel T. Mooney MVB MPhil PhD DipECVIM-CA MRCVS Veterinary Clinical Studies Section, School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Republic of Ireland Raymond F. Nachreiner DVM PhD Professor, Endocrine Section, Diagnostic Center for Population and Animal Health, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA Rhett Nichols DVM DipACVIM Antech Diagnostics, Lake Success, New York and Animal Endocrine Clinic, New York, NY 10025, USA Stijn J.M. Niessen DVM PhD DipECVIM-CA PGCVetEd FHEA MRCVS Lecturer, Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA and Research Associate, Diabetes Research Group, Newcastle Medical School, Framlington Place, Newcastle-upon-Tyne NE2 4HH Kostas Papasouliotis DVM PhD DipRCPath DipECVCP MRCVS Diagnostic Laboratories, Langford Veterinary Services and School of Veterinary Sciences, University of Bristol, Langford, Bristol BS40 5DU Mark E. Peterson DVM DipACVIM Director of Endocrinology and Nuclear Medicine, Animal Endocrine Clinic, New York, NY 10025, USA Ian K. Ramsey BVSc PhD DSAM DipECVIM-CA FHEA MRCVS Professor, School of Veterinary Medicine, University of Glasgow, Bearsden Road, Bearsden, Glasgow G61 1QH Jacquie Rand BVSc(Hons) MACVS DVSc DipACVIM Professor of Companion Animal Health and Director, Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, St Lucia, QLD 4072, Australia Nicki Reed BVM&S Cert VR DSAM(Feline) DipECVIM-CA MRCVS European Veterinary Specialist in Internal Medicine Lecturer in Companion Animal Medicine, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG vi Prelims Endocrinology.indd 6 19/01/2012 08:28 Kent R. Refsal DVM PhD Professor, Endocrine Section, Diagnostic Center for Population and Animal Health, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA Patricia A. Schenck DVM PhD Section Chief, Endocrine Section, Diagnostic Center for Population and Animal Health, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA Johan P. Schoeman BVSc MMedVet PhD DSAM DipECVIM-CA MRCVS Professor, Small Animal Internal Medicine and Head, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa Robert E. Shiel MVB PhD DipECVIM-CA Section of Small Animal Medicine, School of Veterinary and Biomedical Sciences, Faculty of Health Sciences, Murdoch University, Murdoch, WA 6150, Australia Barbara J. Skelly MA VetMB PhD CertSAM DipACVIM DipECVIM MRCVS Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES Annemarie M.W.Y. Voorbij DVM Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands vii Prelims Endocrinology.indd 7 19/01/2012 08:28 Foreword The field of small animal endocrinology has expanded significantly over the last 20 years. Since publication of the third edition of the BSAVA Manual of Canine and Feline Endocrinology (2004) there have been further important advances in knowledge of the discipline. In particular, the diagnosis and treatment of some endocrine disorders now warrant more detailed information and discussion. The editors, Carmel Mooney and Mark Peterson, are to be congratulated on the format and content of this fourth edition of the Manual. The impressive international author list features well known veterinarians working in the field of endocrinology, all of whom bring significant experience and a practical approach to the chapters of this Manual. The book provides an excellent resource for both practising veterinarians and veterinary students to update their knowledge. More experienced specialist readers will also find the content valuable and easy to navigate. In its 300 pages, the Manual contains illustrations, tables and algorithms to assist understanding and allow easy access to information. The first section addresses hormone assays, sample collection and the principles of interpretation of test results. Subsequent chapters on each endocrine gland are complemented by chapters on presenting complaints and their investigation. This Manual should be on the bookshelf of every small animal clinic and veterinary hospital. The information it provides can be easily applied to the clinical diagnosis and treatment of endocrine diseases for the benefit of animal patients and their owners. Boyd R. Jones BVSc FACVSc DipECVIM-CA MRCVS Emeritus Professor, Small Animal Clinical Studies, University College Dublin, Republic of Ireland Adjunct Professor of Companion Animal Medicine, Massey University, New Zealand viii Prelims Endocrinology.indd 8 19/01/2012 08:28 Preface This is the fourth edition of the BSAVA Manual of Canine and Feline Endocrinology. In introducing the third edition in 2004, the unprecedented advances in diagnostic tests and therapies were highlighted. Surprisingly, another 6 years on the advance in these and other areas has continued unabated. For example: disorders once considered rare, such as Conn’s disease, are now investigated more readily and consequently encountered more frequently; the management of diabetic cats has moved from palliation to achieving remission; and, significantly, the genetic risks associated with many disorders have been elucidated. There has been a change in the format of the Manual to provide easier access to relevant information. The first chapter deals with the type of assays used for hormone measurement and the collection and storage of samples and how this may influence the results obtained. The second chapter represents a new and exciting venture, outlining the principles for interpreting endocrine test results and introduces the reader to assessment of test performance and how to improve our diagnostic confidence. The following 17 chapters follow a traditional route, describing disorders associated with each major endocrine gland. Where applicable, chapters outlining feline and canine disorders are divided. The final 9 chapters provide information on solving both clinical and clinicopathological abnormalities for which endocrine disorders are a major consideration. As Editors we have been privileged to work with an internationally renowned panel of experts in their field. Our authors emanate from most corners of the world and have shown true dedication in contributing to this work. Endocrine diseases may vary in prevalence from place to place but essentially require the same diagnostic tests and treatments, whatever their geographical location. As a consequence, treatments that may not be available worldwide are highlighted where applicable, maintaining the international appeal of the Manual. This new edition of the BSAVA Manual of Canine and Feline Endocrinology has been a long time hatching but each chapter provides the reader with the most up-to-date information available. It is a valuable resource not only to those with a specific interest in small animal endocrinology but to all other general practitioners, veterinary nurses and technicians and to undergraduate veterinary students. We hope that it is a worthwhile addition to the practice library. Carmel T. Mooney Mark E. Peterson December 2011 ix Prelims Endocrinology.indd 9 19/01/2012 08:28