(A) retrospective study of clinical relevance between cholestatic disease and pituitary dependent hyperadrenocorticism in dogs

Abstract

A high prevalence of cholestatic disease, including gall bladder mucoceles (GBM), in naturally occurring canine pituitary-dependent hyperadrenocorticism (PDH) patients has been reported. A clinical correlation between cholestatic disease and PDH management is insufficiently identified. There can be significant differences in not only the clinical features of PDH due to concurrent cholestatic disease, but also regarding the management of PDH with trilostane, owing to the water-insolubility of trilostane. Sixty five client-owned dogs with naturally occurring PDH were included. Each dog was treated with trilostane for at least 3 months prior to this study, and exhibited a good clinical response, as determined by owners. Statistical comparisons of clinical signs, routine blood tests, basal and post-ACTH (Adrenocorticotrophic hormone) cortisol concentration, and optimal trilostane dosage were made after the dogs were separated into the following 3 groups through ultrasonographic imaging: control group, cholestasis group, and GBM group. Comparisons were also analyzed pertaining to each dogs sex. Seventy two percent (n = 47) of whole patients turned out to have cholestasis or GBM. The GBM group had not only more severe clinical signs, but also a significantly different total cholesterol (T-Chol) and post-ACTH stimulation test value at the time of diagnosis. There was a tendency (P = 0.057) and significance (P = 0.003) of a high prevalence of cholestatic disease in females and dogs that weighed under 6 kg, respectively. The optimal dosage (kg/mg/day) of the GBM group and the cholestasis group was 2.5 and 1.5 times that the dosage of the control group, respectively (P = 0.000). There was a tendency (P = 0.112) of a low proportion of hypercholesterolemia in female group. This study suggests that gall bladder disease associated with cholestatic disease is closely correlated with canine PDH, related to both clinical features and drug management. Furthermore, those findings may be related to hypercholesterolemia, a female predisposition, and the water-insoluble characteristic of trilostane.