Evaluation of resting cortisol concentration testing in dogs with chronic gastrointestinal signs.

Abstract

BACKGROUND: Resting cortisol concentrations are routinely measured in dogs with chronic gastrointestinal signs to rule out hypoadrenocorticism based on a concentration&#x2009;>2&#xa0;&#x3bc;g/dL (>55&#x2009;nmol/L). HYPOTHESIS/OBJECTIVES: To assess the cross-sectional prevalence of hypoadrenocorticism in a group of dogs with chronic gastrointestinal signs presented to a referral internal medicine service. ANIMALS: Two-hundred and eighty-two client-owned dogs with chronic gastrointestinal signs and with resting cortisol concentration testing performed. METHODS: Retrospective review of medical records (final diagnosis, resting cortisol concentration, and adenocorticotropic hormone [ACTH] stimulation test results) of a referral population of dogs between May 2013 and September 2017. RESULTS: Resting cortisol concentration was <2&#xa0;&#x3bc;g/dL (<55&#x2009;nmol/L) in 79 patients (28%). Repeated resting cortisol concentration measurements were performed in 28 dogs, and in 8, resting cortisol concentrations remained <2&#xa0;&#x3bc;g/dL (<55&#x2009;nmol/L). Post-ACTH cortisol concentration was <2&#xa0;&#x3bc;g/dL (<55&#x2009;nmol/L) in 1 dog, consistent with a diagnosis of hypoadrenocorticism and giving a prevalence estimate of hypoadrenocorticism in this population of dogs of 0.3% (95% confidence interval [95CI], 0.03-1.5%). In 19 dogs with an initial resting cortisol concentration&#x2009;<2&#xa0;&#x3bc;g/dL (<55&#x2009;nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration&#x2009;>2&#xa0;&#x3bc;g/dL (>55&#x2009;nmol/L). Overall, the most common diagnosis was chronic primary inflammatory enteropathy (176/282, 62.4%), followed by extragastrointestinal neoplasia (17/282, 6%), protein-losing enteropathy, pancreatitis and megaesophagus (10/282, 3.5% each). CONCLUSIONS AND CLINICAL IMPORTANCE: Although dogs with hypoadrenocorticism can present with chronic gastrointestinal signs, it was the final diagnosis in only 1 of 282 dogs presenting to a referral internal medicine service for signs of chronic enteropathy. Repeated resting cortisol concentration may be considered as a test to try and exclude hypoadrenocorticism.