1例犬肾上腺皮质功能减退的诊治

Diagnosis and treatment of a dog with hypoadrenocortical insufficiency

研究以遵义某动物医院接诊一患犬为例,旨在探讨肾上腺皮质功能减退的诊断及治疗方法。患犬表现呕吐、低温、肾区疼痛。病原学检测犬瘟热、犬细小、犬冠状病毒、犬钩端螺旋体均为阴性;实验室检查见免疫细胞异常,C反应蛋白(CRP)升高,肌酐、尿素氮、总胆红素、碱性磷酸酶及天门冬氨酸转氨酶升高,提示机体严重炎症感染及肝、肾损伤;综合电解质检查见钾血症、低钠血症、低氯血症及钠钾比降低,疑似肾上腺皮质功能减退;促肾上腺皮质激素(ATCH)刺激试验见肾上腺皮质醇浓度降低,确诊该患犬为原发性肾上腺皮质功能减退。通过激素疗法联合肝损伤治疗、肾损伤治疗,补液连续7 d。经治疗后患犬精神、饮食明显好转;维持治疗选用新戊酸脱氧皮质酮,治疗后第15 d复查患犬各项指标恢复正常水平。该诊断思路及治疗方案可为临床肾上腺皮质功能减退的诊治提供参考。

The purpose of study to explore the diagnosis and treatment of adrenal insufficiency, and a dog was admitted to an animal hospital in Zunyi as an example. The sick dog suffered from vomiting, hypothermia, and pain in the kidney area.The etiological test showed that canine distemper, canine parvum, canine coronavirus, and canine leptospirosis were all negative. Laboratory examination showed abnormal immune cells, increased C-reactive protein(CRP), increased creatinine, blood urea nitrogen, total bilirubin, alkaline phosphatase and aspartate aminotransferase, indicating severe inflammatory infection and liver and kidney damage. Comprehensive electrolyte examination showed potassiumemia,hyponatremia, hypochloremia and decreased sodium-potassium ratio, suspected of adrenal insufficiency.Adrenocorticotropic hormone(ATCH) stimulation test showed decreased adrenal cortisol concentration, confirming the sick dog as primary adrenal insufficiency. Through hormone therapy combined with liver injury treatment and kidney injury treatment, fluid replacement was continued for seven d. After treatment, the sick dog’s spirit and diet improved significantly, deoxycorticosterone pivalate was used for maintenance treatment, and the indexes of the sick dog returned to normal levels on the 15th day after treatment. The diagnostic idea and treatment plan can provide a reference for the diagnosis and treatment of clinical adrenal insufficiency.