Received: 5 October 2021 Accepted: 7 January 2022

DOI: 10.1111/jvim.16365

STANDARD ARTICLE

Evaluation of resting cortisol concentration testing in dogs

with chronic gastrointestinal signs

Ana Fernandez Gallego | Adam G. Gow | Alisdair M. Boag

The Royal (Dick) School of Veterinary Studies

and the Roslin Institute, Easter Bush Campus, Abstract
The University of Edinburgh, Midlothian, Background: Resting cortisol concentrations are routinely measured in dogs with
United Kingdom
chronic gastrointestinal signs to rule out hypoadrenocorticism based on a
Correspondence concentration >2 μg/dL (>55 nmol/L).
Alisdair M. Boag, The Royal (Dick) School of
Veterinary Studies, Easter Bush Campus, The Hypothesis/Objectives: To assess the cross-sectional prevalence of hypo-
University of Edinburgh, Midlothian EH25 adrenocorticism in a group of dogs with chronic gastrointestinal signs presented to a
9RG, United Kingdom.
Email: [email protected] referral internal medicine service.
Animals: Two-hundred and eighty-two client-owned dogs with chronic gastrointesti-
nal 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 μg/dL (<55 nmol/L) in 79 patients
(28%). Repeated resting cortisol concentration measurements were performed in
28 dogs, and in 8, resting cortisol concentrations remained <2 μg/dL (<55 nmol/L).
Post-ACTH cortisol concentration was <2 μg/dL (<55 nmol/L) in 1 dog, consistent
with a diagnosis of hypoadrenocorticism and giving a prevalence estimate of hypo-
adrenocorticism 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 <2 μg/dL
(<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol
concentration >2 μg/dL (>55 nmol/L). Overall, the most common diagnosis was
chronic primary inflammatory enteropathy (176/282, 62.4%), followed by extra-
gastrointestinal 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 enter-
opathy. Repeated resting cortisol concentration may be considered as a test to try
and exclude hypoadrenocorticism.

Abbreviation: ACTH, adenocorticotropic hormone.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
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© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.

J Vet Intern Med. 2022;1–7. wileyonlinelibrary.com/journal/jvim 1

2 GALLEGO ET AL.

KEYWORDS
ACTH stimulation test, Addison's disease, chronic enteropathy, hypoadrenocorticism, resting
cortisol

1 | I N T RO DU CT I O N We hypothesized that: (a) the prevalence of hypoadrenocorticism

in dogs with chronic gastrointestinal signs presented to a referral
Hypoadrenocorticism is an uncommon endocrine disease of dogs, char- internal medicine service would be lower than previously reported,
acterized by insufficient corticosteroid hormone secretion from the adre- and (b) primary gastrointestinal disease would be the most common
1
nal cortex. The estimated cross-sectional prevalence of diagnosis.
hypoadrenocorticism is between 0.06% and 1.1%.2-5 Predisposed breeds
have higher prevalence estimates, including bearded collies (3.4%), stan-
dard poodles (10%), Portuguese water dogs (1.5%)6 and Nova Scotia 2 | MATERIAL AND METHODS
1
duck tolling retrievers (1.4%), and it is considered to be an inherited dis-
ease in these breeds.1 Primary hypoadrenocorticism, a lack of both glu- 2.1 | Design
cocorticoid and mineralocorticoid secretion caused by immune-mediated
adrenal gland damage is most common.1 Glucocorticoid deficiency is Retrospective cohort study assessing patients with resting cortisol
described as responsible for the majority of waxing and waning clinical concentration as part of the assessment for chronic gastrointestinal
signs, with mineralocorticoid deficiency responsible for the classical elec- signs.
trolyte imbalances of hyponatremia and hypokalemia.1 Eunatremic,
eukalemic hypoadrenocorticism (previously known as atypical hypo-
adrenocorticism; Agreed Language In Veterinary Endocrinology [ALIVE] 2.2 | Setting, location, dates, and data collection
criteria)7 describes a clinical presentation of hypoadrenocorticism in dogs
with normal serum electrolyte concentrations. These patients may be Medical records at The Royal (Dick) School of Veterinary Studies
more likely to be presented with gastrointestinal signs.8,9 Dogs presented (University of Edinburgh) between May 2013 and September 2017
with eunatremic, eukalemic hypoadrenocorticism may have isolated hyp- were searched for dogs that had resting cortisol concentration testing,
ocortisolism, either primary or secondary, or hypoadrenocorticism with identified on the basis of billing codes and laboratory records. These
compensatory mechanisms protecting against changes in serum electro- records were retrospectively reviewed using the electronic client data
lyte concentrations secondary to hypoaldosteronism.10 management system (Tristan Veterinary Software Ltd, version
Clinical signs of hypoadrenocorticism can be vague and non- 1.8.3.914, Orion Engineering Services, Orion House, Inverness,
specific, mimicking other diseases, and making diagnosis challenging.1 United Kingdom).
The most common clinical signs reported are lethargy, anorexia,
vomiting, diarrhea, weakness, and weight loss1,5, which may be grad-
ual in onset and commonly wax and wane.1,11,12 2.3 | Case selection
Hypoadrenocorticism is diagnosed by a lack of appropriate corti-
sol response to an adenocorticotropic hormone (ACTH) stimulation All cases with resting cortisol concentration testing performed were
test. However, resting cortisol concentration <2 μg/dL (<55 nmol/L) reviewed. Dogs with a chronic history of gastrointestinal signs
13-15
has excellent sensitivity for hypoadrenocorticism (99.4%-100%). (vomiting, diarrhea, weight loss, hyporexia, anorexia, dysphagia, regur-
As a result, a resting cortisol concentration >2 μg/dL (>55 nmol/L) is gitation, or a combination of these for ≥3 weeks) seen by the internal
commonly used as a screening test to rule out hypoadrenocorticism. medicine service were included in the study. Dogs were excluded if
Because of variable clinical signs and a presentation that can mimic cortisol concentration was part of ACTH stimulation or low dose
chronic enteropathy, including protein-losing enteropathy, hypo- dexamethasone suppression test to evaluate for hyper-
adrenocorticism always must be considered in dogs with chronic gas- adrenocorticism, or for trilostane monitoring. Dogs with a history of
trointestinal signs. Therefore, resting cortisol concentration testing is recent glucocorticoid administration (1 week before presentation for
routinely performed in dogs with chronic gastrointestinal disease to rule short-acting glucocorticoids and 4 weeks for long-acting glucocorti-
out hypoadrenocorticism. To our knowledge, only a single previous coids)15 also were excluded.
study has evaluated the prevalence of hypoadrenocorticism in dogs
with chronic gastrointestinal signs,9 with hypoadrenocorticism being
the final diagnosis in 6/151 dogs, resulting in a prevalence of 4%. 2.4 | Extracted data
Our primary objective was to assess the cross-sectional preva-
lence of hypoadrenocorticism in a group of dogs with chronic gastro- Signalment, presenting complaint(s), resting cortisol concentration
intestinal signs presented to a referral internal medicine service. measurement and final diagnosis (as documented by a European
GALLEGO ET AL. 3

College of Veterinary Internal Medicine - Companion Animal diplo- T A B L E 1 Most common presenting clinical signs in the 282 dogs
mate in the patient record) were evaluated in all dogs. Hematology, that were finally included

biochemistry values and ACTH stimulation test results were extracted Clinical signs Number of dogs (%)
when available. Diarrhea 145 (51.4)
Vomiting 138 (48.9)
Weight loss 74 (26.2)
2.5 | Laboratory testing
Lethargy 37 (13.1)
Hyporexia 27 (9.6)
Resting cortisol concentration measurements for all dogs were evalu-
Regurgitation 28 (9.9)
ated at The Royal (Dick) School of Veterinary Studies, using the Immu-
Anorexia 14 (4.9)
lite 1000 Analyzer (Siemens Healthineers, United Kingdom). The
ACTH stimulation test results for 63/70 cases were evaluated at The
Royal (Dick) School of Veterinary Studies using the previously men-
tioned analyzer. The remaining 7 cases had ACTH stimulation tests
performed at the primary care practice. Three of these results were
reported by Capital Diagnostics Laboratory, United Kingdom, and for
the remaining 4, this information was not known. Hematology results
were unavailable for 8 dogs and serum biochemistry results
unavailable for 3 dogs. For dogs with >1 resting cortisol concentration
measurement, only testing associated with the first consultation was
considered.
Final diagnosis was evaluated for all patients. A diagnosis of pri-
mary enteropathy was made if the patients either had endoscopic
biopsy results consistent with an inflammatory enteropathy or if it
was the main differential diagnosis suspected and the patients had a
good clinical response to appropriate treatment (hydrolyzed diet, pro-
biotics, immunosuppressive drugs, or antibiotics). Diagnosis was clas-
sified as suspected primary enteropathy if it was the main clinical
suspicion, but no endoscopic biopsy samples were taken and the
patients were lost to follow-up.

2.6 | Statistical evaluation F I G U R E 1 Resting cortisol measurements for all 282 dogs with
chronic gastrointestinal signs. Red dashed line represents 2 μg/dL
Data were organized in Microsoft Excel (Microsoft, USA); data ana- (55 nmol/L) cut-off for excluding hypoadrenocorticism
lyses were performed in R (R version 4.0.3) using RStudio (version
1.3.1093). Data were assessed for normality by visual assessment of
histograms and q-q plots. Statistical significance was set at P < .05. 1 month to 15.25 years; interquartile range [IQR], 1.8-8.8 years) and
median body weight was 18.2 kg (range, 1.35-80 kg; IQR, 9-29 kg).
The most common clinical signs on presentation included diarrhea
3 | RESULTS (145/282), vomiting (138/282) and weight loss (74/282, Table 1).

3.1 | Dog data

3.2 | Resting cortisol concentrations and adrenal
A total of 1057 resting cortisol concentration measurements were testing
performed in 856 dogs. The internal medicine service saw 508/856
patients. Two-hundred and eighty-two cases with chronic gastrointes- Resting cortisol concentration was >2 μg/dL (>55 nmol/L) in 203/282
tinal signs met the inclusion criteria. (71.9%) and resting cortisol concentration was <2 μg/dL (<55 nmol/L)
One-hundred and eighty were male (111 neutered, 69 intact) and in 79/282 (28%), no dog had a cortisol concentration of 2 μg/dL
102 were female (75 neutered, 27 intact). The most common breed (55 nmol/L; Figure 1). Resting cortisol concentration was <1 μg/dL
was Labrador retriever (35), followed by boxer (13), Border collie (12), (<27.6 nmol/L) in 25/282 dogs (8.9%).
West highland white terrier (12), French bulldog (12), German shep- Of the patients with a resting cortisol concentration <2 μg/dL
herd (11) and golden retriever (11). Median age was 5.4 years (range, (<55 nmol/L), further adrenal testing was performed in 64/79 (81%)
4 GALLEGO ET AL.

F I G U R E 2 Cortisol measurements in 58 dogs with resting F I G U R E 4 Cortisol measurements in 6 dogs with initial resting
cortisol <55 nmol/L (<2 μg/dL) with a post-ACTH measured cortisol. cortisol >55 nmol/L (>2 μg/dL) with a post-ACTH measured cortisol.
Twenty-three dogs had also pre-ACTH resting cortisol concentration One dog also had a pre-ACTH resting cortisol concentration
measurement. Dashed line represents 2 μg/dL (55 nmol/L) cut-off for measurement. Dashed line represents 2 μg/dL (55 nmol/L) cut-off for
excluding hypoadrenocorticism excluding hypoadrenocorticism

review. Post-ACTH cortisol concentration measurement was <2 μg/

dL (<55 nmol/L) in 1 dog, consistent with a diagnosis of hypo-
adrenocorticism. Post-ACTH cortisol concentration measurement
excluded hypoadrenocorticism in 57/58 dogs (Figure 2). In 6 dogs, ini-
tial resting cortisol concentration was undetectable at <0.5 μg/dL
(<13.8 nmol/L), 3 had a repeat resting cortisol concentration measure-
ment as part of an ACTH stimulation test, and 3 had post-ACTH corti-
sol concentration measured only (Figure 3).
In 6 dogs with initial resting cortisol concentration >2 μg/dL
(>55 nmol/L; range, 2.03-4.9 μg/dL [56.6-136 nmol/L]) further adre-
nal testing was performed; 1 dog had an ACTH stimulation test and 5
post-ACTH cortisol concentrations, and none were consistent with
hypoadrenocorticism (Figure 4).
In total, repeat resting cortisol concentrations were measured in
28 dogs (Figure 5). Eight of these dogs had resting cortisol concentra-
tions <2 μg/dL (<55 nmol/L) twice, in 19/28 dogs the second concen-
tration was >2 μg/dL (>55 nmol/L) and in 1 dog the concentrations
F I G U R E 3 Cortisol measurements in 6 dogs with undetectable
were >2 μg/dL (>55 nmol/L) on both occasions. Eight dogs with rest-
initial resting cortisol (<0.5 μg/dL) with a post-ACTH measured
ing cortisol concentrations <1 μg/dL (<27.6 nmol/L) had repeat resting
cortisol. Three dogs also had a pre-ACTH resting cortisol
concentration measurement. Dashed line represents 2 μg/dL cortisol concentrations measured, and of these only the dog with
(55 nmol/L) cut-off for excluding hypoadrenocorticism hypoadrenocorticism had resting cortisol concentration <1 μg/dL
(<27.6 nmol/L) twice.

dogs associated with the initial consultation; 26/64 had an ACTH

stimulation test performed, 37/64 had a post-ACTH cortisol concen- 3.3 | No follow-up adrenal testing dogs <2 μg/dL
tration measurement and 1 dog had a repeat resting cortisol concen- (<55 nmol/L)
tration without subsequent ACTH stimulation, which was 2.5 μg/dL
(68 nmol/L). Two ACTH stimulation tests were performed by the pri- Follow-up adrenal test results were not available in 15/79 (19%) dogs
mary veterinarian and described as normal, which was assumed to be with resting cortisol concentrations <2 μg/dL (<55 nmol/L). Final diag-
>2 μg/dL (>55 nmol/L), but actual results were not available for noses in this group of patients included primary inflammatory
GALLEGO ET AL. 5

TABLE 2 Final diagnoses in 29 dogs with eosinophilia

Final diagnosis Number of dogs

Chronic enteropathy 18
PLE 2
Megaesophagus 2
Giardiasis 1
Hypoadrenocorticism 1
Multicentric lymphoma 1
Small intestinal mass 1
Hiatal hernia 1
Abscessation 1
Unknown 1

hyporexia, dysphagia, polydipsia, and acute vomiting. Clinicopatholog-

ical abnormalities are summarized in Table S1, and include eosino-
philia and normal serum electrolytes concentrations. Both pre- and
post-ACTH stimulated cortisol concentrations were <0.5 μg/dL
F I G U R E 5 Comparison of initial and follow-up resting cortisol (<13.8 nmol/L).
measurements in 28 dogs that had repeat resting cortisol This patient also had eosinophilia. Eosinophilia (eosinophils
concentration measurement. Black dashed lines represent 2 μg/dL
>1  109/L) was present in 29/282 (10.3%) dogs in our study, includ-
(55 nmol/L) cut-off for excluding hypoadrenocorticism. Red dashed
ing the patient diagnosed with hypoadrenocorticism. Common final
lines represents 1 μg/dL (27.6 nmol/L)
diagnoses in this group of patients included chronic enteropathy (18),
protein-losing enteropathy (2) and megaesophagus (2; Table 2). A final
enteropathy (6), suspected primary inflammatory enteropathy (2), diagnosis was not reached in 1 patient, but an ACTH stimulation test
lymphangiectasia (2), protein-losing nephropathy and chronic kidney excluded hypoadrenocorticism.
disease (1), diaphragmatic hernia (1), gastroenteritis (1), gastric foreign Lymphocytosis was present in 14/282 (5%) dogs. In these
body (1), gastrointestinal lymphoma (1), giardiasis (1), and unknown 14, there were 17 final diagnoses. Primary diagnoses were primary
diagnosis (1). One of the patients diagnosed initially with primary inflammatory enteropathy or suspected primary inflammatory enter-
inflammatory enteropathy was diagnosed 2 months later with gastro- opathy in 9, lymphoma in 2 and brachycephalic airway obstructive
intestinal lymphoma. All of these patients had resting cortisol concen- syndrome, histiocytic ulcerative colitis and megaesophagus in 1 each.
tration, hematology, and serum biochemistry performed. Other Concurrent diagnoses were esophagitis, and Campylobacter infection.
additional tests included abdominal ultrasound examination (14), tho- A lack of stress leukogram (neutrophils and monocytes within
racic radiographs (8), serum cobalamin concentration (6), urinalysis (7), normal limits, lack of immature neutrophils and no lymphopenia) was
and gastrointestinal endoscopy (7). However, it cannot be fully present in 183/282 dogs (64.9%). None of these patients were diag-
excluded that all of these patients had hypoadrenocorticism because nosed with hypoadrenocorticism.
of the retrospective nature of the study. A Na : K ratio <27 was present in 10 dogs. Three of these
One patient was euthanized shortly after diagnosis (patient with patients were diagnosed with primary inflammatory enteropathy or
protein-losing nephropathy). The remaining 14 dogs were discharged suspected primary inflammatory enteropathy, 2 with megaesophagus,
from the hospital; of these, 9/14 were lost to follow-up. Of the 1 each with Mycoplasma canis infection, giardiasis, leishmaniosis,
remaining 5 dogs, 2 were doing clinically well 6 months after dis- chronic kidney disease secondary to leptospirosis, and 1 dog did not
charge (1 with chronic enteropathy and 1 with chronic enteropathy have a final diagnosis.
and lymphangiectasia), and 1 was clinically well 2 years after discharge
(chronic enteropathy and lymphangiectasia). Two dogs were humanly
euthanized 2.5 months after discharge, both with gastrointestinal 3.5 | Final diagnoses
lymphoma.
In total, 337 diagnoses were made in 282 dogs; 1 dog had 4 diagnoses,
9 dogs had 3 diagnoses, 34 had 2 diagnoses, 231 had 1 diagnosis and
3.4 | Dog with hypoadrenocorticism in 7 dogs no final definitive diagnosis was made.
The most common final diagnosis in this population of dogs was
Hypoadrenocorticism was the final diagnosis in 1 dog, a 6-year-old, primary inflammatory enteropathy in 176/282 (62.4%) dogs (con-
female neutered, labradoodle, with a 4-week history of weight loss, firmed in 154/282 and strongly suspected in 22/282). These included
6 GALLEGO ET AL.

dogs with food-responsive enteropathy, immunosuppressant- which has been estimated by previous studies as being between
responsive enteropathy, antibiotic-responsive enteropathy, and histio- 0.06% and 1.1%.2-5
cytic ulcerative colitis. Other frequent diagnoses included: extra- Hypoadrenocorticism and other nongastrointestinal diseases
gastrointestinal neoplasia (17/282, 6%), gastrointestinal neoplasia (including pancreatic diseases, endocrinopathies, diseases of the liver
(13/282, 4.6%), protein-losing enteropathy (10/282, 3.5%), chronic and kidneys and neoplasia) can present clinically with chronic gastro-
pancreatitis (10/282, 3.5%), megaesophagus (10/282, 3.5%), and intestinal signs and 23.4% (66/282) of the patients in our study had
enteritis, gastritis or gastroenteritis (8/282, 2.8%). nongastrointestinal disease as the final diagnosis. Our findings are in
When focusing only on dogs with a resting cortisol agreement with those of a recent German study that assessed resting
concentration <2 μg/dL (<55 nmol/L), the most common final diagno- cortisol concentrations, with primary inflammatory enteropathy as the
sis was chronic enteropathy (43/79 or strongly suspected in 9/79, final diagnosis in more than half of the patients, both with resting cor-
65.8%) followed by megaesophagus (4/79, 4.8%) and giardiasis tisol concentrations higher and lower than 55 nmol/L.9 Our study also
(4/79, 4.8%). agrees with a study that evaluated the final diagnosis in dogs with
Only 1/282 dog was diagnosed with hypoadrenocorticism, giving chronic diarrhea.16 Inflammatory enteropathy was the most common
a prevalence estimate of hypoadrenocorticism in this population of diagnosis in that study with a prevalence estimate for hypo-
dogs of 0.3% (95% confidence interval [95CI], 0.03%-1.5%). adrenocorticism of 0.73%.16
Extragastrointestinal disease was the primary diagnosis in 66/282 Repeat resting cortisol concentration measurements were per-
(23.4%) patients. Nongastrointestinal diseases included non- formed in 27 dogs with an initial resting cortisol <2 ug/dL (<55 nmol/
gastrointestinal neoplasia (17/66), chronic pancreatitis (10/66), neuro- L), including the patient finally diagnosed with hypoadrenocorticism.
logical disease (6/66), exocrine pancreatic insufficiency (3/66), chronic Out of 26 dogs with an initial resting cortisol concentration <2 μg/dL
kidney disease (4/66), portal vein hypoplasia (3/66), and hepatopathy (<55 nmol/L) without hypoadrenocorticism, hypoadrenocorticism was
(2/66). Final diagnosis was not reached in 6/282 dogs (2.1%). Of excluded in 19 (19/26, 73%) based on a repeat resting cortisol
these, 5 patients had a resting cortisol concentration <2 μg/dL concentration >2 μg/dL (55 nmol/L; Figure 5). Previous studies have
(<55 nmol/L) and 1/5 did not have an ACTH stimulation test per- found a resting cortisol concentration of <2 μg/dL (<55 nmol/L) to
formed. This patient was also lost to follow-up and returned to the have excellent sensitivity for hypoadrenocorticism (99.4%-100%).13-15
referring veterinarian. As a result, a resting cortisol concentration >2 μg/dL (>55 nmol/L) is
used as a screening test to exclude hypoadrenocorticism. Unfortu-
nately, specificity is low (between 63.3% and 78.2%) and, as a result, a
4 | DISCUSSION confirmatory test (ACTH stimulation test) is performed on many dogs
that do not have hypoadrenocorticism,13-15 with increased cost for
The prevalence of hypoadrenocorticism in this population of dogs the client. Based on our results, in some circumstances (eg, limited
with chronic gastrointestinal signs and presented to a referral internal financial resources, lack of tetracosactide acetate to perform the
medicine service was 0.3% (95CI, 0.03%-1.5%), lower than previously ACTH stimulation test and its cost, low clinical suspicion, non-
described in a smaller population of dogs (prevalence estimate, 4%; emergency presentation) repeated resting cortisol concentration mea-
95CI, 1.6%-8%).9 One possible reason for the difference between surement could be considered to try to rule out hypoadrenocorticism,
studies is that the prevalence of hypoadrenocorticism in Germany is but an ACTH stimulation test is always required to make a diagnosis
higher than in the United Kingdom. We believe this possibility seems of hypoadrenocorticism. Other diagnostic tests to consider in these
unlikely, with prevalence in other geographically diverse populations circumstances include post-ACTH stimulation cortisol concentration
reportedly being similar.2-5 A further possibility is that referring practi- or cortisol-to-ACTH ratio to exclude or diagnose
1
tioners in the United Kingdom are more likely than those in Germany hypoadrenocorticism.
to screen for hypoadrenocorticism before referral. This possible bias is One dog in our study had a final diagnosis of eunatremic,
intrinsic to studying a referral population of animals because the pop- eukalemic hypoadrenocorticism. These patients usually have a longer
ulation is dependent on the referring veterinarians' routine practices. course of clinical signs before diagnosis,17 with anorexia, lethargy,
Finally, dogs with hypoadrenocorticism can present in acute crisis and diarrhea, vomiting and polydipsia more frequently reported.17,18 Our
in our hospital these cases are seen by the emergency service rather patient's presenting complaints included a chronic history of lethargy,
than the internal medicine service. Therefore, dogs with chronic gas- hyporexia, polydipsia and acute vomiting, but further conclusions
trointestinal signs presenting in subsequent crisis would not be could not be made in our study because of the low number of hypo-
included in this population. adrenocorticism cases. Biochemical abnormalities in dogs with
The prevalence of hypoadrenocorticism in the prior study was eunatremic, eukalemic hypoadrenocorticism are similar to those in
4%.9 Our clinical perception was that, in our referral population of typical cases, except for normal serum sodium and potassium concen-
dogs with chronic gastrointestinal signs, the prevalence of hypo- trations.17 Other biochemical abnormalities our patient had included
adrenocorticism was lower, as was confirmed in our study. The preva- eosinophilia and mild hypocholesterolemia. Hypocholesterolemia and
lence estimate in our study more closely corresponds with the overall hypoalbuminemia appeared to be more marked in dogs with
prevalence of hypoadrenocorticism in the general dog population, eunatremic, eukalemic hypoadrenocorticism compared to cases with
GALLEGO ET AL. 7

changes in serum electrolyte concentrations.17 Eosinophilia is reported 3. Bellumori TP, Famula TR, Bannasch DL, Belanger JM, Oberbauer AM.
in up to 20% of hypoadrenocorticism cases.1 Eosinophilia also is associ- Prevalence of inherited disorders among mixed-breed and purebred
dogs: 27,254 cases (1995-2010). J Am Vet Med Assoc. 2013;242:
ated with inflammatory disease in organs with large epithelial surfaces,
1549-1555.
such as skin, intestine or lungs as well as in parasitic infections.19 Eosin- 4. Kelch WJ. Canine Hypoadrenocorticism (Canine Addison's Disease):
ophilia was found in 10.3% (29/282) of the dogs in our study, with History, Contemporary Diagnosis by Practicing Veterinarians, and
more than half of them having a final diagnosis of primary inflammatory Epidemiology [PhD dissertation]. University of Tennessee; 1996.
5. Schofield I, Woolhead V, Johnson A, Brodbelt DC, Church DB,
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O'Neill DG. Hypoadrenocorticism in dogs under UK primary veteri-
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adrenocorticism. Top Companion Anim Med. 2014;29:96-101.
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concentration <2 μg/dL (<55 nmol/L) did not have an ACTH stimula- tions; 2021. https://www.esve.org/alive/search.aspx. Accessed July
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centration in this patient was 1.92 μg/dL (53.2 nmol/L), close to the
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referral population of dogs with chronic gastrointestinal signs, lower Boretti FS, Reusch CE. Evaluation of aldosterone concentrations in
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estimates of hypoadrenocorticism in the general canine population. 2010;51:63-69.
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13. Bovens C, Tennant K, Reeve J, Murphy KF. Basal serum cortisol con-
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ACKNOWLEDGMENT 14. Gold AJ, Langlois DK, Refsal KR. Evaluation of basal serum or plasma
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No funding was received for this study.
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CONF LICT OF IN TE RE ST DEC LARAT ION plasma cortisol concentrations to rule out a diagnosis of hypo-
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16. Volkmann M, Steiner JM, Fosgate GT, Zentek J, Hartmann S, Kohn B.
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study of dogs with atypical hypoadrenocorticism: a diagnostic cut-off
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(IACUC) OR OTHER APPROVAL DECLARAT ION
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Authors declare no IACUC or other approval was needed. classic hypoadrenocorticism with glucocorticoid-deficient hypo-
adrenocorticism in dogs: 46 cases (1985-2005). J Am Vet Med Assoc.
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19. Lilliehöök I, Gunnarsson L, Zakrisson G, Tvedten H. Diseases associ-
Authors declare human ethics approval was not needed for this study.
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ORCID
Ana Fernandez Gallego https://orcid.org/0000-0002-8290-7559
SUPPORTING INF ORMATION
Alisdair M. Boag https://orcid.org/0000-0002-3819-1821
Additional supporting information may be found in the online version
of the article at the publisher's website.
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