Evaluation of Baseline Cortisol, Endogenous ACTH, and Cortisol/ACTH Ratio to Monitor Trilostane Treatment in Dogs with Pituitary‐Dependent Hypercortisolism. (23rd May 2013)

• Record Type: Journal Article
• Authors: Burkhardt, W.A.; Boretti, F.S.; Reusch, C.E.; Sieber‐Ruckstuhl, N.S.
• Is Part Of: Journal of veterinary internal medicine. Volume 27:Number 4(2013:Jul./Aug.)
• Page Start: 919
• Page End: 923
• Publication Date: 2013-05-23
• Subjects: Veterinary medicine -- Periodicals; 636.0896
• DOI: 10.1111/jvim.12111
• Languages: English
• ISSNs: 0891-6640

Abstract

<abstract abstract-type="main" id="jvim12111-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jvim12111-sec-0001" sec-type="section"> <title>Background</title> <p>The effectiveness of trilostane treatment is currently monitored by regular ACTH stimulation tests, which are time‐consuming and expensive. Therefore, a monitoring system without a stimulation protocol and with less client expense would be preferable.</p> </sec> <sec id="jvim12111-sec-0002" sec-type="section"> <title>Hypothesis/Objectives</title> <p>The aim of our study was to evaluate if baseline cortisol, endogenous ACTH (ACTH) concentration or the baseline cortisol to ACTH ratio (cortisol/ACTH ratio) could replace the ACTH stimulation test.</p> </sec> <sec id="jvim12111-sec-0003" sec-type="section"> <title>Animals</title> <p>Forty trilostane‐treated dogs with pituitary‐dependent hypercortisolism (PDH) were included in this prospective study.</p> </sec> <sec id="jvim12111-sec-0004" sec-type="section"> <title>Methods</title> <p>A total of 148 ACTH stimulation tests and 77 ACTH concentrations and cortisol/ACTH ratios were analyzed. Control of cortisol release was classified according to cortisol concentration after ACTH administration as excessive (<1.5 μg/dL; group 1), adequate (1.5–5.4 μg/dL; group 2), or inadequate (>5.4 μg/dL; group 3).</p> </sec> <sec id="jvim12111-sec-0005" sec-type="section"> <title>Results</title> <p>Baseline cortisol concentrations had considerable overlap between excessively, adequately, and inadequately controlled dogs. Only baseline cortisol >4.4 μg/dL (in 12% of tests) was a reliable diagnosis of inadequate control. Endogenous ACTH concentrations did not differ between groups. The overlap of the cortisol/ACTH ratio between groups was large. Correct classification was only possible if the cortisol/ACTH ratio was >15, which occurred in 4% of tests.</p> </sec> <sec id="jvim12111-sec-0006" sec-type="section"> <title>Conclusions and Clinical Importance</title> <p>To monitor trilostane treatment the ACTH stimulation test cannot be replaced by baseline cortisol, ACTH concentration, or the cortisol/ACTH ratio.</p> </sec> </abstract>