Page 1036 - Cote clinical veterinary advisor dogs and cats 4th

512 Hypoadrenocorticism

Initial Database • Management of inflammation and/or elevated Recommended Monitoring
• Review history: trauma, travel, tick exposure, intraocular pressures improves comfort and Re-examine in 48-72 hours for resorption of
VetBooks.ir • Ophthalmic exam (p. 1137) • Enucleation is the best treatment for patient monitoring of IOP is necessary due to risk of
recent illness
limits sequelae.
blood or rebleeding and IOP changes. Close
○ Examine contralateral eye.
secondary glaucoma.
comfort when the eye is permanently blind
○ Examine periocular region (evidence of
trauma). and painful. PROGNOSIS & OUTCOME
○ Pupillary light and dazzle reflexes, menace Acute General Treatment
response (vision prognosis) • Topical glucocorticoids (e.g., prednisolone • Varies; influenced by underlying cause
○ Intraocular pressure (uveitis, glaucoma) acetate 1% or dexamethasone 0.1% q 6-8h) • Larger volume and blood in vitreous are
○ Fluorescein stain (corneal ulceration) ○ Contraindicated in presence of corneal associated with poorer outcome.
○ Examine cornea/sclera for evidence of ulceration • Ocular sequelae (synechiae, cataract,
perforating injury. ○ Ophthalmic nonsteroidal antiinflamma- glaucoma) can cause visual impairment,
○ Aqueous flare and miosis support anterior tory drugs (NSAIDs) such as flurbiprofen blindness, or loss of the eye.
uveitis. or diclofenac can be used in the setting
○ Fundic exam (posterior hemorrhage, of corneal ulceration. PEARLS & CONSIDERATIONS
retinal detachment) • Topical atropine 1% solution q 24h if miosis
• General physical exam present and IOP < 10-15 mm Hg (goal is Comments
○ Mucous membranes and skin exam to keep the pupil moving so that synechia • Clinicians must rule out other causes of
(petechiae) does not develop) hyphema before presuming a traumatic
○ Abdominal and lymph node palpation • If IOP > 20-25 mm Hg (consistent with cause, especially without confirmed history
(organomegaly and/or lymphadenopathy glaucoma), administer topical carbonic or visual evidence of trauma.
suggestive of systemic diseases) anhydrase inhibitors; other treatments are • Bilateral hyphema is rarely caused by trauma;
○ Thoracic auscultation (pulmonary described on p. 387. a systemic disorder is more likely.
hemorrhage) • Treat any identified systemic disease.
○ Neurologic exam (p. 1136) (head trauma, • Referral for surgical repair of corneal and/ Prevention
intracranial hemorrhage) or scleral defects (p. 213) • Avoid situations that predispose the animal to
• Ocular ultrasound (p. 885) (posterior trauma (e.g., puppies interacting with feisty
segment inflammation, retinal detachment, Chronic Treatment cats).
intraocular neoplasia, or intraocular foreign • Traumatic hyphema: refer for intracameral • Keep toxins (e.g., rodenticides) out of reach
body) tissue plasminogen activator to dissolve clots. of animals.
• CBC, chemistry profile, and urinalysis ○ Within 3-4 days of the hemorrhage • Tick control
(systemic disease) ○ Slight risk of rebleeding • Avoid breeding dogs and cats with predispos-
• Blood pressure measurement (pp. 501 and • Uncontrollable uveitis and/or secondary ing genetic diseases.
1065) glaucoma (i.e., blind, painful eye) • Eye protection (goggles) for exophthalmic
• Infectious disease testing ○ Enucleation and blind dogs
• Surgical removal of hyphema rarely indicated
Advanced or Confirmatory Testing Technician Tips
• Coagulation profile Behavior/Exercise • Gentle restraint minimizes patient excitement
• Fine-needle aspirates/biopsy of organomegaly Restrict activity in acute cases of clotting and risk of further bleeding.
or enlarged lymph nodes disorders or trauma; cage rest with sedation • Avoid jugular puncture for blood collection
• Thoracic radiographs or CT (metastasis) if necessary because coagulopathy may be present.
• Abdominal ultrasound or CT (metastasis)
• Skull radiographs (metallic foreign bodies) Drug Interactions SUGGESTED READING
• Ocular histopathology (after enucleation) NSAIDs are often avoided to minimize Telle MR, et al: Hyphema: considerations in the
secondary bleeding but may be necessary if small animal patient. Top Companion Anim Med
TREATMENT glucocorticoids are contraindicated. 30:97-106, 2015.
Treatment Overview Possible Complications AUTHOR: Christine C. Lim, DVM, DACVO
EDITOR: Diane V. H. Hendrix, DVM, DACVO
• Immediate treatment is necessary to limit Rebleeding, secondary glaucoma, synechiae,
bleeding and development of sequelae cataract, blindness, phthisis bulbi
(secondary glaucoma, synechiae, cataract).
• Treatment of an underlying cause is the most
important aspect of management.

Hypoadrenocorticism Bonus Material Client Education
Sheet
Online

BASIC INFORMATION Synonyms Epidemiology
• Addison’s disease SPECIES, AGE, SEX
Definition • Glucocorticoid-deficient hypoadrenocorti- • Most common in young/middle-aged, female
An endocrine disorder caused by adrenocortical cism (with normal serum electrolyte con- dogs, but any age, sex, or breed may be
insufficiency centrations): atypical hypoadrenocorticism affected.

www.ExpertConsult.com