Page 1482 - Cote clinical veterinary advisor dogs and cats 4th

Paraneoplastic Syndromes 755

• Myasthenia gravis: regurgitation, dyspnea • Myasthenia gravis: antibody production • Hyperviscosity syndrome: serum/urine
(secondary to aspiration pneumonia), targeted against acetylcholine receptors at protein electrophoresis to document
VetBooks.ir • Hypertrophic osteopathy: lameness, lethargy • Acromegaly: excessive growth hormone (GH) • Hyperadrenocorticism: urine cortisol/ Diseases and Disorders
neuromuscular junctions
monoclonal gammopathy
weakness/collapse (p. 668)
creatinine ratio, ACTH stimulation test,
(p. 508)
and/or IGF-1 production
• Hyperadrenocorticism: PU/PD, polyphagia,
ACTH to identify inappropriate pituitary-
bilaterally symmetric alopecia, muscle DIAGNOSIS dexamethasone suppression test, endogenous
wasting, pendulous abdomen, comedones, adrenal axis
calcinosis cutis (p. 485) Diagnostic Overview • Myasthenia gravis: measure serum acetyl-
• Acromegaly: PU/PD, weight gain, enlarged When animals present with signs related to a choline receptor antibody titer to prove
head/limbs, exercise intolerance (p. 17) PNS, discovery of the underlying malignancy autoimmunity.
• Peripheral neuropathy: cranial nerve is essential. • Acromegaly: measure serum GH, IGF-1 to
deficits, altered proprioception, urinary/ confirm inappropriate hormone secretion.
fecal incontinence Differential Diagnosis
• Superficial necrolytic dermatitis: ulcerated • Hypercalcemia: granulomatous disease, TREATMENT
cutaneous lesions, cracked/painful paw pads hypoadrenocorticism, renal secondary
(p. 952) hyperparathyroidism, hypervitaminosis- Treatment Overview
D, young/growing, spurious, osteogenic The severity of a PNS often parallels the status
PHYSICAL EXAM FINDINGS disease of the neoplasm. Direct treatment of the
Depends on tumor type (see History, Chief • Cachexia: intestinal parasites, poor-quality primary tumor (surgical excision, chemotherapy,
Complaint) diet, inadequate feeding, malabsorptive/ or radiation therapy) should be the ultimate
maldigestive disorder, heart disease, infectious goal and can resolve the PNS. Some patients
Etiology and Pathophysiology disease, renal disease may be debilitated by the PNS and initially
• Hypercalcemia: due to excessive parathyroid • Hypoglycemia: sepsis, iatrogenic (insulin unable to undergo definitive therapy. Supportive
hormone (PTH) production by parathyroid overdose), spurious/old sample (p. 1240) measures include
adenomas or humoral production of PTH- • Gastroduodenal ulceration: nonsteroidal • Hypercalcemia: saline diuresis, loop diuretics,
related peptide (PTHrP) and other cytokines antiinflammatory drugs (NSAIDs), corticosteroids, bisphosphonates, calcitonin
(interleukin-1 [IL-1], transforming growth corticosteroids, foreign body, toxins, uremia, to reduce serum calcium
factor-beta [TGF-beta]), prostaglandins, liver failure, other • Hyperviscosity syndrome: phlebotomy,
receptor activator of nuclear factor kappa • Erythrocytosis: hemoconcentration, breed- plasmapheresis to reduce serum globulins
B ligand (RANKL) related variation (greyhounds, sled dogs), • Gastroduodenal ulceration: gastroprotectants
• Cachexia: complex metabolic derangement dehydration, hypoxemia, other (histamine receptor antagonists, proton-
due to altered cytokine milieu (especially • Bleeding disorder: anticoagulant rodenticide pump inhibitors, coating agents, prosta-
increased IL-1beta, IL-6, tumor necrosis ingestion, sepsis, idiopathic immune- glandin analogs) to reduce/protect against
factor-alpha [TNF-alpha]), increased mediated thrombocytopenia, others (p. 433) excess gastric HCl production; antiemetics,
anaerobic glycolysis, misappropriation of • Hyperadrenocorticism: iatrogenic (cortico- antidiarrheals as needed
nutrients steroid administration) • Myasthenia gravis: cholinesterase inhibi-
• Hypoglycemia: excessive insulin or insulin- • Cardiac arrhythmias/altered blood pres- tors and/or immunosuppressive therapy to
like growth factor 2 (IGF-2) production sure: primary cardiac disease, renal failure, improve esophageal muscular tone; upright
• Gastroduodenal ulceration: usually result others feedings or gastrostomy tube to reduce risk
of hyperhistaminemia leading to excessive • Cytopenias: infectious disease (especially of aspiration
gastric acid in mast cell tumors; rarely Rickettsiae) • Cytopenias: blood product transfusion as
hypergastrinemia in pancreatic gastrinoma • Myasthenia gravis: hypothyroidism, hypoad- needed; prophylactic antibiotics to prevent
• Erythrocytosis: excessive production of renocorticism, lead intoxication, esophagitis, opportunistic infection if neutropenic
erythropoietin idiopathic megaesophagus, others • Hypoglycemia: dextrose, corticosteroids,
• Bleeding disorder: antibody coating of and diazoxide to increase serum glucose
platelets, platelet loss/sequestration/consump- Initial Database concentration; frequent small meals with
tion, or inappropriate activation of secondary CBC, chemistry panel, urinalysis, coagula- complex carbohydrates to prevent spikes in
coagulation cascade tion profile, thoracic radiographs, abdominal serum glucose
• Hyperviscosity syndrome: excessive immu- ultrasound, tumor aspiration/biopsy to confirm • Seizures: anticonvulsant medications,
noglobulin production and subsequent neoplasia corticosteroids, mannitol (as needed for
antibody coating of red blood cells, leading increased intracranial pressure)
to aggregation Advanced or Confirmatory Testing • Hypertrophic osteopathy: nonsteroidal
• Hyperadrenocorticism: excessive cortisol • Hypercalcemia: measure PTH/PTHrP, antiinflammatories, opioids, bisphosphonates
production in adrenal glands; usually ionized calcium to identify inappropriate as needed for analgesia
due to excessive ACTH release from function of hormone axis; parathyroid
pituitary tumors but may be primarily gland ultrasound to identify tumor; bone PROGNOSIS & OUTCOME
produced by adrenal tumors or rarely marrow aspiration to identify sequestered
ectopically neoplasia Depends on individual tumor type, although
• Cardiac arrhythmias/altered blood pressure: • Hypoglycemia: measure serum insulin; some PNSs influence long-term prognosis:
excessive catecholamine production, hypoxia, concentration should be below reference • Hypercalcemia shortens survival for
sepsis range; if level is high or within reference lymphoma ± anal sac apocrine gland
• Cytopenias: hemorrhage, chronic inflamma- range with concurrent hypoglycemia, this adenocarcinoma.
tion, immune-mediated hemolysis, hormone- suggests inappropriate function of hormonal • Myasthenia gravis: megaesophagus shortens
induced suppression, myelophthisis feedback axis. survival for thymoma patients.
• Leukocytosis: excessive production of • Pancytopenia: bone marrow aspiration to • Gastroduodenal ulceration: patients with
granulocyte-macrophage colony-stimulating evaluate for infiltrative disease, maturation MCT and clinical signs have shorter survival
factor (GM-CSF) or G-CSF arrest of cell lines times.

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