Page 1891 - Cote clinical veterinary advisor dogs and cats 4th

Stunted Growth 947

GEOGRAPHY AND SEASONALITY See Small Stature and Body Condition • Thoracic/abdominal radiographs: look for
Certain infectious organisms are endemic to a table. megaesophagus, cardiac shape change,
VetBooks.ir encountered in other regions (e.g., Histoplasma, DIAGNOSIS • Abdominal ultrasound: kidney disease, Diseases and Disorders
microhepatica, other
specific geographic area, whereas they are rarely
PSS
Pythium).
ASSOCIATED DISORDERS Diagnostic Overview • ACTH-stimulation test: hypoadrenocorticism
• Echocardiography: congenital heart defects
History (nutrition, parasite control, accompa-
• Juvenile diabetes mellitus: pancreatic acinar nying clinical signs) and a thorough physical • Scintigraphy: PSS, ciliary dyskinesia
atrophy and exocrine pancreatic insufficiency exam (distinction between good/poor BCS,
• Pituitary dwarfism: hypoadrenocorticism proportionate or disproportionate dwarfism, TREATMENT
• PSS: urate urolithiasis, microvascular cardiac auscultation) are the cornerstone in the
dysplasia diagnosis of disorders causing stunted growth. Treatment Overview
• Megaesophagus: myasthenia gravis, vascular Laboratory tests and diagnostic imaging modali- Correct diseases that are reversible as soon as
ring anomaly, congenital cardiac disease (e.g., ties are then selected as needed based on most possible.
persistent ductus arteriosus [PDA]) likely differentials.
• Cleft palate: middle ear abnormalities Chronic Treatment
Differential Diagnosis • Nutritional: provide a good-quality, balanced
Clinical Presentation Small stature and poor body condition: diet in appropriate quantity.
DISEASE FORMS/SUBTYPES • Nutritional: poor-quality diet, underfeeding • Parasitic: deworming
Subdivision according to body condition score • GI: parasites, inflammatory bowel disease, • GI: supplementation of pancreatic enzymes
(BCS; good or poor thrift) and according to food intolerance/allergy, exocrine pancreatic (exocrine pancreatic insufficiency), hypoal-
body stature (proportionate or disproportion- insufficiency, obstruction lergenic diet (food intolerance/allergy),
ate) is particularly helpful in the approach to • Esophageal disease: megaesophagus, supportive treatment (megaesophagus) ±
patients with stunted growth. congenital myasthenia gravis, vascular ring surgical correction (vascular ring anomaly)
anomaly • Congenital hypothyroidism: supplementation
HISTORY, CHIEF COMPLAINT • Cardiac: congenital malformations with levothyroxine
• Pet lags behind littermates in growth/does • Systemic disease • Hyposomatotropism: porcine growth
not have the expected body stature. ○ Metabolic: PSS (or other hepatic disease), hormone or progestins (the latter only after
• Quantity and palatability of the diet, kidney disease, glycogen storage disease ovariohysterectomy, side effects: pyoderma,
deworming history, and onset and progres- ○ Infectious: respiratory infections (e.g., mammary gland tumors, acromegaly, skeletal
sion of signs are important. bacterial pneumonia), GI infections, other maldevelopment, diabetes mellitus, cystic
• ± Signs of mental dullness • Endocrine: diabetes mellitus, hypoadre- endometrial hyperplasia), often in combina-
• ± Regurgitation (since weaning), diarrhea nocorticism, diabetes insipidus, juvenile tion with levothyroxine when there is also
or voluminous stools hyperparathyroidism (rare) TSH deficiency
• ± Polyuria/polydipsia Small stature and good body condition or • Cardiac: interventional or surgical correction
• ± Medication exposure (e.g., glucocorticoids, overweight: if amenable
androgens, estrogens) • Disproportionate stature: chondrodystrophy, • Systemic disease: as indicated for specific
• May be unnoticed by owner or noticed at endocrine (congenital hypothyroidism) condition
a late stage • Proportionate stature: hyposomatotropism
(growth hormone deficiency), hyperadreno- Possible Complications
PHYSICAL EXAM FINDINGS corticism (rare) Early diagnosis and intervention are crucial
• Determine BCS to distinguish between good A detailed differential diagnosis is provided in to prevent major complications for certain
and poor body condition. Section 3. conditions such as PSS, cardiac disease, vascular
• Determine whether the patient has propor- ring anomalies.
tionate or disproportionate body stature. Initial Database
○ Congenitally hypothyroid patients and • First rule-outs: nutritional causes and GI Recommended Monitoring
chondrodysplastic patients are dispro- parasites Body weight, BCS
portionate dwarfs (limbs are exceptionally ○ Diet history: good-quality diet, appropriate
short). By contrast, with proportional daily quantity (p. 1077) PROGNOSIS & OUTCOME
dwarfism (e.g., due to growth hormone ○ Fecal flotation, deworming
deficiency), the limbs, trunk, and head • CBC/serum biochemistry panel/urinalysis • Many underlying diseases are reversible, but
are of appropriate relative sizes. for systemic disease for some disorders, prognosis depends greatly
• Examine patient for • If no significant abnormalities are found on early diagnosis and intervention.
○ Mental dullness or disorientation with these tests and physical exam is oth- • Osteochondrodysplastic dogs can fare well,
○ Cleft palate erwise unremarkable, proceed to advanced but the disorder is irreversible.
○ Cough, respiratory distress testing.
○ Heart murmur, arrhythmia PEARLS & CONSIDERATIONS
○ Bloated abdomen Advanced or Confirmatory Testing
○ Signs of diarrhea staining coat • Disproportionate dwarfism: congenital hypo- Comments
thyroidism → joint radiographs (epiphyseal • Key to correct diagnosis is distinction between
Etiology and Pathophysiology dysgenesis and delayed skeletal formation); good and poor BCS and proportionate and
Common underlying disease types: thyroxine (T 4 ), thyroid-stimulating hormone disproportionate dwarfism.
• Nutritional (TSH), and advanced thyroid function • A thorough physical exam including
• Gastrointestinal (GI) testing may be necessary. careful cardiac auscultation is essential for
• Esophageal • Proportionate dwarfism: hyposomatotropism diagnosis.
• Endocrine → serum level of insulin-like growth factor • Adequate nutrition and effective deworm-
• Cardiac • Trypsin-like immunoreactivity: exocrine ing should be assured before performing
• Systemic disease (infectious/metabolic) pancreatic insufficiency expensive diagnostic tests.

www.ExpertConsult.com