Dorsal alopecia ina male crossbred dog
Author: Ewan Ferguson
Editor: David Lloyd
  © European Society of Veterinary Dermatology
sept93_2
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History - 1
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Dorsal alopecia and mild pruritus of 9 monthsduration in a male crossbred dog
Weight 25 kg
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 2
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Mild papular rash on dorsum and ventrum.
Comedones on dorsum and ventrum.
Ventral coat thin but skin “normal”
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 3
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Coat has become longer and finer in texture in recentmonths
Polyuria and polydipsia (3 litres per day) reported
Good appetite. Poor exercise tolerance
No previous history of dermatological disease
2 cats in the house, both healthy
Diagnosed by the referring veterinarian as flea allergydermatitis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 4
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Ectoparasite control
Dog and both cats treated with fipronil (Frontline Spot-On, Merial) monthly
Home environment treated annually with pyroxyfenand permethrin spray (Indorex, Virbac)
No improvement
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 5
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Pruritus now reported to be controlled with 10 mgprednisolone orally once daily, over the last 4 months
No hair re-growth seen
All therapy stopped 2 weeks before referralappointment
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 1
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The ventral abdominal skin
A few scatteredpapules, epidermalcollarettes & crusts ondorsum & ventrum
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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Alopecia & hyperpigmentation in dorsal lumbar region
No visual evidence ofectoparasitism
Pendulous abdomen& ventral liver lobespalpably enlarged
Testes normal onpalpation
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would youapproach this case?
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Signs
What are the next steps you would take?
Make a list of your principle differential diagnoses
List any samples you would collect
List any tests you would perform to assist in making adefinitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Differentialdiagnoses
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Principle differential diagnoses
Allergy (fleas, atopy, ?food), Hormonal imbalanceincluding iatrogenic Cushings syndrome, ectoparasiticinfestation, dermatophytosis
Secondary pyoderma, Malassezia dermatitis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 1
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Skin scrapings, tape strips, hair plucks and coatbrushings - no evidence of ectoparasites or fungi
Fasted blood sample
Biochemistry: Alkaline phosphatase - 1850 iu/l;Alanine aminotransferase - 170 iu/l; Glucose - 8.4mmol/l; Cholesterol - 9.1 mmol/l
Haematology: Mild mature neutrophilia &eosinopenia
Urianalysis: Specific gravity - 1.005; No glycosuria
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What now?
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What are the next steps you would take?
What are now your principle differentialdiagnoses?
Are there any other samples you would collect?
List any tests you would perform to assist inmaking a definitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 2
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Principal differential diagnosis
Hormonal imbalance particularly natural andiatrogenic Cushings syndrome
Secondary folliculitis
Tests
ACTH response test to provide evidence ofpossible Cushings syndrome and to identifyiatrogenic disease
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results - 1
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What is the significance of this test?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results - 2
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results - 3
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What do these tests tell us?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
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Do the investigations permit a definitive diagnosis?
List any additional investigations which you think mayneed to be done
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 3
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Radiography
Mass suspected in the left adrenal region
Ultrasonography
Hypoechoic foci in the liver suggestive ofmetastases
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
Hyperadrenocorticism resulting from adrenalneoplasia
Likely metastasis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Prognosis
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Prognosis is guarded
Surgery is not indicated in view of likely metastasis
Medical management with trilstane (Vetoryl,Arnolds) recommended
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Conclusion
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sept93_6 copy
The owner requestedeuthanasia. At postmortem examination anadrenal neoplasm andmultifocal metastaseswere demonstrated.
The adrenal tumour canbe seen in the centre ofthe photograph, thekidney is on the left side
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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