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Adrenomegália felina : qual o significado clínico?
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A literatura sobre adrenomegália felina é escassa, aparentando ser rara e um achado
ecográfico acidental na prática clínica. Este estudo teve como objetivos avaliar a prevalência
de adrenomegália em gatos submetidos a ecografia abdominal, associando-a ao diagnóstico
final estabelecido e estimando a sua relevância clínica. Os relatórios referentes a ecografia
abdominal de gatos, realizados no HEV da FMV-ULisboa entre Outubro de 2018 e Fevereiro
de 2021, foram revistos retrospetivamente, com posterior seleção dos gatos com
adrenomegália (eixo dorsoventral maior que 4,8 mm em corte longitudinal ou transversal em
pelo menos uma das glândulas adrenais). Foram revistos os dados relativos a raça, género,
idade, peso, status reprodutivo, ambiente, motivo de realização de ecografia e respetiva
caracterização ecográfica das adrenais, se a adrenomegália foi uni- ou bilateral e o
diagnóstico final estabelecido. A adrenomegália foi considerada relevante se fossem
realizados ou sugeridos exames complementares específicos pelos clínicos. Foi realizada
estatística descritiva e inferencial (p<0,05) com recurso a testes não
paramétricos/paramétricos. Foram revistos 983 relatórios ecográficos tendo sido identificada
adrenomegália em 68 (6,9%) dos mesmos. A adrenomegália foi bilateral em 36/68 (52,9%)
gatos e unilateral com glândula contralateral não atrofiada nos restantes. Houve uma sobre
representação de gatos machos (44/68; 64,7%), Europeu Comum (62/68; 91,2%),
esterilizados (54/68; 79,4%) e indoor (50/68; 73,5%). A média da idade e do peso foram,
respetivamente, 11,6 ± 4,3 [2-22] anos e 4,0 ± 1,7 [1,6-8,5] kg. Os dois principais motivos para
a realização de ecografia abdominal foram exploração de DRC - doença renal crónica (39/68;
57,3%) e suspeita clínica de pancreatite (10/68; 14,7%). Em 6 gatos (8,8%), a ecografia
abdominal foi realizada especificamente no contexto da exploração de uma doença endócrina,
destacando: cetoacidose (3/68; 4,4%), suspeita de hiperaldosteronismo primário (2/68; 2,9%)
e insulinorresistência (1/68; 1,5%). Em 48/68 (70,6%) gatos, o diagnóstico final estabelecido
ou presumido foi definido como uma doença não-endócrina. Após a avaliação ecográfica, a
exploração médica da adrenomegália foi sugerida em 12/68 (17,6%) casos, mas realizada em
apenas 6 (8,8%) deles, devido a restrições financeiras ou morte do animal. Este estudo mostra
que a adrenomegália felina não é um achado prevalente e quando presente parece mais
comum em gatos machos esterilizados geriátricos. A adrenomegália foi identificada com maior
frequência na exploração de DRC, com destaque para o papel da doença crónica ou causa
endócrina concomitante inexplorada. Após a sua identificação, a adrenomegália foi explorada
apenas em uma pequena percentagem dos casos, ressaltando que parece estar
subvalorizada na prática clínica.
ABSTRACT - FELINE ADRENOMEGALY: WHAT IS THE CLINICAL SIGNIFICANTE? - Literature on feline adrenomegaly is scarse, appearing to be rare and an accidental echographic finding in clinical practice. This study aimed to evaluate the prevalence of adrenomegaly in cats undergoing abdominal ultrasound, associating it with the final diagnosis established and estimating its clinical features. All the reports from feline abdominal ultrassounds, performed at the HEV of the FMV-ULisboa between October 2018 and February 2021, were retrospectively reviewed. Cats with adrenomegaly (dorsoventral axis greater than 4.8 mm in longitudinal or transverse section in at least one of the adrenal glands) were selected and the data were reviewed for breed, gender, age, weight, breeding status, environment of living, reason for performing abdominal ultrasound, whether the adrenomegaly was uni- or bilateral and the final established diagnosis. Adrenomegaly was considered relevant if complementary exams were performed or suggested by clinicians after abdominal ultrasound. Descriptive and inferential statistics (p <0.05) were performed using non parametric/parametric tests. A total of 983 ultrassound reports were reviewed and adrenomegaly was identified in 68 (6.9%) of them. Adrenomegaly was bilateral in 36/68 (52.9%) cats and unilateral with non-atrophied contralateral gland in the remaining. There was an over representation of male (44/68; 64.7%) Common European (62/68; 91.2%), sterilized (54/68; 79.4%) and indoor (50/68; 73.5%) cats. Mean age and weight were, respectively, 11.6 ± 4.3 [2-22] years and 4.0 ± 1.7 [1.6-8.5] kg. The two main reasons for performing an abdominal ultrasound were exploration of CKD - chronic kidney disease (39/69; 57.3%) and clinical suspicion of pancreatitis (10/68; 14.7%). In 6 (8,8%) cats, abdominal ultrasound was performed specifically in the context of exploration of an endocrine disease, highlighting: ketoacidosis (3/68; 4.4%), suspected primary hyperaldosteronism (2/68; 2.9%) and insulin resistance (1/68; 1.5%). In 48/68 (70.6%) cats, the final established or presumed diagnosis was defined as a non-endocrine disease. After ultrasound evaluation, medical exploration of adrenomegaly was suggested in 12/68 (17.6%) cases but performed in only 6 (8.8%) of them, due to financial constraints or death of the animal. This study shows that feline adrenomegalia is not a prevalent finding and when present seems more common in spayed geriatric male cats. Adrenomegaly was identified most frequently in the exploration of CKD, with emphasis on the role of chronic disease or concomitant unexplored endocrine cause After its identification, adrenomegaly was explored only in a small percentage of cases, noting that it seems to be undervalued in clinical practice.
ABSTRACT - FELINE ADRENOMEGALY: WHAT IS THE CLINICAL SIGNIFICANTE? - Literature on feline adrenomegaly is scarse, appearing to be rare and an accidental echographic finding in clinical practice. This study aimed to evaluate the prevalence of adrenomegaly in cats undergoing abdominal ultrasound, associating it with the final diagnosis established and estimating its clinical features. All the reports from feline abdominal ultrassounds, performed at the HEV of the FMV-ULisboa between October 2018 and February 2021, were retrospectively reviewed. Cats with adrenomegaly (dorsoventral axis greater than 4.8 mm in longitudinal or transverse section in at least one of the adrenal glands) were selected and the data were reviewed for breed, gender, age, weight, breeding status, environment of living, reason for performing abdominal ultrasound, whether the adrenomegaly was uni- or bilateral and the final established diagnosis. Adrenomegaly was considered relevant if complementary exams were performed or suggested by clinicians after abdominal ultrasound. Descriptive and inferential statistics (p <0.05) were performed using non parametric/parametric tests. A total of 983 ultrassound reports were reviewed and adrenomegaly was identified in 68 (6.9%) of them. Adrenomegaly was bilateral in 36/68 (52.9%) cats and unilateral with non-atrophied contralateral gland in the remaining. There was an over representation of male (44/68; 64.7%) Common European (62/68; 91.2%), sterilized (54/68; 79.4%) and indoor (50/68; 73.5%) cats. Mean age and weight were, respectively, 11.6 ± 4.3 [2-22] years and 4.0 ± 1.7 [1.6-8.5] kg. The two main reasons for performing an abdominal ultrasound were exploration of CKD - chronic kidney disease (39/69; 57.3%) and clinical suspicion of pancreatitis (10/68; 14.7%). In 6 (8,8%) cats, abdominal ultrasound was performed specifically in the context of exploration of an endocrine disease, highlighting: ketoacidosis (3/68; 4.4%), suspected primary hyperaldosteronism (2/68; 2.9%) and insulin resistance (1/68; 1.5%). In 48/68 (70.6%) cats, the final established or presumed diagnosis was defined as a non-endocrine disease. After ultrasound evaluation, medical exploration of adrenomegaly was suggested in 12/68 (17.6%) cases but performed in only 6 (8.8%) of them, due to financial constraints or death of the animal. This study shows that feline adrenomegalia is not a prevalent finding and when present seems more common in spayed geriatric male cats. Adrenomegaly was identified most frequently in the exploration of CKD, with emphasis on the role of chronic disease or concomitant unexplored endocrine cause After its identification, adrenomegaly was explored only in a small percentage of cases, noting that it seems to be undervalued in clinical practice.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Glândula Adrenal Ecografia Adrenomegália Gato Adrenal Gland Ultrassound Adrenomegaly Cat
Contexto Educativo
Citação
Oliveira JMG. 2021. Adrenomegália felina : qual o significado clínico? [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa.
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária