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BattLab
Newsletter 08/2018
We are pleased to welcome you to the monthly BattLab newsletter. This newsletter will bring you the latest news and information about our laboratory and all tests that we can offer to all our clients.
This month we have a summer special for our newsletter. We would like to take this opportunity to provide a little more in-depth insight into one of the most hot topics of the moment: the monitoring of dogs on treatment for hyperadrenocorticism.
 
Cortisol is only one of the many endocrinology tests we offer at Batt Laboratories with same day turnaround time. For a more extensive list of all the tests we offer, check our catalogue. Do not forget also to subscribe to our Facebook page in order to be updated about all the seminars, promotions we are about to launch. Stay tuned!
UPDATES! An improved method of monitoring treatment for hyperadrenocorticism (HAC) in dogs
 
The ACTH stimulation test has been widely used and recommended as the monitoring method of choice for dogs receiving trilostane. However, interestingly it has never been validated for this purpose. More recently, alternative methods of monitoring dogs receiving trilostane have been investigated with varying success. These methods include baseline cortisol endogenous ACTH and cortisol/ACTH ratio, haptoglobin and the urine corticoid:creatinine ratio (UCCR) before and after trilostane. In all of these studies, control was ultimately defined by the results of the post-ACTH stimulation cortisol and the owners’ perception of clinical control is often not well described.
 
A recent study (Macfarlane et al., 2016) demonstrated that pre-trilostane cortisol is better than post-ACTH stimulation cortisol at differentiating between excellent control and poor control of HAC, and also at detecting cases of oversuppression. This also appears better correlating with owner’s perception of treatment progression. Furthermore, pre-trilostane cortisol is not influenced by once-daily or twice-daily dosing and it eliminates the use of the relatively expensive tetracosactide (ACTH). Below some information that will help you to better understand this new way of monitoring hyperadrenocorticism.
  • Appointment. The appointment should be booked at, or up to 2 hours after, dog’s normal trilostane dosing time. If the dog is normally given pill at an inconvenient time, the owner should be asked to change the time of the pill the day before.
Example. A dog with HAC is given trilostane once a day at 6 am. The appointment at the vet is booked for Monday, at 9 am. A day before the appointment (Sunday) the pill will be given by the owner at 9 am, instead of 6 am. The dog will be medicated on the day of the appointment ONLY AFTER the blood sample is taken.
  • Clinical examination. During the appointment, the dog is examined, and the clinical history is taken. The clinician should pay special attention for any clinical signs of hyperadrenocorticism (e.g. PU/PD, alopecia, polyphagia, obesity, lethargy) or hypoadrenocorticism (e.g. lethargy, abdominal pain, mild GI signs). It is very important that no stressful event (e.g. vomiting, injury) took place on that morning as this might invalidate the result of the test.
  • Blood sampling. A blood sample is taken immediately after the examination (ideally 24h before the last pill).
  • Interpretation of the results. This relies on the clinical signs presented by the dog and the cut-off values (<40 nmol/, 40-140 nmol/L, > 140 nmol/L, respectively) of the pre-trilostane cortisol, are used to differentiate between oversuppression, poor and excellent control of HAC.
Below a table provided by Ian Ramsey (University of Glasgow) that summarises nicely how to interpret pre trilostane cortisol levels in dogs.
FECAVA LABOKLIN travel scholarship!
 
During the last FECAVA congress in Tallinn, UK FECAVA Director Krista Arnold (right) received the cheque for the FECAVA Laboklin travel scholarship from Elisabeth Muller, CEO at LABOKLIN (centre) on behalf of this year's recipients from Glasgow and Palma de Mallorca. On the left, FECAVA president Wolfgang Dohne. The FECAVA Travel Scholarship encourages small animal veterinarians to appreciate the differences in veterinary life in other European cultures. The initiative allows two groups of small animal veterinary surgeons from different parts of Europe, to visit each other for a few days to observe practice life and ideally participate in a joint Continuing Education event.  The scholarship, totalling €2,000 is made possible through the generous support of LABOKLIN, who partner FECAVA on this project.
Yours sincerely,
The BattLab team
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