Case Study

Addison`s disease in a 10 year old MN West Highland White Terrier

10 year old MN West Highland White Terrier was presented to a referral hospital from a 24h emergency hospital. The patient was diagnosed with Addison’s disease 7 years ago, and the owner reported that the dog had been markedly lethargic recently. On physical examination, the dog was mildly dehydrated and had a mildly tense abdomen on palpation. Blood chemistry revealed hyperphosphatemia and decreased triglyceride concentrations. The CBC showed a decreased RBC count, hematocrit and hemoglobin concentration, a leukocytosis secondary to a neutrophilia, as well as a thrombocytosis.

DX

Addison`s disease

Sonographic Differential Diagnosis

Small flat adrenals.

Image Interpretation

Both adrenal glands were barely visible, small and flat in this patient consistent with Addison`s disease.

Outcome

Patient was discharged from the referral hospital and the owner was advised to return to his rDVM for continued IV therapy.

Clinical Differential Diagnosis

Addisonian crisis is possible, although one would think that if he were poorly controlled, that he wouldn’t have the ability to mount a neutrophilic leukocytosis. The anemia could be caused by iron deficiency secondary to a gastrointestinal ulcer, which can occur in dogs with Addison’s disease. Pancreatitis, in combination with chronic blood loss and iron deficiency secondary to a GI ulcer, is also possible here. Hemolysis unlikely based upon the fact that there is no mention of spherocytes, agglutination, etc. Presence of an inflammatory process or infection is likely causing the neutrophilic leukocytosis.