Received: 9 May 2019

Accepted: 21 February 2020

DOI: 10.1111/jvim.15752
Received: 9 May 2019

STANDARD ARTICLE

Received: 9 May 2019

前田塾2020.9.26 入江

Accepted: 21 February 2020

DOI: 10.1111/jvim.15752

Accepted: 21 February 2020
STANDARD ARTICLE

DOI: 10.1111/jvim.15752

Prevalence and characterizationof hypoadrenocorticism
Prevalence and characterizationof hypoadrenocorticism
in dogs with signs of chronic gastrointestinal disease:in dogs with signs ofchronic gastrointestinal disease:
A multicenter study
Prevalenceandstudy
characterization of hypoadrenocorticism
A multicenterChristina Hauck| Silke S. Schmitz| Iwan A. Burgener| Astrid Wehner |in dogs with signs ofgastrointestinal
Kohn | Thomas Rieker | disease:
Sven Reese | Stefan Unterer
Retochronic
Neiger | Barbara
Hauck1| Silke S. Schmitz2| Iwan A. Burgener3| Astrid Wehner1 |AChristina
multicenter
study
45671
STANDARD ARTICLE

14Reto Neiger

Introduction
1|

2351

67

1

1

Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich, Munich, Germany

2

Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK

Barbara Kohn|

Thomas Rieker|

Sven Reese|

Stefan Unterer

3

Department for Companion Animals and Horses, Clinic for Small Animal Internal Medicine, University of Veterinary Medicine, Vienna, Austria

4

Small Animal Hospital Hofheim, Hofheim, Germany

5

Clinic for Small Animals, Freie Universität Berlin, Berlin, Germany
Clinic of Small Animal Medicine,
Centre for Clinical
Veterinary Medicine,
Ludwig Maximilian University of Munich,
123 Munich, Germany

1ChristinaHauck| Silke AniCura
S. Schmitz| Ravensburg,IwanA. Burgener| Astrid Wehner |Kleintierspezialisten Ravensburg,
Germany▶副腎皮質機能低下症(HA)は、副腎皮質の緩徐な破壊や持続的な萎縮に起因すると考えられている。
2
Hospital for Small Animals, Royal (Dick) School ofVeterinary
The Roslin
University
UKInstituteHistologyandand Embryology,
LMUInstitute,
Munich,Germany of Edinburgh, Edinburgh,
4
5of Anatomy,Studies
6 Munich,▶犬では珍しい内分泌疾患で、罹患率は全体の犬の0.09%とされている(J.M.
Reese7et al,| 2016)。
Stefan Unterer1
RetoNeiger | Barbara Kohn | Thomas Rieker | SvenHanson
3
Department for Companion Animals and Horses, Clinic for Small Animal Internal Medicine, University of Veterinary Medicine, Vienna, Austria▶ミネラルコルチコイド(球状帯で生成)欠乏により典型的な電解質異常を示すが、約30%は非定型HAである。
Correspondence
1 4Small Animal Hospital Hofheim, Hofheim, Germany
Clinic of Small Animal Medicine, Centre for Clinical
Veterinary Medicine, Ludwig Maximilian
University of Munich, Munich, Germany
Abstract
Stefan Unterer, Clinic of Small Animal
グルココルチコイド(束状帯で生成)欠乏による胃腸症状(SGD)は、原発性胃腸疾患との区別が難しい。
Medicine, Centre for Clinical Veterinary
25
Background:
Dogs withhypoadrenocorticism(HA)UK
frequently show signs of gastroinClinicforSmallAnimals,FreieUniversität
Berlin,Berlin,
Germany
Hospital for Small Animals, Royal (Dick) School of Medicine,
Veterinary
TheofRoslin Institute, Universityof Edinburgh,
Edinburgh,
LudwigStudies
Maximilianand
University
testinal disease (SGD). The prevalence of dogs presented for chronic SGD with HA is
Munich, Munich, Germany.
→確定診断には、ACTH刺激試験が必要と言われている。
36
AniCura Kleintierspezialisten
Ravensburg,Ravensburg,
Department
for Companion Animals
and Horses,
ClinicforGermany
Small Animal Internal Medicine, University of Veterinary Medicine, Vienna, Austria
Email: s.unterer@medizinischeunknown.
kleintierklinik.de▶目的：①慢性SGD犬の中のHA罹患率の調査。
47InstituteofAnatomy,Histology
andEmbryology,
LMU
Munich,Munich, Germany Objectives: The aims of this study were to determine the prevalence of HA in dogs
Small Animal Hospital Hofheim, Hofheim, Germany
Funding information
with chronic SGD and to identify clinical and laboratory variables for HA in this5Clinic for②ACTH刺激試験を実施する前にHAを診断or除外するのに有効な項目がないか調査。
Small Animals, Freie Universität Berlin, Berlin,
Germany
IDEXX Laboratories
676
Materialand Method
AniCura Kleintierspezialisten
Ravensburg, Ravensburg, Germany

population.

Animals: One hundred fifty-one dogs with chronic SGD.

Correspondence
7Methods: In this multicentered prevalence study a standardized workup was perInstituteof Anatomy,Histologyand Embryology, LMU Munich,Munich, Germany
Abstract▶prospectivestudy
Stefan Unterer,
Clinicof Small Animal
formed in prospectively enrolled dogs with SGD > 3 weeks duration. Basal serum corMedicine, Centre for Clinical Veterinary
Background: Dogs withtisol
hypoadrenocorticism(HA) frequently show signs of gastroin▶組み入れ基準：
concentration was measured in every dog with ACTH stimulation test (ACTHST)
Medicine, Ludwig Maximilian University ofifbasalserumcortisolconcentrationwas <3 μg/dL. for chronic SGD with HA is
testinal disease (SGD). The prevalence of dogs presented-2014年11月〜2015年12月
Munich, Munich, Germany.
Correspondence
Results:
Basal
serum
cortisolconcentrationwas <3 μg/dL in 80/151 (53%) dogs,
Abstract
Email:Unterer,s.unterer@medizinischeStefan
Clinic of Small Animal
unknown.
-6ヶ月齢以上の犬<2 μg/dL in 42/151 (28%) dogs, and < 1 μg/dL in 9/151 (6%) dogs. In 6/151 dogs HA
kleintierklinik.de
Medicine, Centre for Clinical Veterinary

Background:with ofhypoadrenocorticism
frequently
show
signs ofwasdiagnosed
on ACTHST(stimulated theserumprevalencecortisol concentration< 2inμg/dogs
Objectives: Dogs
The aims
thisstudybased
wereto(HA)
determineof gastroinHA-慢性(3週間以上)SGD症状
Medicine, Ludwig Maximilian University ofdL),prevalencea prevalence of of4%.dogs
There wasno differencein history,
physicalexamination,and istestinaldisease(SGD).
The
presentedfor
chronic
SGD
withHA
Funding
information
Munich, Munich, Germany.
with chronic SGD and laboratory
to identify
clinical and laboratory variables for HA in this
-ステロイドを使用している場合は、条件をつけて組み入れる(表１)variables between dogs with HA and those with other causes of chronic
IDEXX
Laboratories
Email:
s.unterer@medizinischeunknown.
▶評価項目：臨床症状→Canine
Chronicpopulation.
Enteropathy Clinical Activity Index(CCECAI, 表２)で評価
kleintierklinik.de
Objectives: The aims of this study were to determine the prevalence of HA in dogs
血液検査→全頭でCBC、生化学(一般的な項目、電解質、血清TLI、cPL、葉酸、コバラミン)
Animals: One hundred fifty-one dogs with chronic SGD.
Funding information
Abbreviations:
ACTH stimulation
test; ALT,
alaninetoaminotransferase;
CI, confidence
interval; GDH,
glucocorticoid-deficienthypoadrenocorticism;
GI, gastrointestinal;
withACTHST,
chronic
SGD
andidentify
clinicalandlaboratory
variablesfor HAGIS,in this▶ベースライン血清コルチゾール濃度は全頭で測定し、ACTH刺激試験は<3μg/dLの場合に実施。
Methods:
In Smallthisprevalence
study a standardized
workup
was pergastrointestinal
signs; GSAVA, German
Animalmulticentered
Veterinary Association; HA, hypoadrenocorticism;
HPA, hypothalamus-pituitary-adrenalaxis; MGDH, mineralocorticoidand glucocorticoid
IDEXX Laboratories

population.
formed in prospectively enrolled dogs with SGD > 3 weeks duration. Basal serum corAnimals:
One hundred fifty-one dogs with chronic SGD.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
tisol concentration was measured in every dog with ACTH stimulation test (ACTHST)▶組み入れられた150頭のうちHAと診断されたのは6頭(4%)で、全て非定型HAであった。
medium, provided the original work is properly cited and is not used for commercial purposes.
Methods:
Inofthis
multicentereda ofstandardizedworkup
wasper© 2020
The Authors. Journal
Veterinary
Internal Medicine publishedprevalenceby Wiley Periodicals,study
on behalf
the American College of Veterinary
InternalMedicine.
if basal serumcortisol
concentrationwas <3Inc.μg/dL.
▶犬種、年齢、性別、体重、臨床症状の重症度に優位差はなかった。
in prospectively enrolled dogs with SGD > 3 weeks duration.
Basal serum corJ Vet formed
Intern Med. 2020;34:1399–1405.
wileyonlinelibrary.com/journal/jvim
1399
Results: Basal serum cortisol concentration was <3 μg/dL in 80/151 (53%) dogs,▶血液・生化学検査結果にも優位差は認められなかった。
tisol concentration was measured in every dog with ACTH stimulation test (ACTHST)<2 μg/dL in3μg/dLであり、そのうちHA犬は全て42/151 (28%) dogs, and < 1 μg/dL in 9/151 (6%)
dogs. In 6/151 dogs HA▶ベースライン血清コルチゾール濃度は、53%が1μg/dL(６％)であった。
if basal serum cortisol concentration was <3 μg/dL.
was diagnosed based on ACTHST (stimulated serum cortisol concentration < 2 μg/Discussion
Results: Basal serum cortisol concentration was <3 μg/dL in 80/151 (53%) dogs,dL), a prevalence of 4%. There was no difference in history, physical examination, and▶二次診療施設のため過大評価 or 全HA犬が紹介もしくは検査できた訳ではないため過小評価の可能性もある。
<2 μg/dL in 42/151 (28%) dogs, and < 1 μg/dL in 9/151 (6%) dogs. In 6/151 dogs HAlaboratory variables Baumstark
between dogsetwith
and those with other causes of chronic▶典型的なHAであっても電解質が正常な期間がある(M.E.
al,. HA2014)。
was diagnosed based on ACTHST (stimulated serum cortisol concentration < 2 μg/Results

deficient hypoadrenocorticism; SGD, signs of gastrointestinal disease.

This study was presented as an abstract at the 2017 American College of Veterinary Internal Medicine Forum, National Harbor, Maryland.

▶臨床症状や検査結果では優位差はないが、消化管出血が認められる場合は特に疑うべきである。
dL), a prevalence of 4%. There was no difference in history, physical examination, and▶非HA犬の33%でベースラインコルチゾール濃度は 2μg//dL。→以前の報告(A.J. Gold et al. 2016)と一致しておlaboratory variables between dogs with HA and those with other causes of chronicり、>2μg/dL(感度100%、特異度64.7%)であれば除外が可能と考えられる。
Abbreviations: ACTHST, ACTH stimulation test; ALT, alanine aminotransferase; CI, confidence interval; GDH, glucocorticoid-deficient hypoadrenocorticism; GI, gastrointestinal; GIS,Conclusion
gastrointestinal signs; GSAVA, German Small Animal Veterinary Association; HA, hypoadrenocorticism; HPA, hypothalamus-pituitary-adrenal axis; MGDH, mineralocorticoid- and glucocorticoid
deficient hypoadrenocorticism; SGD, signs of gastrointestinal disease.

▶SGD犬の中では、HAの罹患率は予測よりも高かった。
This study was presented as an abstract at the 2017 American College of Veterinary Internal Medicine Forum, National Harbor, Maryland.
Abbreviations: ACTHST, ACTH stimulation test; ALT, alanine aminotransferase; CI, confidence interval; GDH, glucocorticoid-deficient hypoadrenocorticism; GI, gastrointestinal; GIS,
▶臨床症状や血液検査結果からはHAは除外できない。
gastrointestinal signs; GSAVA, German Small Animal Veterinary Association; HA, hypoadrenocorticism; HPA, hypothalamus-pituitary-adrenal axis; MGDH, mineralocorticoid- and glucocorticoid
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any▶本研究ではアルドステロン濃度は測定していないが、アルドステロン濃度が低値でも電解質が正常の場合もある。
deficient hypoadrenocorticism; SGD, signs of gastrointestinal disease.
medium, provided the original work is properly cited and is not used for commercial purposes.
This study was presented as an abstract at the 2017 American College of Veterinary Internal Medicine Forum, National Harbor, Maryland.
▶ベースライン血清コルチゾール濃度の測定は、標準的なHAのスクリーニング検査として実施されるべきで、© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
2μg//dLなら更なる検査に進むべきである。
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
J Vet Intern Med. 2020;34:1399–1405.

medium, provided the original work is properly cited and is not used for commercial purposes.
批評

wileyonlinelibrary.com/journal/jvim1399© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

▶決して多くはない疾患だが、慢性の消化器疾患の場合は特に、電解質異常がなくてもHAを考慮する必要がある。
J Vet Intern Med. 2020;34:1399–1405.
wileyonlinelibrary.com/journal/jvim1399▶画像検査での副腎の大きさも測定すれば、さらに早期の診断が可能であると考えられる。
→左副腎の厚さが3.2mm未満(28/29頭)だとHAを強く示唆(M. Wenger et al. 2010)。

表１：ステロイドの使用歴がある場合の組み入れ基準短期作用型(例: ヒドロコルチゾン)

・1週間以内の使用・最低でも組み入れ1週間前に休薬

中間作用型(例: プレドニゾロン)

・1週間以内の使用・最低でも組み入れ4週間前に休薬

長期作用型(例: デキサメタゾン)

・最低でも組み入れ3ヶ月前に休薬

表２：Canine Chronic Enteropathy Activity Index(CCECAI)
活動性
0 正常
1 わずかに減少
2 中程度の減少
3 重度の減少

食欲0 正常1 わずかに減少
2 中程度の減少
3 重度の減少嘔吐
0 正常
1 軽度(1回/週)
2 中程度(2-3回/週)
3 重度(>3回/週)

便の硬さ
0 正常
1 わずかに軟便
2 かなり軟便
3 水様性下痢

便の頻度
0 正常
1 わずかに増加(2-3回/日)
or 粘膜便、血便 or 両方
2 中程度に増加(4-5回/日)
3 重度に増加(>5回/日)

体重減少
0 なし
1 軽度(<5%)
2 中程度(5-10%)
3 重度(>10%)

アルブミン
0 >20g/L
1 15-19.9g/L
2 12-14.9g/L
3 <12g/L

腹水・末梢浮腫
0 なし
1 軽度の腹水 or 末梢浮腫
2 中程度の腹水/末梢浮腫
3 重度の腹水/胸水と末梢浮腫

瘙痒0 なし1 時々のかゆみ
2 定期的なかゆみだが、寝てる時はない
3 痒みで定期的に起きる

K. Allenspach et al. J Vet Intern Med, 2007