C10019103 / invoice 10000

Reason: Intermittent inappetance, vomiting, and lethargyHistory: Brought in by Sarah.Presenting for eunatraemic, eukalaemic hypoadrenocorticism.Went onto prednisolone initially and energy levels normalised but she had marked UI. Went onto cortate and energy levels reduced markedly - they couldn't even walk her around the complex as she would lay down. She also seemed agitated, restless and was humping and nibbling owners, which are behaviours she's never exhibited. She was also panting excessively.  Had electrolytes a week ago and they were normal. Went back to prednisolone about a week ago, 5 mg PO SID, not having UI to anywhere the same extent but it's still occurring. O has nappies for her. Energy levels have improved cf to on the cortate but she is still very lethargic. Still can't go for walks - with only short walks around the complex she will lay down. She used to spend time outside prior to being unwell but now just spends all her time lying in her bed indoors. Was previously having diarrhoea and vomiting, hair loss and abnormal hair coat - longer and fluffier, losing clumps of hair, which started end of last year. Vomiting and diarrhoea has resolved and hair coat is improving, but still abnormal. Also had reduced appetite but this has normalised. Primary concern is the ongoing lethargy and UI, however lethargy has improved and UI is better than it was. O had noted that tail appears much thicker than normal and that her neck is swollen.Usually weighs about 18 kg.  Has lost quite a bit of muscle. UI is much worse when she has been exerted - eg a vet visit, slightly longer walk. Prior this she was very active and fit, very food motivated and only had minor issues - allergies, ears infections, anal gland issues, nothing that was concerning to O. Has had UI in the past. When she was about 2 years old, she was on medication for UI for about a month. Also had a UTI however. The UI resolved and hasn't been a recent issue. Seen 19/12/25 for lethargy, diarrhoea, vomiting and hyporexia, poor coat quality, back pain, tx gabapentin. Returned 16/1/26, ongoing marked lethargy, abnormal hair coat, vomiting, hyporexia, and had bloods - mild hypocholesterolaemia, mild ALT elevation 97 U/L (1.1x), creatinine elevation 157 umol/L, mild neutropenia 2.7 mmol/L, Had AUS 28/1/26, which showed adrenals which were reported to be small and hard to find, however caudal pole measurement was 5 mm diameter bilaterally. Also had a 1 cm nodule visceral surface left liver. Urine analysis 28/1/26 - USG 1.032, 1+ protein, rest normal; thoracic rads - on review look unremarkable - maybe occasional osteoma. Resting cortisol <28 nmol/L. ACTH stim 30/1/26 0 hr < 14 and 1 hr <14 nmol/L. Electrolytes repeated and were normal. Started on prednisolone 5 mg PO SID = 0.26 mg/kg PO SID. 4/2/26 - some improvement in energy, urinary incontinence, prednisolone reduced to 0.1 mg/kg PO SID18/2/26 - energy levels reduced, ongoing UI, changed to cortate 12.5 mg PO SID = 0.6 mg/kg PO SIDProblem List: 1) Hx allergic dermatitis2) Hx anal sacculitisCould return to prednisolone at 0.04-0.05 mg/kg PO divided q 12 hrs (0.5 mg PO BID), and for hydrocortisone is 0.1 mg/kg PO q 12 hrs (2.5 mg PO BID).Recommend doubling dose of glucocorticoid during time of stress.Most dogs with eunatraemic, eukalaemic hypoadrenocorticism (EEH) don't develop mineralcorticoid deficiency.ALT elevation has been reported with EEH - monitor for resolution.Could have measured endogeneous ACTH at time of dx to differentiate primary from secondary disease, however primary is much more common.Could have measured aldosterone, as even though aldosterone deficient dogs can have normal electrolytes, they may be dogs that would benefit from more regular electrolyte monitoring long-term.    Vital Signs    Weight: 19.8;