Use of ketoconazole in the treatment and control of clinical and hematological changes in canine hyperadrenocorticism: Case Report

Abstract

Hyperadrenocorticism (HAC), also known as Cushing's Syndrome, is a disease manifested by a series of clinical changes and multisystem abnormalities resulting from increased chronic exposure to glucocorticoids secreted by the adrenal glands or excessive administration of this hormone. Two different categories of medications are currently used in the treatment of HAC: inhibitors of steroidogenesis and modulators of ACTH secretion. Among the drugs inhibiting steroidogenesis the most indicated in practice by veterinarians is trilostane. However, due to its high cost, there is a need to study drugs that may have a systemic action in the control of clinical and hematological alterations in CAH. Thus, the present study aims to evaluate the use of ketoconazole as the drug of choice in the treatment and control of clinical and hematological changes of canine hyperadrenocorticism. At 8-year-old Poodle dog with diagnosis of hyperadrenocorticism was attended at the Metropolitan Veterinary Polytechnic of Caucaia - HVM. The guardian reported that the dog was 4 months without using Trilostan because it did not have financial conditions to maintain the treatment, which significantly worsened the clinical signs previously presented: polydipsia, polyuria, polyphagia, hyperpigmented skin with lesions, symmetrical alopecia, telangiectasia, pendular abdomen, muscle weakness in the pelvic limbs. Dyspnea was visually detected and cardiac auscultation detected tachycardia. Laboratory, ultrasonographic and cardiac evaluation (electrocardiogram and echocardiogram) were requested. Due to changes in the results of the tests, the veterinarian suggested the use of ketoconazole at the initial dose of 5mg / kg / VO / BID for 7 days and silymarin 180mg / VO / SID.com for purpose of controlling the patient's clinical symptoms and the observed changes in the examinations carried out. After this period, there was a significant improvement in the hematological and biochemical alterations of the patient, however the animal clinically presented worsening, presenting frequent vomiting and inappetence. In view of the above, it can be concluded that the use of ketoconazole in the treatment of patients with canine CAH should be used only as an adjuvant treatment, since despite the significant improvement of the hematological and biochemical changes related to the endocrine disorder does not improve clinical symptoms.