Diagnóstico y tratamiento de un gato (Felis silvestris catus) con hiperaldosteronismo primario

Descripción del caso. Se presentó a consulta en el Hospital Veterinario de Especialidades (HVE) de la UNAM un paciente felino de 12 años con semiología compatible con miopatía hipocalémica con tres meses de evolución. En el examen físico general se observó condición corporal 2/5, posición plantígrada y ventroflexión cervical. Acudió a consulta con hemograma y bioquímica con valores alterados. Al realizar ultrasonido (US) abdominal, se evidenció proceso neoplásico en glándula adrenal.Hallazgos clínicos e interpretación. Neutrofilia y linfopenia asociadas a estrés, incremento de AST y CK, e hipocalemia, asociados a miopatía hipocalémica, que en conjunto con las alteraciones en el ultrasonido fueron compatibles con hiperaldosteronismo primario, secundario a carcinoma corticoadrenal.Tratamiento y evolución. Se descartaron otras afecciones que generan miopatía hipocalémica y se instauró tratamiento médico con espironolactona y gluconato de potasio, mejorando así su semiología.Pruebas de laboratorio. Como las alteraciones en el hemograma y la bioquímica realizadas fuera del HVE eran compatibles con miopatía hipocalémica, se decartó enfermedad renal crónica debido a que los niveles de creatinina se encontraban dentro de los valores de referencia del laboratorio. La T4T estaba dentro de los intervalos de referencia. La aldosterona fue compatible con hiperaldosteronemia.Discusión y relevancia clínica. El hiperaldosteronismo primario felino parece ser una enfermedad subdiagnosticada, porque los principales diagnósticos diferenciales para este padecimiento son el hipertiroidismo y la enfermedad renal crónica. Asimismo, estos pacientes pueden presentar hipertensión arterial sistémica y, hoy en día, se reconoce que el hiperaldosteronismo es la causa más común de hipertensión endocrina en gatos. Por lo tanto, es importante proporcionar bases y orientación a los médicos veterinarios para diagnosticar y tratar este padecimiento, debido a que en México no se cuenta con la prueba diagnóstica definitiva. Diagnosis and treatment of a cat (Felis silvestris catus) with primary hyperaldosteronism Abstract Case description. A 12 years old feline patient presented to the Hospital Veterinario de Especialidades (HVE) de la UNAM with clinical signs consistent with hypokalemic myopathy of three months duration. The physical exam revealed a body condition score of 2/5, plantigrade stance and cervical ventroflexion. Previous complete blood count and biochemistry revealed abnormal values. Abdominal ultrasound was performed and identified neoplasia in the adrenal gland.Diagnostics and interpretation. A stress leukogram characterized by neutrophilia and lymphopenia, increase in AST and CK, and hypokalemia associated with hypokalemic myopathy. These results along with ultrasonographic findings, were consistent with primary hyperaldosteronism secondary to adrenal carcinoma.Treatment and clinical response. Other causes of hypokalemia and hypokalemic myopathy were ruled out. Treatment was initiated with oral spironolactone and potassium gluconate, with marked improvement of its clinical signs. compatible con hiperaldosteronemia.Laboratory tests. Based on the results of complete blood count and biochemistry performed outside the HVE consistent with hypokalemic myopathy, other etiologies such as renal disease was ruled out as the levels of creatinine were within the reference interval. The T4T was also within reference intervals. Aldosterone levels were consistent with hyperaldosteronemia.Discussion and clinical relevance. Feline primary hyperaldosteronism appears to be an underdiagnosed disease, as diagnostic tests are limited to ruling out hyperthyroidism and chronic kidney disease. Similarly, these patients are likely to present with systemic hypertension and nowadays it is recognized that hyperaldosteronism is the most common cause of endocrine hypertension in cats. Therefore, it is important to educate and guide veterinarians in the diagnosis and treatment of this condition, as a final diagnostic test is not available in Mexico.Keywords: Feline primary hyperaldosteronism, hypertension, hyperaldosteronemia, adreno-cortical hyperplasia, adrenal adenoma or carcinoma, hypokalemic myopathy.

Ozone therapy in familial hypokalemic myopathy

We report the case of a 56-year-old male with a familial hypokalemic paralysis suffering from progressive myopathy of the lower limbs. While episodes of paralysis were well controlled with oral potassium supplementation, muscle weakness in the lower limbs gave little response to rehabilitative therapies. The patient underwent a series of treatments of ozone therapy alternated with large autohemoinfusion (GAEI) and rectal insufflation twice a week; GAEI was then maintained once a month. The muscle strength of the various muscle segments was evaluated during physiotherapy. A significant improvement in musculoskeletal strength and therefore in the response to rehabilitation treatments has been observed. Oxygen-ozone therapy appears to be effective in increasing muscle strength in patients with genetic alterations of the potassium and calcium channels, thus making physiotherapeutic rehabilitation more effective.