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Feline Skin Fragility Syndrome猫的皮肤脆性综合症

2014-07-10 08:37阅读：

http://blog.sina.cn/dpool/blog/u/2842237014

Feline Skin Fragility Syndrome
猫的皮肤脆性综合症

Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Basics
OVERVIEW
· A disorder of multifactorial causes characterized by extremely fragile skin
· Tends to occur in old cats that may have concurrent hyperadrenocorticism, diabetes mellitus, or excessive use of megestrol acetate or other progestational compounds
·
A small number of cats have had no biochemical alterations.
SIGNALMENT
· Naturally occurring disease tends to be recognized in old cats.
· Iatrogenic cases have no age predilection.
· No breed or sex predilection
SIGNS
Historical Findings
· Gradual onset of clinical signs
· Progressive alopecia (not always present)
· Often associated with weight loss, lusterless coat, poor appetite, and lack of energy
Physical Examination Findings
· The skin becomes markedly thin and tears with normal handling.
· The skin rarely bleeds upon tearing.
· Multiple lacerations (both old and new) may be noted on close examination.
· Partial to complete alopecia of the truncal region may be noted.
· Sometimes associated with rat tail, pinnal folding, pot-belly appearance
CAUSES & RISK FACTORS
· Hyperadrenocorticism—pituitary or adrenal dependent
· Iatrogenic—secondary to excessive corticosteroid or progestational drug use
· Diabetes mellitus—rare, unless associated with hyperadrenocorticism
· Possibly idiopathic
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Diagnosis
Differential Diagnosis
· Cutaneous asthenia
· Feline paraneoplastic syndrome—pancreatic neoplasia, hepatic lipidosis, cholangiocarcinoma
· Progestogen administration
CBC/BIOCHEMISTRY/URINALYSIS
· Of little diagnostic significance in most cases
· Approximately 80% of cats with hyperadrenocorticism have concurrent diabetes mellitus (hyperglycemia, glucosuria).
OTHER LABORATORY TESTS
· ACTH-stimulation test—70% of cats with hyperadrenocorticism have an exaggerated response.
· LDDST—15%–20% of normal cats may fail to decrease cortisol levels; typically unsuppressed with hyperadrenocorticism and nonadrenal illness
· HDDST—normal cats show decreases in cortisol concentrations; typically decreased with nonadrenal illnesses; considered by many clinicians to be the best screening test for hyperadrenocorticism; unreliable for discriminating between adrenal tumors and pituitary-dependent causes of hyperadrenocorticism, because both conditions fail to show suppression
· Endogenous ACTH levels—normal range for most labs is 20–100 pg/mL.
IMAGING
· Abdominal ultrasonography—adrenal masses are often small until end-stage disease.
· CT and MRI—small pituitary tumors may be difficult to visualize; MRI may be more successful.
DIAGNOSTIC PROCEDURES
N/A
PATHOLOGIC FINDINGS
Histopathology—suggestive, not diagnostic; epidermis and dermis are thin; attenuated collagen fibers are evident.
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Treatment
· Underlying metabolic disease should be ruled out.
· Many patients are debilitated and require supportive care.
· Surgical correction of the lacerations—not helpful because the tissue cannot withstand any pressure from the sutures
· Hyperadrenocorticism—adrenalectomy is the preferred treatment.
· Cobalt 60 radiation therapy—variable success in the treatment of pituitary tumors
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Medications
DRUG(S)
· Medical management—may be useful for preparing patient for surgery and for minimizing postoperative complications (e.g., infections and poor wound healing)
· No known effective medical therapy for feline hyperadrenocorticism
· o,p'-DDD (mitotane)—12.5–50 mg/kg PO q12h; response has been equivocal; side effects include anorexia, vomiting, and diarrhea.
· Ketoconazole (Nizoral)—10–15 mg/kg PO q12h; variable response
· Metyrapone—65 mg/kg PO q12h; clinical improvement noted more often with this drug than the others
CONTRAINDICATIONS/POSSIBLE INTERACTIONS
Hyperadrenocorticism—closely monitor diabetic cat; adjust insulin to prevent hypoglycemia when the cortisol levels fall.
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Follow-Up
Patients are often quite debilitated, making any form of treatment risky; close monitoring is required in all cases.
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Miscellaneous
ABBREVIATIONS
· HDDST = high-dose dexamethasone-suppression test
· LDDST = low-dose dexamethasone-suppression test
· o,p'-DDD = 1,1-(o,p'-dichlorodiphenyl)-2,2-dichloroethane
Feline <wbr>Skin <wbr>Fragility <wbr>Syndrome猫的皮肤脆性综合症 Suggested Readings
· Gross TL, Ihrke PJ, Walder EJ. Veterinary dermatopathology. Philadelphia: Mosby, 1992.
· Helton Rhodes K. Cutaneous manifestations of hyperadrenocorticism. In: August JR, ed. Consultations in feline internal medicine. Philadelphia: Saunders, 1997:191–198.

Author: Karen Helton Rhodes
 Consulting Editor: Karen Helton Rhodes

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