Unexpected causes of acute abdominal pain in dogs part I: hypoadrenocorticism
This is poor Paddy: presented with several day hunched attitude, apparent abdominal pain, stiff gait, unwilling to move.
His routine haematology and biochemistry are pretty unremarkable. Same goes for thoracic and abdominal ultrasound except that his left adrenal is only 2.5mm wide at maximum.
left adrenal maximum diameter <3.0 mm is highly suggestive of hypoadrenocorticism (beware effects of any recent glucocorticoid administration by any route). Maximum diameter >4.5mm pretty much rules it out.
And his heart is looking a little under-filled:
That LV lumen:wall ratio at end diastole should be at least 3.5:1
Long story short….he has ‘atypical’ Addison’s. No response to ACTH stimuation test.
The interesting bit is his presenting signs. In people a wide variety of presenting signs are reported…some of which we might struggle to recognise in our patients. However,
‘Sudden penetrating pain in the legs, lower back, or abdomen‘
…is a well documented phenomenon in human hypoadrenocorticism. I have been caught out by this several times in dogs who really looked as though they might have pancreatitis or disc disease. I’m not sure that the exact mechanism is fully elucidated.
