黃慧璧臺灣大學:獸醫學研究所連于欣Lien, Yu-HsinYu-HsinLien2010-05-042018-07-092010-05-042018-07-092009U0001-2106200917164100http://ntur.lib.ntu.edu.tw//handle/246246/178945腎上腺功能亢進症主要分為三類型：腦下垂體型、腎上腺腫瘤型及醫源型腎上腺功能亢進症。腦下垂體型及醫源型腎上腺功能亢進症是台灣犬貓最常見的類型。CTH刺激檢驗是唯一可區別腦下垂體型及醫源型腎上腺功能亢進症的檢驗。本研究比較2種不同劑量(5 and 10μg/kg)的ACTH對於臨床健康犬隻以及腎上腺功能亢進犬隻的可行性。結果顯示，健康犬隻或腎上腺功能亢進犬隻以5μg/kg的ACTH進行ACTH刺激檢驗皆可獲得有效的結果。下垂體型腎上腺功能亢進症主要以藥物控制疾病。本研究評估ketoconazole控制犬隻腦下垂體型腎上腺功能亢進症的療效。回溯患有腦下垂體型腎上腺功能亢進症犬隻的病歷發現90%病犬在治療期間有明顯臨床症狀的改善；所有病犬在服用ketoconazole後血清cortisol濃度在進行ACTH刺激檢驗前及後皆明顯下降；血清ALKP及ALT值在服用ketoconazole後也明顯下降。平均存活期為25個月。Ketoconazole是安全且有效控制腦下垂體型腎上腺功能亢進症得藥物。腹高血糖值是腎上腺功能亢進症常見的現象。本研究調查正常犬、無糖尿病併發的腎上腺功能亢進犬隻以及糖尿病犬的血液糖化血紅素A1c值；同時也評估腦下垂體型腎上腺功能亢進犬隻經trilostane控制後的血糖值及糖化血紅素值的變化。結果顯示，正常犬、無糖尿病併發的腎上腺功能亢進犬隻以及糖尿病犬的血液糖化血紅素A1c值有明顯差異；腦下垂體型腎上腺功能亢進犬隻經trilostane控制後糖化血紅素值有明顯下降，但血糖值並無變化。血液糖化血紅素A1c值可應用於腎上腺功能亢進犬隻的控制評估。的醫源型腎上腺功能亢進症相當罕見。回溯研究12隻患皮膚疾病且長期接受類固醇治療的貓，非皮膚相關的臨床症狀包括厭食、嗜睡、頻渴、頻尿及後腿肌肉萎縮；血液檢驗異常包括白血球增多症、ALT值上升以及高血糖值。其中4隻貓併發暫時性糖尿病，4隻貓併發暫時性甲狀腺功能低下症。這些臨床症狀在停用類固醇後平均4.9個月消失，恢復正常。Hyperadrenocorticism, also known as Cushing’s disease, can be classified into 3 types: pituitary dependent HAC, adrenocortical carcinoma or adenoma, and iatrogenic HAC. In our area, the most common type of HAC is pituitary dependent HAC and iatrogenic HAC. CTH stimulation test is the only validated test to differentiate from these 2 types of HAC. The study compared cortisol response to two doses (5 and 10μg/kg) of synthetic ACTH stimulation in healthy dogs and those diagnosed with hyperadrenocorticism. The results showed that ACTH stimulation using 5 μg/kg synthetic ACTH was effective in clinically healthy dogs and those diagnosed with hyperadrenocorticism.ituitary-dependent HAC was mainly managed by medically treatment. To evaluate the effectiveness of ketoconazole as a treatment for dogs with pituitary-dependent hyperadrenocorticism (PDH). Medical records of dogs with PDH that were treated with ketoconazole were retrospectively studied. 90% dogs had evidence of clinical improvement during the treatment period. In all dogs, treatment with ketoconazole resulted in significantly lower serum cortisol concentrations as measured before and after ACTH stimulation testing. Serum ALKP and ALT activities significantly decreased after treatment with ketoconazole. The median survival time after diagnosis of PDH was 25 months. Ketoconazole was a safe and effective option for treating dogs with PDH.igh-fasting blood glucose concentrations are commonly associated with insulin antagonism in hyperadrenocorticism. The study investigated glycosylated hemoglobin concentrations in clinically healthy dogs and in dogs with pituitary-dependent hyperadrenocorticism and/or diabetes mellitus. The effect of trilostane treatment on glucose and glycosylated hemoglobin concentration in dogs with pituitary-dependent hyperadrenocorticism was also evaluated. Hemoglobin A1c concentrations were significantly different among the clinically healthy dogs, dogs with non-diabetic hyperadrenocorticism, and diabetic dogs. Trilostane treatment decreased hemoglobin A1c concentrations of dogs with non-diabetic hyperadrenocorticism, but not glucose concentrations. The applicability of glycosylated hemoglobin A1c concentrations may be of clinical value in assessment of PDH management. atrogenic hyperadrenocorticism is an extremely rare condition in cats. Twelve cats with a medical history of progressive skin lesions and long-term treatment with corticosteroids were retrospectively studied. Noncutaneous signs in the cats were variable and included anorexia, lethargy, polydipsia, polyuria, and atrophy of the thigh muscles. Laboratory abnormalities included leukocytosis, elevated alanine aminotransferase levels, and hyperglycemia. Transient diabetes mellitus was a secondary complication in four cats, and transient hypothyroidism was suspected in four cats. The mean time for remission of signs was 4.9 months after corticosteroid withdrawal.目 錄試委員審定書……………………………………………………………………….i謝…………………………….…...…………………………………………………ii文摘要……………………….……...……………………………………………...iii文摘要……………………….………...…………………………………………...ivbbreviations………………………………………………………………………….vihapter I Scope of the thesis 1hapter II Introduction of hyperadrenocorticism in dogs 4hapter III Effect of alternative doses of synthetic adrenocorticotropic hormone ollowing intramuscular administration on serum cortisol concentrations in healthy dogs and dogs with hyperadrenocorticism 22hapter IV Use of ketoconazole to treat dogs with pituitary-dependentyperadrenocorticism: 48 cases (1994-2007) 36hapter V Glycosylated hemoglobin concentrations in dogs withyperadrenocorticism and/or diabetes mellitus compared to clinically ealthy dogs 59hapter VI Introduction of hyperadrenocorticism in cats 74hapter VII Iatrogenic hyperadrenocorticism in 12 cats 78hapter IIX General discussion 103application/pdf1049173 bytesapplication/pdfen-US腎上腺功能亢進症腦下垂體型腎上腺功能亢進症醫源型腎上腺功能亢進症HyperadrenocorticismPituitary-dependent hyperadrenocorticismIatrogenic hyperadrenocorticism[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/178945/1/ntu-98-D95629004-1.pdf