• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.19-21
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• 2018

A 7-year-old female American cocker spaniel presented with chronic regurgitation and megaesophagus on radiography at a local hospital. Dry and coarse hair coat, tail alopecia, and bradycardia were observed during physical examination. Mild, non-regenerative anemia was indicated by complete blood count (CBC) analysis. Concurrent hypercholesterolemia and hypertriglycemia were indicated by biochemistry tests. Decreased levels of total and free thyroxine (T4) and increased canine thyroid stimulating hormone (cTSH) levels were also detected. Megaesophagus was confirmed by radiographic examination. Based on the results, a diagnosis of hypothyroidism with megaesophagus was made. The patient was initially treated with levothyroxine sodium at a dosage of 0.02 mg/kg twice a day. After two weeks of treatment for hypothyroidism, the dilated esophagus returned to its original size and no further regurgitation was observed. No relapse was observed during two months of follow-up.

• Childhood Kidney Diseases
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• v.24 no.1
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• pp.42-46
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• 2020

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.