Lethargy and weakness in endocrine disease

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Lethargy and weakness are common presenting signs in first-opinion practice but can be difficult to distinguish for both the owner and clinician. They may be primary signs but are more commonly secondary to another disease process. Many conditions can result in lethargy and/or weakness, and in order to determine the exact cause of the signs, a full history should be obtained and clinical examination and diagnostic work-up performed. This chapter looks at history, physical examination, differential diagnosis, diagnostic tests and endocrine disorders causing lethargy and weakness.

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17.2 Differentiating orthopaedic, endocrine and muscular disorders in dogs presenting with lethargy and/or weakness.
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17.3 Control of thyroid hormone release. Red arrows = negative feedback. TRH = thyroid releasing hormone; TSH = thyroid stimulating hormone.
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17.4 A 6-year-old male neutered Irish Terrier with hypothyroidism, showing bilateral flank alopecia.
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17.5 An 8-year-old neutered Staffordshire Bull Terrier bitch with hyperadrenocorticism, showing flank alopecia and ‘rat-tail’. The same bitch following treatment with trilostane for 6 months; there is hair regrowth on the body and tail.
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17.6 Diagnostic plan for suspected cases of hyperadrenocorticism. ACTH = adrenocorticotrophic hormone; ALP = alkaline phosphatase; ALT = alanine aminotransferase; USG = specific gravity.
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17.7 An ECG from a 5-year-old male neutered German Shepherd Dog with hypoadrenocorticism. The marked hyperkalaemia in this case is shown on this ECG as an absence of P waves (atrial standstill) and peaked T waves.
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17.8 There are two types of insulin authorized for use in dogs: Caninsulin and Prozinc. Caninsulin is the more widely used and is available in two formulations: the VetPen; or with specific insulin syringes. Owners may find it easier to inject insulin with the VetPen.
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