Case 7

The next morning Roscoe seems to feel better. He is much livelier and did not vomit overnight. You offer him a small amount of bland dog food, which he promptly wolfs down. A recheck packed cell volume is 31%, and the total protein concentration is 5 g/dl. You tell the owners Roscoe feels better but you are still concerned about his anemia and you haven't uncovered the cause of his vomiting. You recommend adding a resting cortisol concentration to Roscoe's lab work to screen for atypical hypoadrenocorticism. They agree and elect to take Roscoe home in the meantime to see how he does.

The resting cortisol concentration is 0.7 µg/dl (reference range: 1 to 5 µg/dl).

QUESTION 4

What would you do next? (There is more than one correct response.)

a) Diagnose hypoadrenocorticism, and initiate therapy with prednisone and fludrocortisone acetate.

b) Diagnose hypoadrenocorticism, and initiate therapy with prednisone.

c) You suspect Roscoe may have hypoadrenocorticism based on the low resting cortisol concentration, so you recommend he return for an ACTH stimulation test.

d) Based on your suspicion of hypoadrenocorticism, you call in a prescription of prednisone for Roscoe and recommend that an ACTH stimulation test be done as soon as possible.

e) You decide to run a low-dose dexamethasone suppression test to confirm your suspicion that Roscoe has hypoadrenocorticism.

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