Expert Veterinary Internal Medicine and Endocrinology Consulting Services
ACVIM Consensus Statement on HAC
January 7, 2014
The ACVIM has recently published a consensus statement for the diagnosis of dogs with spontaneous hyperadrenocorticism. In addition to a review of common physical examination and laboratory findings, the panel delineates the following indications for HAC-specific testing:
Compatible history and physical exam findings
Unexpected identification of an adrenal mass
Difficult to control diabetic dog
Conversely, the absence of common laboratory abnormalities such as an elevated alkaline phosphatase or specific gravity ≤1.018 should decrease suspicion of HAC.
The consensus panel notes that no test is 100% accurate under every circumstance and recommends that HAC-specific testing be avoided in the face of serious illness. Unless iatrogenic HAC is suspected, the consensus statement recommends a low dose dexamethasone suppression test as the screening test of choice. ACTH stimulation testing remains the gold standard for the diagnosis of iatrogenic HAC and the use of compounded ACTH is discouraged.
On the topic of atypical or “occult” HAC, the role of sex hormones is still unclear and the specificity of adrenal hormone panel testing is low.