Dişi Bir Köpekte Piyometra ve Eşlik Eden Diyabetes Mellitus Olgusunun Başarılı Tedavisi

Piyometra hiç doğum yapmamış dişi köpeklerde sıklıkla görülen, endometriumun uzun süreli progesterona maruz kalması sonucunda şekillenen bir dioestrus dönemi hastalığıdır. Kapalı serviks piyometra ise prognozu zayıf, mortalite oranı yüksek hızlı müdahale gerektiren acil bir tıbbi durumdur. Diyabet gibi kronik bir hastalık ile ilişkili olduğunda tedavi olasılığı daha da sınırlıdır. Progesteron kaynaklı insülin direncinden dolayı köpeklerde diabetes mellitusun eşlik ettiği piyometra vakalarına rastlanması olası bir durumdur. Bu olgu, uzun süre kontraseptif uygulanmış 4 yaşlı bir köpekte diyabetes mellitus eşlik eden kapalı serviks piyometrayı tanımlamaktadır. Tanı, kapalı serviks piyometra için tipik ultrason görüntüsü, diöstrusu işaret eden vajinal smear bulgusu ve yüksek (52 ng/mL) serum progesteron seviyesi ile doğrulandı. Eşlik eden diabetes mellitus durumu, yüksek serum fruktozamin seviyesi (475 µmol/L) ile teşhis edildi. Tedavi amacıyla ovaryohisterektomi operasyonu ve normoglisemi sağlamak için glarjin insulin uygulaması gerçekleştirildi. Bu rapor, klinik pratikte köpeklerde piyometra olgularında genellikle eksik tanıya neden olan ve dikkate alınmayan, sinsi diyabetes mellitus gelişim potansiyelini vurgulamayı amaçlamaktadır.

Successful Treatment of Pyometra Concomitant with Diabetes Mellitus in a Bitch

Pyometra, a diestrus period disorder with a long term of progesterone exposure to endometrium, is a common disease of nulliparous female dogs. Closed-cervix pyometra is an emergency medical condition that requires rapid intervention. The possibility of treatment is further limited when associated with a chronic disease such as diabetes. This case describes a closed cervix pyometra in a 4-year-old bitch with comorbid diabetes mellitus and long-term contraceptive therapy. Closed-cervix pyometra was diagnosed and confirmed by ultrasound examination typical of pyometra, vaginal smear indicating diestrus and serum progesterone level (52 ng/mL). Serum fructosamine level was 475 µmol/L, interpreting diabetes mellitus. Treatment included ovariohysterectomy and normoglycemia was achieved with glargine insulin. Although, reproductive hormones and diestrus are associated with Type II diabetes mellitus in bitches, there are no reports limited to our search, on pyometra concomitant with diabetes mellitus except Elkhounds. Since the situation has a vital clinical importance, this report aims to emphasize the insidious diabetes mellitus development potential and treatment in canine pyometra which is usually misdiagnosed or unconsidered in clinical practice.

PDF

___

1. Batista PR, Blanco PG, Gobello C: Treatment of canine pyometra with the gonadotropin-releasing hormone antagonist acyline: A case series. Top Companion Anim Med, 30 (1): 25-27, 2015. DOI: 10.1053/j. tcam.2015.01.005
2. Hagman R: Clinical and molecular characteristics of pyometra in female dogs. Reprod Domest Anim, 47 (Suppl. 6): 323-325, 2012. DOI: 10.1111/rda.12031
3. Sant’Anna MC, Giordano LGP, Flaiban KKMC, Muller EE, Martins MIM: Prognostic markers of canine pyometra. Arq Bras Med Vet Zootec, 66 (6): 1711-1717, 2014. DOI: 10.1590/1678-6859
4. Rautela R, Katiyar R: Review on canine pyometra, oxidative stress and current trends in diagnostics. Asian Pac J Reprod, 8 (2): 45-55, 2019.
5. Jitpean S, Ström-Holst B, Emanuelson U, Höglund OV, Pettersson A, Alneryd-Bull C, Hagman R: Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases. BMC Vet Res, 10:6, 2014. DOI: 10.1186/17466148-10-6
6. Wheaton LG, Johnson AL, Parker AJ, Kneller SK: Results and complications of surgical-treatment of pyometra- a review of 80 cases. J Am Anim Hosp Assoc, 25 (5): 563-568, 1989.
7. Schaer M: Surgery in the diabetic pet. Vet Clin North Am Small Anim Pract, 25 (3): 651-660, 1995. DOI: 10.1016/S0195-5616(95)50060-9
8. Jitpean S, Ambrosen A, Emanuelson U, Hagman R: Closed cervix is associated with more severe illness in dogs with pyometra. BMC Vet Res, 13:11, 2016. DOI: 10.1186/s12917-016-0924-0
9. Arena MN, Albino MVC, Botelho FA, Luchi RAS, Ponce FG, Severo JS: Evaluation of blood glucose in dogs with pyometra. In, World Small Animal Association, World Congress, Sao Paolo, Brazil, 21-24 July 2009.
10. Smith FO: Canine pyometra. Theriogenology, 66 (3): 610-612, 2006. DOI: 10.1016/j.theriogenology.2006.04.023
11. Feldman EC, Nelson RW: Canine and Feline Endocrinology and Reproduction. 3rd ed., 486-538, Saunders, Missouri, 2004.
12. Fall T, Hedhammar A, Wallberg A, Fall N, Ahlgren KM, Hamlin HH, Lindblad-Toh K, Andersson G, Kämpe O: Diabetes mellitus in elkhounds is associated with diestrus and pregnancy. J Vet Intern Med, 24 (6): 1322-1328, 2010. DOI: 10.1111/j.1939-1676.2010.0630.x
13. Pöppl AG, Mottin TS, González FHD: Diabetes mellitus remission after resolution of inflammatory and progesterone-related conditions in bitches. Res Vet Sci, 94, 471-473, 2013. DOI: 10.1016/j.rvsc.2012.10.008
14. Scott-Moncrieff JC: Feline hyperthyroidism. In, Canine and Feline Endocrinology. 4th ed., 136-196, Saunders Elsevier, St. Louis, Missouri, 2015.
15. Sloan JM, Path MRC, Oliver IM: Progestogen-induced diabetes in the dog. Diabetes, 24 (4): 337-344, 1975. DOI: 10.2337/diab.24.4.337
16. Fernoagă C, Codreanu MD, Cornilă M, Raluca Teodora NAE, Constantinescu R: Use of fructosamine in small animals with diabetes. Scientific Works, Series C Vet Med, 61 (2): 99-102, 2015.