A case of nutritional secondary hyperparathyroidism in a Siberian tiger cub

A three-month-old female Siberian tiger cub with hindlimb ataxia was referred to the veterinary teaching hospital of Konkuk University. The patient was fed only beef without supplementation of calcium and vitamins after weaning. The tiger was presented with ataxia and back pain on digital palpation. In addition, abnormal gait, reluctance to move, and depressed withdrawal reflex were noted at the neurological examination. The overall osteodystrophic change of the lumbosacral vertebrae was observed on the lateral and ventrodorsal view of radiographic examination. And also PTH level was increased in hormonal assay when compared to that of cat reference range. Based on the results of examinations, nutritional secondary hyperparathyroidism was diagnosed. Clinical signs of this patient were improved after administration of vitamin D and calcium. This case demonstrates that nutritional hyperparathyroidism could be occurred in wild animals raised on a meat diet containing imbalanced calcium and phosphate.     

A novel CYP27B1 mutation causes a feline vitamin D-dependent rickets type IA

A 12-week-old domestic cat presented at a local veterinary clinic with hypocalcemia and skeletal abnormalities suggestive of rickets. Osteomalacia (rickets) is a disease caused by impaired bone mineralization leading to an increased prevalence of fractures and deformity. Described in a variety of species, rickets is most commonly caused by vitamin D or calcium deficiencies owing to both environmental and or genetic abnormalities. Vitamin D-dependent rickets type 1A (VDDR-1A) is a result of the enzymatic pathway defect caused by mutations in the 25-hydroxyvitamin D(3)-1-alpha-hydroxylase gene [cytochrome P27 B1 (CYP27B1)]. Calcitriol, the active form of vitamin D(3), regulates calcium homeostasis, which requires sufficient dietary calcium availability and correct hormonal function for proper bone growth and maintenance. Patient calcitriol concentrations were low while calcidiol levels were normal suggestive of VDDR-1A. The entire DNA coding sequencing of CYP27B1 was evaluated. The affected cat was wild type for previously identified VDDR-1A causative mutations. However, six novel mutations were identified, one of which was a nonsense mutation at G637T in exon 4. The exon 4 G637T nonsense mutation results in a premature protein truncation, changing a glutamic acid to a stop codon, E213X, likely causing the clinical presentation of rickets. The previously documented genetic mutation resulting in feline VDDR-1A rickets, as well as the case presented in this research, result from novel exon 4 CYP27B1 mutations, thus exon 4 should be the initial focus of future sequencing efforts.     

Exacerbative effect of vitamin A on malabsorption syndrome in chicks

The interaction between malabsorption syndrome (MAS) and dietary vitamins A and D was studied in broiler chicks reared in floor pens for 4 weeks. The chicks were naturally infected with MAS, whereas hatchmates fed the same diets but in a separate facility (battery brooder) did not exhibit signs of MAS and, therefore, were considered controls. MAS significantly reduced body weights, bone ash, serum calcium and phosphorus concentrations, and liver lipids and increased the incidence of skeletal abnormalities (tibial dyschondroplasia and rickets). Rather than ameliorating the effects of MAS, vitamin A caused a further reduction in body weight and bone ash. A possible nutrient interaction between vitamin A and vitamin D or vitamin E in birds with MAS may account for the exacerbative effect of vitamin A.     

Occurrence of Problems after Three Techniques of Bilateral Thyroidectomy in Cats

Bilateral thyroidectomy was performed in 106 cats with hyperthyroidism by one of three techniques: original intracapsular, modified intracapsular, or modified extracapsular. Hypocalcemia was detected in the first 3 days after surgery in 11 (22%) of 50 cats treated by the intracapsular technique, 10 (33%) of 30 cats treated by the modified intracapsular technique, and 6 (23%) of 26 cats treated by the modified extracapsular technique. Hypocalcemia was classified as mild or severe. No signs of hypoparathyroidism developed in any of the 13 cats with mild hypocalcemia. Of the 14 cats with severe hypocalcemia, 8 had clinical signs of hypoparathyroidism before and during treatment with calcium and vitamin D, 3 were treated and no clinical signs developed, 2 were not treated but no clinical signs developed, and 1 was lost to follow-up. No cat required permanent calcium or vitamin D supplementation after surgery. Severe hypocalcemia and clinical signs of hypoparathyroidism occurred in 3 (6%) of the 50 cats treated by the intracapsular technique, 4 (13.3%) of the 30 cats treated by the modified intracapsular technique, and 1 (3.8%) of the 26 cats treated by the modified extracapsular technique. Twelve cats had recurrence of hyperthyroidism at a median time of 23 months. The intracapsular technique was used in 11 of these cats, and the modified extracapsular technique was used in 1. No clinical signs of hypothyroidism were detected in any of the cats. The modified intracapsular and modified extracapsular techniques of bilateral thyroidectomy are effective procedures for the treatment of feline hyperthyroidism.     

A probable case of hypoparathyroidism in a cat

Idiopathic hypoparathyroidism was suspected in a young female cat. The relevant historical and clinical findings were: anorexia, intermittent muscle tremors, hindlimb ataxia, behavioural changes and cataracts. Salient laboratory findings were: hypocalcaemia, hyperphosphataemia and normal renal function (normal serum urea and creatinine concentrations with hypersthenuria). No evidence of intestinal malabsorption, pancreatitis or nutritional secondary hyperparathyroidism was found. Treatment with oral synthetic vitamin D (1,25 dihydroxycholecalciferol) and intravenous and oral calcium supplements was successful in correcting the hypocalcaemia and abolishing the clinical signs.     

Composition and use of puppy milk replacers in German Shepherd puppies in the Netherlands

Enostosis or eosinophilic panosteitis is a common disease in young growing large-breed dogs, such as the German Shepherd, and the risk of developing the disease by 3-4 months of age is increased by a high calcium intake. The aim of the study was to investigate whether German Shepherd puppies raised on milk replacers receive more calcium and/or vitamin D than their requirements in the pre-weaning period and thus are at increased risk of developing skeletal diseases. To this end, we surveyed German Shepherd breeders in the Netherlands about the use of puppy milk replacers (PMR). The metabolizable energy, calcium, phosphorus and vitamin D content of the eight most used PMR were compared with that of bitch milk, as reported in the literature. The protein and fat content of most PMR were somewhat lower (range 24.4-33.2 g per 100 g on dmb and 18.3-37.5 g per 100 g on dmb respectively) compared with bitch milk (31.9 and 40.2 g on dmb respectively). The vitamin D content of one of the PMR samples was sevenfold the level recommended by the NRC (Nutrient Requirements of Dogs and Cats, National Academy Press, 2006) and threefold the average level of bitch milk. The clinical relevance of this high amount is questionable, as bitch milk contains mainly 25-hydroxy-vitamin D [3843 μg (96.1 IU) per 100 g on dmb] and only limited amounts of vitamin D [524 μg (13.3 IU) per 100 g on dmb], as was determined in this study. Dutch German Shepherd breeders tended to overfeed their puppies. We calculated that misguided use of PMR can increase the risk of excessive calcium, phosphorus and possibly vitamin D intake during a vulnerable period, potentially giving rise to bone and cartilage problems later in life.     

Primary hypoparathyroidism in dogs: a retrospective study of 17 cases

OBJECTIVE: To evaluate the clinico-pathological findings, response to treatment and prevalence of complications in dogs with primary hypoparathyroidism. DESIGN: Retrospective study of 17 dogs presenting to the University of Melbourne Veterinary Clinical Centre and Murdoch University Veterinary Hospital over a 15 year period (1990 to 2004). Case records were evaluated for signalment, body weight, diet type, historical and clinical findings, serum total calcium, phosphate, albumin and parathyroid hormone concentrations, urinary fractional excretion ratios of calcium and phosphate, electrocardiogram (ECG) results, treatments administered, outcome and period of follow-up. RESULTS: The most common breeds identified were St Bernard (three dogs), Chihuahua (two dogs), German Shepherd (two dogs) and Jack Russell Terrier (two dogs). Three dogs were cross bred. Seizures, muscle tremors and fasciculations, stiff gait, tetany, muscle cramping, behavioural change and hyperventilation were the most common clinical signs. Vomiting, inappetence, diarrhoea, abdominal pain, hyperthermia, facial pruritus, ataxia, weakness, cataracts, and circling also occurred with less frequency. The mean duration of observed clinical signs preceding diagnosis was 33 days (median 13 days, range 1 to 173 days). All dogs had marked hypocalcaemia with normal or mildly increased serum albumin concentrations. Mean phosphate concentrations were significantly higher in inappetent dogs (P = 0.049). Mean serum calcium concentrations were significantly lower in dogs with cataracts compared to those without (P = 0.046). There were no other significant relationships between serum calcium or phosphate concentrations and the clinical presentation or outcome. No significant correlations were identified between the presence of a particular clinical sign and the duration of clinical signs. ECGs were obtained in four dogs and all exhibited QT interval prolongation due to a ST-segment prolongation. Sixteen of 17 dogs were treated successfully for hypocalcaemia and discharged from hospital. Acute management included parenteral calcium gluconate (10 dogs) and intravenous anticonvulsants (five dogs). Chronic therapy included oral vitamin D analogues and calcium supplementation. Treatment complications occurred in two dogs and included acute renal failure (one dog) and iatrogenic tissue necrosis following subcutaneous calcium administration (one dog). The mean follow-up period was 14.5 months (median 13 months, range 0 to 39 months). Twelve dogs were alive at the last follow up and two dogs were euthanased for unrelated reasons. The type of vitamin D analogue used was not associated with outcome. CONCLUSION: Primary hypoparathyroidism was an uncommon diagnosis in dogs. Saint Bernards, cross bred dogs, German Shepherd dogs and Terrier breeds were most commonly affected. Neurological signs were the most common presenting clinical signs, although alimentary signs may have been more common than previously reported. Dogs with primary hypoparathyroidism appeared to have a good prognosis following initiation of calcium supplementation and vitamin D therapy. Complications of treatment were uncommon and could be minimised with regular monitoring.     

Primary hypoparathyroidism in a cat complicated by suspect iatrogenic calcinosis cutis.

An adult male cat presented to the Ontario Veterinary College after having a seizure at the humane society. The cat was diagnosed with primary hypoparathyroidism and was treated with calcium and vitamin D3 supplementation. Calcium supplementation included subcutaneous (SC) administration of diluted calcium gluconate according to protocols described in recent literature. Seven days after SC calcium administration, firm SC masses developed in the intrascapular area where the injections were given and in the dependent axillary area. These areas became raised, formed crusts, necrosed, and left scars. Although not histopathologically confirmed, the author postulates that this was a direct reaction to SC calcium gluconate administration.     

Rickets in turkey poults

Fifteen outbreaks of rickets were diagnosed in turkey poults in Saskatchewan between 1978 and 1981. No relationship to farm, source of poults, or source of feed was apparent. Most outbreaks started when the poults were between 10 and 14 days of age, and they had recovered by 28 days of age. Losses varied from 1% to 14% of poults started. Skeletal lesions were characteristic of a vitamin D or calcium deficiency. On the basis of chemical analyses, adequate levels of calcium and phosphorus and proper amounts of vitamin premixes were present in the feed, but in five outbreaks biological feed tests implicated feed as a causative factor. The severity of rickets in poults fed defective feeds was markedly reduced by providing the poults with extra vitamin D in the drinking water or by injection. Two premixes used in different feeds contained adequate available vitamin D on the basis of biological testing. In some of the outbreaks, the rickets may have resulted from inadequate distribution of vitamin D in the feed, destruction of vitamin D during feed processing, or some unknown factor in the feed interfering with vitamin D utilization.     

Primary hyperparathyroidism in cats: seven cases (1984-1989).

The medical records of 7 hypercalcemic cats with primary hyperparathyroidism were evaluated. Mean age was 12.9 years, with ages ranging from 8 to 15 years; 5 were female; 5 were Siamese, and 2 were of mixed breed. The most common clinical signs detected by owners were anorexia and lethargy. A cervical mass was palpable in 4 cats. Serum calcium concentrations were 11.1 to 22.8 mg/dl, with a mean of 15.8 mg/dl calculated from each cat's highest preoperative value. The serum phosphorus concentration was low in 2 cats, within reference limits in 4, and slightly high in 1 cat. The BUN concentration was greater than 60 mg/dl in 2 cats, 31 to 35 mg/dl in 2 cats, and less than 30 mg/dl in 3 cats. Abnormalities were detected in serum alanine transaminase, aspartate transaminase, and alkaline phosphatase activities from 2 or 3 cats. Parathormone (PTH) concentrations were measured in 2 cats before and after surgery. The preoperative PTH concentration was within reference limits in 1 cat and was high in 1 cat. The PTH concentrations were lower after surgery in both cats tested. A solitary parathyroid adenoma was surgically removed from 5 cats, bilateral parathyroid cystadenomas were surgically resected in 1 cat, and a parathyroid carcinoma was diagnosed at necropsy in 1 cat. None of the cats had clinical problems with hypocalcemia after surgery, although 2 cats developed hypocalcemia without tetany, one of which was controlled with oral administration of dihydrotachysterol and the other with oral administration of 1,25 dihydroxyvitamin D. All 5 of the cta that underwent removal of an adenoma were alive at least 240 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary hypoparathyroidism in two horses

Two Thoroughbred horses were presented with various clinical signs which included sweating, agitation, muscle twitching and synchronous diaphragmatic flutter. These signs were associated with profound hypocalcaemia. A diagnosis of primary hypoparathyroidism was made on the basis of low serum ionised calcium concentration, hyperphosphataemia and markedly reduced serum immunoreactive parathyroid hormone concentrations in the presence of normal renal function. Treatment with a combination of intravenous calcium and subsequently oral calcium, magnesium and a vitamin D analogue (dihydrotachysterol) for up to 65 days resulted in complete remission of clinical signs. Horse 1 was euthanased 12 months after the initial recognition of signs. Results of necropsy were unremarkable apart from an absence of detectable parathyroid tissue. Horse 2 returned to athletic activities while receiving only maintenance doses of oral calcium carbonate.     

Vitamin D doses for alpacas (Lama pacos)

OBJECTIVE: To assess the effectiveness of cholecalciferol (D3) doses for maintaining adequate vitamin D status in crias and adult female alpacas at pasture. DESIGN: A field experiment during winter and early spring in a herd on a farm in South Australia. ANIMALS AND PROCEDURE: Crias, usually less than 6 months of age and female alpacas, aged 2 to 6 years, were given a single subcutaneous dose of 0, 1000 or 2000 IU D3/kg body weight. Plasma concentrations of 25-hydroxycholecalciferol (25-OH D3), phosphorus, calcium and vitamins A and E and alkaline phosphatase activity were measured at intervals over a period of 16 weeks after treatment. RESULTS: Crias not given a vitamin D supplement had reduced growth rate during winter and one animal showed clinical signs of rickets. Vitamin D treatment had no effect on the body weight of mature females. Vitamin D supplements increased the 25-OH D3 and phosphorus concentrations in plasma of both crias and adult females; alkaline phosphatase activity was not affected by treatment. CONCLUSION: It is suggested that for alpacas in southern Australia a subcutaneous dose of 1000 IU D3/kg body weight to crias in late autumn and again in mid winter and to adult females in mid winter should prevent vitamin D inadequacy.     

High vitamin D3 requirements in broilers for bone quality and prevention of tibial dyschondroplasia and interactions with dietary calcium, available phosphorus and vitamin A

1. Two experiments were carried out to investigate responses in performance and bone compositional and structural characteristics in broilers fed diets containing 4 concentrations of vitamin D3 (5, 20, 125 and 250 microg cholecalciferol/kg) at different concentrations of calcium, available phosphorus and vitamin A. 2. In experiment 1, body weight and tibia breaking strength were maximised at 14d with 250 microg vitamin D3/kg, tibia ash was maximised with 125 microg vitamin D3/kg. A high incidence of tibial dyschondroplasia (TD) was decreased to very low levels with 125 microg vitamin D/kg. 3. At 42d, performance and bone characteristics showed no response to vitamin D3 concentrations above 20 microg/kg. 4. Dietary vitamin A within the range 2-4 to 4.5 mg retinol/kg did not show any interaction with vitamin D3 status at either age. 5. In experiment 2, responses to vitamin D3 were strongly influenced by dietary calcium/available phosphorus. With 13 g calcium and 5 g available phosphorus/kg, performance and bone characteristics responded to vitamin D3 concentrations up to 125 microg/kg but more was needed at less optimal concentrations of calcium and available phosphorus. TD incidence was minimised with 250 microg/kg. 6. This study shows that high dietary concentrations of vitamin D3 can prevent TD. It is concluded that the vitamin D3 requirement of broilers up to 14 d of age at optimal dietary calcium and available phosphorus concentrations may be in the range 35 to 50 microg/kg for cortical bone quality and up to 250 microg/kg for prevention of TD. The vitamin D3 requirement for cortical bone quality after 14 d is not higher than 20 microg/kg. These requirements are much higher than earlier estimates and may be related to higher calcium requirements of modern broiler genotypes. Current regulations limiting maximum vitamin D3 concentrations in broiler starter diets may need to be reviewed.     

Historical and current perspectives on the treatment, control and pathogenesis of milk fever in dairy cattle

Milk fever has been recognised in cattle for about 215 years and its clinical signs have not changed since they were described by Victorian veterinary surgeons in the mid-nineteenth century. It was only 80 years ago that abnormal parathyroid gland function was associated with the pathogenesis of the hypocalcaemia characteristic of the disease, and the current basis for its treatment with intravenous calcium salts was established. Although this treatment is effective, most recent research has focused on preventing the disease through an understanding of the endocrine control of extracellular calcium homeostasis. In the 1970s the synthetic vitamin D analogue 1alpha-hydroxycholecalciferol was developed for intramuscular injection before a cow calved, but variable results encouraged other preventive strategies to be considered, including restricting the dietary intake of calcium, and manipulating the dietary cation-anion balance of cows before they calved. Currently, the role of extracellular calcium receptors in the parathyroid gland is under investigation as a preliminary step to devising more effective treatments and/or preventive methods for milk fever.     

Short-term prednisolone therapy has minimal impact on calcium metabolism in dogs with atopic dermatitis

Glucocorticoids (GCs) are a large group of drugs used to treat a range of inflammatory, autoimmune and neoplastic diseases in dogs. Glucocorticoids have been linked to disturbances in calcium metabolism and skeletal disorders in humans, yet their effects at therapeutically effective dosages in dogs with spontaneous diseases are poorly understood. Serum concentrations of calcium, phosphate, vitamin D metabolites and plasma concentrations of parathyroid hormone and ionised calcium together with urinary fractional excretion of calcium and phosphate, were measured in 16 dogs with atopic dermatitis before and 6weeks after standard dosage prednisolone treatment (0.93-1.06mg/kg) every other day after 7days of treatment with the same dosage once daily. The severity of their physical signs, as assessed by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS), decreased in all dogs following prednisolone treatment. There was no significant difference in any of the biochemical parameters measured following prednisolone treatment. This study indicates that prednisolone, used at a therapeutically effective dose, has minimal impact on calcium metabolism in dogs with atopic dermatitis.     

Long-term follow-up of laminin alpha2 (merosin)-deficient muscular dystrophy in a cat

Progressive muscle weakness beginning at 6 months of age was observed in a male Persian-mix cat. Muscle atrophy and joint contracture progressed over the next 3 years. The cat had developed gait difficulty at 8 months of age. The cat died at age of 5 years and 3 months due to an acute respiratory disorder. The clinical, laboratory, necropsy and histopathological findings of the cat were consistent with those of muscular dystrophy. The cat was diagnosed as having laminin alpha2 (merosin)-deficient muscular dystrophy on the basis of immunohistochemical findings. The cat was born in an inbred colony, and another related cat exhibited similar clinical signs. Few cases of laminin alpha2-deficient muscular dystrophy have been reported in cats, and this report provides additional information about the disease.     

Pathology of experimental vitamin D deficiency in turkeys and the effects of various vitamin D supplements.

One-day-old poults fed a vitamin D3-deficient diet were examined for clinical, biochemical, and morphological changes at 14 days of age. Changes in these parameters were compared at 15.5 and 17 days of age after one of the following vitamin D-replacement therapies was provided: water-soluble vitamin-mineral packs that contained vitamin D3; vitamin D3 in the feed; or vitamin D, 1,25-dihydroxyvitamin D3 in the feed. The vitamin D3-deficient poults were lame and had significant decreases in weight gain and in longitudinal skeletal growth. None of the therapies alleviated all these changes, but clinical lameness subsided in poults provided 1,25-dihydroxyvitamin D3. Calcium concentrations were significantly improved by all therapies. Treatment with vitamin D3 in the feed and water significantly increased 25-hydroxyvitamin D3 concentrations in vitamin D-deficient poults. The growth plate zones, with the exception of the mineralized hypertrophied zone, were all increased in length and not modified by treatment. However, the mineralized hypertrophied zones in the 1,25-dihydroxy-vitamin D3 group and the group receiving vitamin D3 in the water were comparable to that in the controls on day 15.5.     

Nutrition in relation to skeletal growth deformities

The pathophysiology of alimentary hyperparathyroidism and its pathological fractures and growth deformities are described. Renal hyperparathyroidism with hyperostotic osteodystrophy in young animals and isostotic osteodystrophy in old animals is briefly mentioned. Hypercalcitoninism caused by excessive prolonged calcium intake in growing dogs will go together with disturbances in skeletal remodelling and disturbed enchrondral ossification, leading to such entities as canine wobbler syndrome, enostosis, osteochrondrosis dissecans, and radius curvus syndrome. Dogs, who are dependent upon dietary vitamin D sources, can develop rickets with skeletal growth deformities when a diet deficient in vitamin D is fed under controlled conditions. Growth plates and mineralisation grade normalised when commercial dog food was given. As a sole therapy normalisation of the diet will not be sufficient in all skeletal growth deformities as described above. Prevention by feeding diets with optimal contents will be of benefit to veterinarians and their patients.     

Effect of source and quantity of dietary vitamin D in maternal and creep diets on bone metabolism and growth in piglets

Piglets are born with reduced plasma concentrations of 25-hydroxycholecalciferol (25-OH-D(3)) and are thus highly predisposed to vitamin D deficiency. Furthermore, sow milk contains little vitamin D, and the slow intestinal vitamin D absorption of sows limits the efficacy of dietary vitamin D supplementation. Hence, the neonate depends, to a large extent, on the vitamin D stores built up in fetal tissues from maternal sources. The current study was undertaken to evaluate whether the source and quantity of dietary vitamin D provided to the gestating and lactating sow, and also directly in the form of creep feed to the piglet, would influence the vitamin D status, growth performance, and skeletal development of piglets. A total of 39 primiparous and multiparous sows were randomly assigned to 1 of 3 dietary treatments (13 in each treatment), supplemented with either 5 or 50 μg of the commonly used cholecalciferol (vitamin D(3)) or 50 μg of 25-OH-D(3) per kilogram of feed. By wk 3 of lactation, piglets were offered a creep diet with vitamin D supplementation according to the treatment of the dam, and they were offered the same creep diets after weaning at d 35 of age until they reached a BW of approximately 20 kg. When dietary 25-OH-D(3) was provided, circulating concentrations of 25-OH-D(3) in piglet serum increased (P < 0.05) as early as d 21 and later at d 33 and 77, indicating greater body stores in those animals. Bone-breaking strength and cortical bone mineral content and density at the tibial midshaft of piglets were reduced (P < 0.05) when vitamin D(3) was supplemented at 5 μg/kg compared with the bone traits of other groups, but no differences (P > 0.05) were observed between the 2 other groups. After weaning, ADFI was greater (P < 0.05) and growth performance tended (P = 0.08) to improve when doses of 50 μg/kg were administered, regardless of the vitamin D source. In conclusion, supplementation of the diet with 50 μg/kg of either source of vitamin D was proved to be adequate in meeting the needs of gestating sows and in permitting the accumulation of vitamin D in fetal tissues, as well as for normal skeletal mineralization and growth in the offspring. Furthermore, the markedly improved vitamin D status of piglets whose mothers received 25-OH-D(3) possibly resulted from greater tissue reserves present at birth and a greater availability of vitamin D when released from those stores.     

A case of mannosidosis in the cat: clinical and histopathological findings

A case of feline mannosidosis is described. The animal was very small for its age (nine months) and showed skeletal defects and severe neurological signs which were first recognized at seven months of age. There was extensive cytoplasmic vacuolation of cells in visceral organs and in the nervous system. The vacuoles were usually empty. This case of mannosidosis in the cat most closely resembles the severe human variant of this disease rather than the bovine disease.