Pseudocyesis

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Pseudocyesis BASIC INFORMATION           DEFINITION Pseudocyesis is a common syndrome observed in nonpregnant diestrous or early anestrous bitches. It is characterized by different degrees of maternal behavior, mammary gland enlargement, and lactation. SYNONYM(S) Overt False pregnancy Nervous anorexia Pseudopregnancy EPIDEMIOLOGY SPECIES, AGE, SEX: Postpubertal female dogs of any age; cats are not affected. GENETICS AND BREED PREDISPOSITION: Any breed can be affected, although the incidence is higher in Dalmatian, basset hound, and pointer breed dogs. German shepherds are rarely affected. RISK FACTORS: Exogenous administration of progestins, diestrous ovariectomy, and hypothyroidism may trigger its occurrence. ASSOCIATED CONDITIONS AND DISORDERS: Pseudocyesis can coexist with other diestrous diseases, such as pyometra. CLINICAL PRESENTATION DISEASE FORMS/SUBTYPES: Depending on the intensity of clinical signs, pseudocyesis can be classified as: ·        Covert (physiologic although recognizable from the rest of the estrous cycle) ·        Overt, which can even become a clinical problem (clinical pseudocyesis) HISTORY, CHIEF COMPLAINT: History reveals the occurrence of estrus at 6 to 12 weeks previously without an ensuing pregnancy. The chief complaints mainly focus on mammary problems (engorgement, lactation, licking of the glands) and abnormalities associated with aberrant maternal behavior (nesting, digging, adoption of animals or objects). In addition, the bitch may have depression or anxiety, anorexia, and excessive vocalization (whining). PHYSICAL EXAM FINDINGS: Physical exam reveals some degree of mammary enlargement, which can vary from turgid nipples to painful engorgement and galactostasis. Mammary enlargement is most evident in the caudal pair of glands. Intra mammary dermatitis is occasionally present if excessive licking occurs. Mastitis may also be present. ETIOLOGY AND PATHOPHYSIOLOGY The high plasma concentration of prolactin at the end of the luteal phase, when progesterone concentrations decrease abruptly, is associated with the development and maintenance of pseudocyesis. Individual and breed sensitivity to these hormonal changes and environmental factors have been hypothesized to influence its occurrence. DIAGNOSIS                               Overview statement The diagnosis is suspected in any diestrous, non -pregnant bitch with mammary enlargement (and milk secretion) in which other mammary disease has been ruled out. DIFFERENTIAL DIAGNOSIS ·        Pregnancy ·        Pyometra ·        Mastitis ·        Mammary tumors ·        Any other cause of anorexia, depression, or anxiety should be ruled out ·        Pseudocyesis can even coexist with pyometra, mastitis, and mammary tumors INITIAL DATABASE ·        History and physical findings (as already described) ·        Complete blood count (CBC) is normal ADVANCED OR CONFIRMATORY TESTING Use ultrasonography or radiography for confirming the absence of pregnancy or pyometra. TREATMENT                            Treatment Overview Treatment mainly consists on the administration of prolactin decreasing drugs (dopamine agonists or antiserotonergic compounds). ACUTE GENERAL TREATMENT ·        Administer dopamine agonists with food to reduce digestive side effects: Cabergoline (5 mg/kg PO q 24h for 5 to 7) days is a safer choice compared to other prolactin decreasing compounds. ·        Avoid steroid hormones (progestins/ androgens) because they usually postpone the problem. ·        See Mastitis, p XX; Acute Moist Dermatitis, p XX. CHRONIC TREATMENT Clinical, chronic, unresponsive, or recurring pseudocyesis cases should be treated surgically (ovariectomy) after the acute phase of the syndrome has been controlled or during anestrus. Nutritional/dietary therapeutics Although nutritional management was anecdotally indicated for this syndrome, no cure could be detected after short term partial food restriction. Behavioral/physical activity recommendations ·        Discourage maternal behavior, using aversion methods. ·        Avoid stimulation on the mammary glands (e.g., padding [either hot or cold], touching, or milking). ·        If necessary, Elizabethan collars can be used for preventing licking and self-milking. DRUG INTERACTIONS ·        Avoid administering phenothiazine drugs during pseudocyesis because they increase plasma prolactin concentrations. ·        Do not administer the antiserotonergic drug (e.g.,metergoline) for anxious and restless bitches because this could potentiate pseudocyesis behavior. POSSIBLE COMPLICATIONS ·        Mammary dermatitis and mastitis are the most frequent complications and may have an influence in perpetuating the problem. ·        Repeated episodes of pseudocyesis have been hypothetically associated with the future development of mammary tumors. PROGNOSIS AND OUTCOME    Pseudocyesis typically resolves spontaneously within a few weeks (2 or 3 weeks) from its onset; however, pseudocyesis can occasionally persist until the next estrous cycle. PEARLS & CONSIDERATIONS  COMMENTS ·        Pseudocyesis is a good indicator of ovulatory estrous cycles. ·        Predisposed bitches usually suffer the syndrome after each estrous cycle, with the disorder becoming more severe throughout life. PREVENTION ·        Ovariectomy in predisposed bitches. ·        Pregnancy does not prevent future episodes. CLIENT EDUCATION Teach clients to recognize pseudocyesis and to ask for treatment if it becomes clinically relevant. Información suministrada por el agente en SIGEVA