Ultrasonography is frequently utilized in patients with urinary incontinence to screen for structural abnormalities such as ectopic ureters (EUs). Furosemide can be administered during an ultrasound for a better assessment of the ureters and their insertions. Furosemide decreases urine specific gravity (USG), and differences in specific gravity allow a better visibility of ureteral jets on ultrasound; however, it is unknown whether furosemide has utility in patients with hyposthenuria or isosthenuria. The aims of this study were to determine if furosemide administration improves the diagnosis of EUs using ultrasound and if there is a USG below which furosemide will not increase ureteral jet visibility. Thirty-one dogs with clinical suspicion for EUs, and seven dogs with polyuria and polydipsia were included. Urinary tract ultrasonography was performed, and a diagnosis of the presence or absence of EUs was made. Urine collected by urocystocentesis was used to measure USG, furosemide was administered, and the exam was repeated. Ultrasound results were compared to cystoscopy or other means of negative diagnosis to determine accuracy. The accuracy of the EU diagnosis following furosemide was not statistically significant. There was a significant increase in the confidence of diagnosis post-furosemide; there was no association between increased confidence and improved accuracy. Ureteral jets were visible following furosemide in dogs with USGs as low as 1.006. On the basis of these findings, furosemide can be helpful to improve confidence of EU diagnosis and can be administered to increase ureteral jet visibility in dogs with hyposthenuria or isosthenuria.

Hypothalamic obesity (HO) is a severe complication of suprasellar tumors characterized by hyperphagia, rapid weight gain, and resistance to lifestyle interventions. We describe a case of a woman diagnosed with suprasellar germinoma at 16 years of age who was treated with chemotherapy and radiotherapy. Subsequently, she experienced progressive weight gain, increasing from 57 kg to a peak of 138 kg by age 37 years, and developed type 2 diabetes mellitus at age 28 years. At age 38 years, she presented with polydipsia, polyuria, and fatigue, and was admitted for the management of hyperglycemia with class III obesity (123.5 kg; body mass index [BMI], 51.4 kg/m2). Intensive insulin therapy (up to 100 units/day) resolved glucotoxicity. After initiation of semaglutide (titrated from 0.25 to 0.5 mg/week), appetite markedly decreased, and subsequent weight loss was achieved. Three months after discharge, her weight decreased from 131 kg to 112.1 kg, representing an approximate 14% reduction, accompanied by optimized glycemic control. Body composition analysis revealed that weight loss was primarily due to fat mass reduction with relative preservation of muscle mass. This case demonstrates the potential efficacy of semaglutide in patients with HO and type 2 diabetes mellitus after suprasellar germinoma treatment.

The post-covid-syndrome (PCS) is characterized by severe persisting fatigue and other long haul symptoms following COVID-19 infection. Disease-driving mechanisms are elusive, biomarkers are missing, treatment options few, and yet millions of people worldwide are affected. We hypothesized that the common complaint of polydipsia/polyuria and its attendant effect on osmolality can be quantified and identified as an unrecognized clinical feature of the PCS. We conducted a clinical case-series of 10 consecutive patients with PCS (5 females, 5 males; mean age 44 ± 14 y) who completed questionnaires covering health status, quality-of-life and post-covid symptoms. Detailed anamnestic work-up and clinical assessment were performed, and serum and urine osmolality (S-osm, U-osm) were determined after overnight fasting and fluid deprivation. Polydipsia and/or polyuria were reported by 7 patients, and measures of osmolality were abnormal in all 10 individuals. S-osm was above the reference range (285-292 mOsm/kg) in 9/10 patients (mean 298 ± 4), and U-osm was below the reference (>750 mOsm/kg) in 7/10 patients (mean 707 ± 149). The combination of high serum and low urine osmolality (n=6) was associated with poorer health status, when compared to single abnormality only (n=4). Signs of connective tissue disorders were common among participants, as were previous head-and-neck traumas and activities associated with myofascial distension. Data from this uncontrolled limited sized case series suggests disrupted fluid homeostasis as an unrecognized clinical feature of the PCS. The objective findings of high serum and low urine osmolality are candidates for diagnostic biomarkers as well as potential therapeutic targets and outcome measures.

An 8-month-old intact male Labrador retriever dog from New Brunswick was referred to the Atlantic Veterinary College Small Animal Internal Medicine service (Prince Edward Island) for evaluation of marked hypercalcemia, polyuria-polydipsia, and urinary incontinence. Thoracic radiographs revealed a nonspecific, patchy-to-diffuse, interstitial-to-alveolar lung pattern, despite the absence of respiratory signs or abnormal lung auscultation. Fecal examination by Baermann analysis identified 1st-stage larvae of Angiostrongylus vasorum. Although A. vasorum has been documented in wild canid populations in parts of eastern Canada, this was the first confirmed case of an autochthonous infection in a companion animal in mainland Canada. The findings provide further evidence for the geographic expansion of A. vasorum within the Canadian Maritimes and contribute to a growing body of reports describing its emergence in North America. The dog's clinical presentation was atypical for angiostrongylosis, with no respiratory signs despite radiographic abnormalities, and hypercalcemia as a prominent clinical feature. These findings highlighted the variable and sometimes nonspecific nature of A. vasorum infection in dogs. Veterinarians practicing in eastern Canada should consider A. vasorum as a differential diagnosis in dogs with compatible clinical or imaging findings, even in the absence of respiratory signs or known endemicity. Routine Baermann fecal screening and prophylaxis with effective anthelmintics are recommended for dogs with increased risk of exposure to gastropod intermediate hosts. Key clinical message: Angiostrongylus vasorum is an emerging parasite in North America and can induce a variety of clinical signs in dogs. Veterinarians, specifically in the Canadian Maritimes, need to consider A. vasorum as a potential cause of respiratory signs, neurological signs, bleeding, and other clinical signs, and should recommend appropriate parasite prophylaxis in newly endemic areas.

Acute water intoxication is an uncommon but potentially fatal condition characterized by excessive water consumption over a brief period. It results in dilutional hyponatremia. The condition is frequently associated with psychiatric disorders, endurance athletics, or iatrogenic causes. Early recognition and prompt treatment are crucial for preventing serious complications and ensuring favorable outcomes. A 38-year-old male patient presented to the emergency department exhibiting sudden loss of consciousness followed by altered mental status, confusion, and an episode of seizure. The history revealed ingestion of approximately 8 liters of water within a three-hour period while waiting for uroflowmetry testing. Initial laboratory tests indicated severe hyponatremia with serum sodium of 120 mEq/L. He was diagnosed with acute water intoxication with dilutional hyponatremia. Management involved fluid restriction, electrolyte monitoring, and gradual correction of sodium levels utilizing 3% hypertonic saline. The patient's neurological status improved progressively, and he was discharged after five days. This case highlights the significance of identifying acute water intoxication as a potential etiology of dilutional hyponatremia, particularly in patients presenting with neurological symptoms and a history of excessive fluid intake. Expeditious diagnosis and appropriate management are essential to prevent severe complications such as cerebral edema and permanent neurological damage.

Apparent mineralocorticoid excess (AME) is a rare autosomal recessive disorder caused by loss-of-function mutations in HSD11B2, leading to impaired conversion of cortisol to cortisone and inappropriate mineralocorticoid receptor activation. Early recognition is critical, as untreated disease results in progressive cardiovascular and renal complications. We describe a 2-year-old boy with severe early-onset hypertension, polyuria, polydipsia, abdominal distension, and growth retardation. Biochemistry revealed hypokalemic metabolic alkalosis with suppressed renin and low aldosterone. Renal ultrasonography demonstrated bilateral medullary nephrocalcinosis. Whole-exome sequencing identified a novel homozygous missense mutation in HSD11B2 (c.478G>A; p.Gly160Ser)-previously reported as a variant of unknown significance. Targeted therapy with spironolactone, a thiazide diuretic, potassium supplementation, and adjunct antihypertensives achieved normalization of blood pressure and potassium levels, resolution of alkalosis, and significant catch-up growth over 6 months, with stable renal function. This case expands the mutational spectrum of HSD11B2 and demonstrates that early genetic confirmation and tailored therapy can reverse biochemical abnormalities, promote growth, and prevent long-term sequelae. AME should be considered in children with low-renin, low-aldosterone hypertension, particularly in consanguineous populations.

The epidemiological, clinical and anatomopathological findings of oesophageal pythiosis in two dogs in northeastern Brazil are described. During the study period, 7696 canine tissue samples were evaluated, of which 33 cases of pythiosis were diagnosed (31 intestinal and two oesophageal), with oesophageal involvement accounting for 0.03% of all samples and 6.1% of pythiosis cases. The first dog was a 3-year-old female American Pit Bull Terrier, which was referred with a 2-month history of dysphagia, salivation, regurgitation, weight loss and swelling in the ventral aspect of the cervical region. The second dog was a 3-year-old female mixed breed dog, which was referred with a 30-day history of anorexia, dysphagia, constant salivation, regurgitation, polydipsia and weight loss. Necropsies revealed firm light-yellow multinodular masses extending longitudinally through the oesophageal wall, involving the cervical to mid-oesophagus in case 1 and the middle to distal third in case 2, with a transmural fistulous tract in the latter. Histologically, granulomatous inflammation and necrosis, with intralesional hyphae that failed to stain with haematoxylin and eosin, were observed. Immunohistochemistry (IHC) for Pythium insidiosum revealed strong immunolabelling of the hyphae. The diagnosis of pythiosis was based on the epidemiological, clinical and anatomopathological findings, and confirmed by IHC. Oesophageal pythiosis should be considered as a differential diagnosis in dogs with chronic digestive clinical signs. Histological evidence of granulomatous inflammation associated with unstained hyphae may represent an important diagnostic clue and should prompt further investigation by microbiological, immunohistochemical or molecular methods.

Background: Paraneoplastic limbic encephalitis (PLE) with anti-Ma2 antibodies is a rare immune-mediated disorder associated with testicular cancer, particularly in young males. While neurological manifestations are well documented, hypothalamic-pituitary dysfunctions remain underreported. We present a case of anti-Ma2 PLE associated with testicular cancer together with a systematic review of PLE associated with testicular cancer, selectively restricted to anti-Ma2 positive cases and focusing on hypothalamic-endocrine involvement. Case presentation: We describe a 21-year-old male diagnosed with anti-Ma2 PLE and intratubular germ cell neoplasia of the right testis. He underwent orchifunicolectomy and immunosuppressive therapy with neurological improvement. Four years later, he developed new-onset temporal seizures, decreased libido, and a polyuria-polydipsia syndrome. Dynamic endocrine testing, including a water deprivation test and copeptin measurement, supported a diagnosis of partial central diabetes insipidus (CDI). Methods: A systematic literature review was performed in accordance with PRISMA guidelines. PubMed was searched using predefined keywords without time restriction. Studies reporting PLE associated with testicular tumors in humans with confirmed anti-Ma2 antibody positivity were included. Results: Eleven studies were included, reporting a total of 38 patients with anti-Ma2-associated PLE and testicular cancer. Hypothalamic or diencephalic involvement was described in 16 patients (42.0%), while endocrine manifestations were explicitly reported in four cases. Only two previous reports mentioned CDI, without detailed diagnostic evaluation. Conclusions: This study highlights the importance of recognizing hypothalamic-endocrine manifestations in PLE. In patients presenting with polydipsia and polyuria, CDI should be carefully differentiated from primary polydipsia using dynamic testing. Hypothalamic involvement may emerge years after tumor treatment, warranting long-term endocrine surveillance.

Type 1 diabetes mellitus (DM) usually presents in the pediatric population as weight loss, polyuria, polydipsia, and, occasionally, with abdominal pain, vomiting, and Kussmaul breathing consistent with diabetic ketoacidosis. In this case report, we describe a 17-year-old boy presenting with fatigue and bilateral blurry vision, found to have hyperglycemia and subsequent DM on a laboratory draw before cataract surgery commenced. This patient also had an added complication of pseudophakic cystic macular edema of both eyes after uncomplicated cataract removal, which has not been described in previous case reports of pediatric patients with DM.