Hypoadrenocorticism in a Dog Following Recovery from Alpha-Amanitin Intoxication

SIMPLE SUMMARY: Amanitin-containing mushroom poisonings occur worldwide and affect both humans and animals. Intoxication from these mushrooms can cause severe gastrointestinal, liver, and neurologic dysfunction, which can result in death. This case report discusses amanitin-induced liver dysfunction and the development of hypoadrenocorticism following recovery in a dog. A clearer understanding of post-intoxication outcomes would help veterinarians prepare pet owners to understand the implications and long-term consequences of amanitin intoxication. ABSTRACT: A 10-year-old, female spayed Labrador Retriever was referred for acute hepatopathy and urinary retention. Blood work from the initial presentation (day 0) revealed a severe, mixed hepatopathy. Over the course of the patient’s hospitalization, the patient developed liver insufficiency. Urine was submitted for toxicological screening and revealed detection of a trace concentration of alpha-amanitin. The patient was treated supportively for alpha-amanitin intoxication and was discharged from the hospital on day 8, with most biochemical parameters being markedly improved. The patient was persistently hyporexic at the time of discharge. On day 15, at a recheck appointment, the patient had lost 2.4 kg and liver enzymology revealed improved values. On day 24, the patient was presented for anorexia and vomiting and had lost another 2.3 kg. Blood work and endocrinological testing at that time were consistent with hypoadrenocorticism. The patient was started on glucocorticoids and mineralocorticoids. At day 106, the patient was doing well clinically while receiving monthly mineralocorticoids and daily glucocorticoids. This case report is the first to describe the chronological association between alpha-amanitin-induced liver dysfunction and the subsequent development of adrenal insufficiency in a dog.