Update
DIAGNOSIS:
Intersexuality ( hemaphrodite)
Bilateral Nephroliths and Mineralization of the Kidneys
HISTORY:
AmberLeah LouLou is a 7 month old intact female Chihuahua. Her owner bought her from a breeder off of Craigslist
when she was 6 weeks old on May 1st. At that time she believed that she had a larger than normal vulva but it has
gradually increased in size since then and is now elongated and swollen. She has never gone through a heat cycle. She
also has been polydipsic, polyuric and pollakiuric since she brought her home. The owner reports that she drinks a lot
during the day. She will frequently urinate multiple times in an hour. Occasionally she will dribble when walking but
the owner has not noticed any wet spots after she lays down or on her blankets after she takes a nap. Two months ago
she collected urine from AmberLeah LouLou and brought it to her referring veterinarian for a urinalysis. They found
some blood in her urine and prescribed an antibiotic which did not improve her polyuria/polydypsia. She is an indoor
only dog that uses peepads throughout the house but has frequent accidents. She also had some hair loss, which the
owner reports that she had this at 6 weeks but that the hair loss has gotten worse over the past few months.
AmberLeah Loulou is fed Wellness puppy a mix of dry and canned about a fistful of both twice daily. She is hand fed
her food as she is a picky eater though she readily eats the 4-5 wellness puppy treats she receives daily. She is normally
on Revolution though she is two weeks overdue and they found a flea on her a couple of day s ago and gave her a flea
bath. She is up to date on her puppy vaccines though she still needs her rabies and lepto. Her parents were both 8
pounds and the breeder refuses to answer emails regarding genetic problems and if the other puppies are small. She lost
her deciduous tooth 805 last week.
PHYSICAL FINDINGS:
On physical exam AmberLeah Loulou was bright, alert and responsive. She had a temperature of 102.0 F, her HR was
200 bpm and she was shaking. She weighed 3.07 pounds and had a BCS of 5/9. She had an enlarged and protruding
vulva about 3cm by 1 1/2cm in size. Palpation of the vulva alluded to a thin hard structure inside the vulva consistent
with an os clitoris. She also has some bilateral symmetrical hair loss over her rump, chest, ears and shoulders. She has a
mottled pattern of hair loss over her dorsum. She was very tense on abdominal palpation and her kidneys could not be
palpated. She had a retained deciduous tooth 305.
DIAGNOSTIC TESTS:
Abdominal ultrasound:
Summary:
Bilateral nephroliths and/ or dystrophic mineralization of the renal diverticula
CBC:
DATE OF ADMISSION: 11/15/2011 DATE OF DISCHARGE: 11/15/2011
PRESENTING COMPLAINT: PU/PD and an enlarged vulva
Procedure Ref Range Units.
DISMISSAL INFORMATION:
AmberLeah was referred for abnormal vulvar conformation and increase water intake and urination. Given the
diagnostics previously performed our differential included: underlying systemic disease causing pu/pd like behavior
(endocrine, liver, renal), urinary tract infection or vaginitis, and possible exterior genital abnormalities cause by
inappropriate androgen secretion. This over exposure is usually due to the fetus being exposed to excess androgens,
otherwise known as sex hormones, during development. Much less commonly it can occur to due self release of
androgens from the adrenal glands or sex organs. This type of change would be described a hermaphroditism (or a mix of
both female and male reproductive organs) now termed intersexuality.
Diagnostics today showed no major abnormalities on bloodwork or urinalysis that would easily explain her increased
thirst and urination or physical changes. There was a mild increase in calcium, hypercalcemia can cause Pu/pd to occur
but often at much higher values. Abdominal ultrasound revealed small renal nephroliths and cystic mineralization. This
could be due to underlying renal disease or cyclic increases in this hypercalcemia causing mineralization. Her specific
gravity indicated that she was able to concentrate urine well and that no indication of infection was noted. In terms of her
increased thirst and urination we would recommend performing an ionized calcium (which is a truer reflection of the
calcium circulating in the body).
In terms of her sex organs no obvious abnormalities which seen on abdominal ultrasound. The ovaries were both
visualized, and her uterus was present. Ultrasound is a sensitive medium but there is still some chance that
abnormalities were visualized. If AmberLeah is truly a hermaphrodite (Intersexual changes) then a normal appearing
reproductive tract could be seen with changes to tissue type being more microscopic. We recommend that AmberLeah
LouLou have an exploratory laparotomy (abdominal explore) and be spayed at MSU. At that time we would also like to
perform a vaginal exam consider running some further endocrinological tests to find the source of the excess androgens,
otherwise known as sex hormones, that are resulting in the increase in vulvar size. We may use human gonadotropin
hormone to stimulate androgen release, then we will measure her hormone levels after this to determine if her adrenal
gland is secreting excess androgens or other endocrine hormones. If Amberleah undergoes a spay then she should live a
normal life span to little with no side effects from her conformational changes. Occasionally there is a small piece of
cartilage or bone present in the clitoris of the female dog (like an os penis) that has to be reduced or removed to help
with recurrent urinary signs. This would be address far after her spay.
AmberLeah Loulou's excessive urination and drinking may be due to an anatomic abnormality due to her
pseudohermaphroditic condition, or due to early renal disease. It will be important to submit an ionized calcium level
and consider further endocrine testing. It would be our recommendation to return to MSU and drop Amberleah off with
the internal medicine department to finish her medical work up, then transfer her to soft tissue surgery the next day for
her abdominal explore and spay. Please let us know what date might be convenient for us to pursue this care.
Thank you for bringing AmberLeah LouLou to MSU VTH. She was a wonderful patient.
Thank
my instincts were right
