>...I noticed a couple of weeks ago a slightly swollen vulva on my 3.5
>year old female Mitzi.  We decided to draw some blood and send out an
>adrenal panel to Tennessee.  We also checked some blood chemistries at
>work and they came back normal.  Her urinalysis came back with some
>traces of blood and some strange looking white cells, so we put her on
>Clavamox drops for a week and decided to recheck at that time.  By that
>time the Tennessee panel came back and her values on that were:
>
>  Estradiol 91.9 (normal range 30-180)
>  17-hydroxyprogesterone less than .03 (normal 0-0.8)
>  Androstenedione 16.4 (normal 0-15)
>
>Meanwhile, the second urinalysis came back still with a slight trace of
>blood, and still some funky white cells and she was on Clavamox for a
>few more days and we will probably be re-checking that again.  Her vulva
>still looks about the same size to me.
>
>I have noticed that she doesn't seem to be the pushover she was when I
>first brought her home this past December from a shelter, but that could
>also be that she's settled into our group more and feels more confident,
>but I mention that also in case her behavior changes could be relevant.
 
Here's my read on this one = early adrenal.  Swollen vulva - pretty
classic, questionable behavioral signs, but a definitely (and reproducible)
elevation of an androgen.
 
Females with swollen vulvas may have elevated estrogens if they are intact,
have an estrogen remnant, or adrenal disease.  However, if the androgens
are elevated, that eliminates the others and points to adrenal disease.
There is really no other reason for androgens to be elevated.
 
Regarding the urinalysis, I would also include a stump pyometra in the
differential diagnosis - this may be the source of the "funky white
cells" - could they be uterine endometrium?
 
With kindest regards,
Bruce H. Williams, DVM, DACVP
 
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---
The sensitivity of the 7 hormones that the U of Tenn runs varies.
Androstenedione has the highest sensitivity of all of them (0.76).  Since
her Andro level was elevated and she has a swollen vulva, it does indeed
sound like an adrenal case.  A lot of the females with a swollen vulva
will develop a vaginitis and/or bladder infection.  I would continue with
Clavamox (or Baytril) and schedule her for surgery.
 
Hope that helps,
Jerry Murray, DVM
[Posted in FML issue 3420]