18/01/2021
PANDORA SYNDROME IN CATS❗❗
The term “Pandora syndrome” is based on 4 decades of research and clinical experience with cats with chronic lower urinary tract (LUT) signs (i.e., hematuria, pollakiuria, periuria, and stranguria). Studying LUT signs in cats, they were referred to as “feline urological syndrome” (FUS) or “feline lower urinary tract disease” (FLUTD) and were thought to result from consumption of an improperly formulated diet that contained too much magnesium and that resulted in a urinary pH that promoted formation of a magnesium-ammonium-phosphate (struvite) stone, which was the proximate cause of the LUT signs. It has turned out that nearly all of this explanation was wrong. Struvite urolithiasis was found not to be the most common cause of chronic LUT signs; rather, reducing the magnesium and urine pH (primarily by adding acid to the diet) only succeeded in a shift from the most prevalent stone type being struvite to about half of stone diagnoses being calcium oxalate, and cats continued to suffer from chronic LUT signs without any stone present at all.
Pandora syndrome is an “anxiopathy”: that is, a pathologic condition resulting from chronic activation of the central stress response system (CSRS). Persistent activation of this system by a chronic perception of threat that exceeds the animal’s perception of control mobilizes activity in variable combinations of the autonomic nervous, endocrine, and immune systems. The result can be pathology affecting any organ system or combination of organ systems.
The variability in response to chronic perception of threat may result from organ-specific differences in familial (genetic, epigenetic, environmental) vulnerability and from exposure to threatening events such that the CSRS is durably sensitized to the environment. Such events often occur early in life, even before birth when the CSRS is most plastic and vulnerable to the events communicated to it by the mother through the placenta. However, the CSRS can be sensitized by sufficiently harsh events at any time of life.
DIAGNOSING PANDORA SYNDROME
Many organ systems are represented in expression of Pandora syndrome
Pandora syndrome is only one possible cause of the disorders listed and may or may not be eventually added to the differential diagnostic criteria for that disorder.
A tentative diagnosis of Pandora syndrome rests primarily on the results of a comprehensive history and physical examination. Evaluation of the quality of resources for safe space; food and water availability, location, and management; litter box hygiene, opportunities for activity, play, and social contact can also be helpful.
Decisions about medical care of cats with Pandora syndrome depend on the specific presenting problem
Regards
Dr Faizan Asghar (DVM , RVMP)
03038183132