02/24/2024
10y FS Maltese with a 1y history of progressive bilaterally-symmetrical alopecia and hyperpigmentation of the flanks. Endocrine, right? Here’s the twist: CBC, Chem, urinalysis, and thyroid panel were ALL NORMAL! Here’s some other clues: her v***a and ni***es have been enlarging and she has occasionally shown signs of heat despite being spayed. You guessed it! Hyperestrogenism! Her greatly elevated serum estradiol levels confirmed it. Her owner had been prescribed a topical estrogen medication to apply to the inner wrists around the time her symptoms started. This disease occurs in smaller dogs that spend a lot of time in their (usually middle-aged or older, female) owner’s arms. Once the estrogen exposure is removed, the symptoms should eventually fade away (if they don’t, we’d need to look for an ovarian remnant 🤮).
The details in this case were not immediately obvious, and it took a close examination of the medical records, thorough derm exam, and very in depth convo with the owner to figure this one out. It highlights how important good history taking is with dermatology. Often the diagnosis comes primarily from the history!
