Today's Veterinary Practice

SEP-OCT 2018

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PEER REVIEWED 32 SEPTEMBER/OCTOBER 2018 todaysveterinarypractice.com For what seemed to be a similar syndrome in cats, I proposed the term "Pandora syndrome" 2 to describe the signs exhibited by domestic cats receiving veterinary care for chronic clinical signs referable to many organ systems. The name is derived from the many complicated problems released when Pandora opened the mythical box she encountered. These cats experience variable combinations of a ■ history of early adverse experience or severe stressful events ■ comorbid health problems ■ waxing and waning of clinical signs associated with environmental events Nearly all of these cats also respond to Multimodal Environmental MOdification (MEMO) with resolution of both the index and comorbid signs. Use of the term "Pandora syndrome" avoids applying any particular organ name to the disorder in the absence of evidence that the disease arose in the LUT (and presence of evidence that it did not), as opposed to the LUT being affected by pathology in another system. CENTRAL STRESS RESPONSE SYSTEM Pandora syndrome is an "anxiopathy": that is, a pathologic condition resulting from chronic activation of the central stress response system (CSRS) ( FIGURE 1 ). 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 ( TABLE 1 ). 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 TABLE 1 Signs That May Indicate Pandora Syndrome SYSTEM SIGNS OR DISORDERS Behavioral Excessive hiding, pica, aggression, periuria, perichezia Cardiovascular Hypertrophic cardiomyopathy, saddle thrombi Endocrine Obesity, type 2 diabetes mellitus, others? Gastrointestinal Odontoclastic resorptive lesions, regurgitation, vomiting, hairball expulsion, large bowel diarrhea, perichezia Immune Upper respiratory infections Nutritional Obesity, finicky eating Respiratory Asthma Skin Overgrooming, chin acne, atopy, behavioral ulcerative dermatitis Urinary Stones, interstitial cystitis, periuria, spraying, chronic kidney disease FIGURE 1. The central stress response system. O RG A N ( S ) Immune Endocrine Autonomic T H R E AT Hypothalamus The Central Stress Response System

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