This 5-year-old MN Golden Retriever was presented for lethargy, walking strange, falling over, confusion, muscular twitching, and anorexia. The physical exam was normal except for mild hyperthermia. Progressive seizure activity also developed in the following days after the patient was treated for arthritic disease. CBC and survey blood chemistry were normal except for moderate hypoglycemia. Tick borne disease titers were normal. The patient was hospitalized and responded well to IV fluids and treatment for hypoglycemia as well as dexamethasone.
This 5-year-old MN Golden Retriever was presented for lethargy, walking strange, falling over, confusion, muscular twitching, and anorexia. The physical exam was normal except for mild hyperthermia. Progressive seizure activity also developed in the following days after the patient was treated for arthritic disease. CBC and survey blood chemistry were normal except for moderate hypoglycemia. Tick borne disease titers were normal. The patient was hospitalized and responded well to IV fluids and treatment for hypoglycemia as well as dexamethasone. The hypoglycemia remained unresponsive to therapy. An insulin:glucose ratio was submitted but canceled due to the histopathologic findings.
Case Study
Neuroendocrine carcinoma; insulinoma in a 5 year old MN Golden Retriever dog
DX
Sonographic Differential Diagnosis
Severe mesenteric lymphadenopathy consistent with neoplastic infiltration.
Image Interpretation
A markedly enlarged, mildly irregularly shaped, hypoechoic mesenteric lymph node lacking delineation between cortex and medulla is being biopsied with ultrasound guidance (linear echogenicity represents the needle).
Outcome
The patient was euthanized due to poor medical response. The actual pancreatic lesion was never visualized which is often the case when insulinoma is present. Insulinomas are often small and isoechoic to surrounding pancreatic parenchyma thus making them difficult to visualize.
Clinical Differential Diagnosis
Insulinoma- extra-pancreatic neoplasia causing hypoglycemic syndrome, metabolic disease, liver disease.
Sampling
16-gauge US guided biopsy of the mesenteric LN shown revealed neuroendocrine carcinoma consistent with insulinoma.
Video
Patient Information
Clinical Signs
- Anorexia
- Ataxia
- Difficulty walking
- Disorientation
- Lethargy
- Neurologic signs
- Staggering
Exam Finding
- Fever
Images
Blood Chemistry
- Glucose, Low
Clinical Signs
- Anorexia
- Ataxia
- Difficulty walking
- Disorientation
- Lethargy
- Neurologic signs
- Staggering
Special Testing
- 4Dx Negative