Pituitary dependant hyperadrenocorticism in a 13 year old FS mixed breed dog

Case Study

Pituitary dependant hyperadrenocorticism in a 13 year old FS mixed breed dog

A 13 year old, SF mixed breed dog was presented for polyuria, polydypsia, and loss of fur. On physical examination, she had a pot-bellied appearance. Urinalysis revealed 2+ proteinuria and positive microalbuminuria. Elevated ALP activity and hyperlipasemia were evident on blood chemistry. ACTH stimulation test showed normal baseline cortisol level with an elevated level post ACTH. Adrenal panel revealed increased baseline androstenedione with elevated level post ACTH, increased baseline estradiol with normal value post ACTH, and normal baseline progesterone with elevated level post ACTH.

A 13 year old, SF mixed breed dog was presented for polyuria, polydypsia, and loss of fur. On physical examination, she had a pot-bellied appearance. Urinalysis revealed 2+ proteinuria and positive microalbuminuria. Elevated ALP activity and hyperlipasemia were evident on blood chemistry. ACTH stimulation test showed normal baseline cortisol level with an elevated level post ACTH. Adrenal panel revealed increased baseline androstenedione with elevated level post ACTH, increased baseline estradiol with normal value post ACTH, and normal baseline progesterone with elevated level post ACTH. On dexamethasone suppression test, basal cortisol was 2.6 and the 8 hour value was 8.6. T4 was low.

Sonographic Differential Diagnosis

Pituitary dependent hyperadrenocorticism versus bilateral adrenal enlargement due to concurrent disease or stress.

Image Interpretation

The adrenals are bilaterally enlarged, smooth in echogenicity and retaining normal shape and capsular integrity.

DX

Pituitary dependant hyperadrenocorticism

Outcome

The patient was started on Soloxine 0.5 mg once daily by mouth and trilostane 40 mg once daily by mouth.

Clinical Differential Diagnosis

Cushing’s disease, adrenal sex hormone imbalance.

Sampling

None

Patient Information

Patient Name : Noelle B
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 07_00046

Clinical Signs

  • Alopecia
  • PU-PD

Exam Finding

  • Pot belly

Images

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Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • Hypothyroidism
  • Lipase, High

Clinical Signs

  • Alopecia
  • PU-PD

Special Testing

  • ACTH Stim Positive for Cushing's

Urinalysi

  • Albumin Present
  • Protein Present
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