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Right adrenal gland mass with early phrenic vein invasion in a 13 year old MN DSH cat

Case Study

Case Study

Right adrenal gland mass with early phrenic vein invasion in a 13 year old MN DSH cat

A 13-year-old NM DLH with a history of diabetes mellitus was presented for evaluation of corneal changes and a pendulous large abdomen. The only abnormality on urinalysis was glycosuria. Abnormalities on serum biochemistry were elevated fructosamine (648), amylase (1507), triglycerides (402) and PSL (405).

A 13-year-old NM DLH with a history of diabetes mellitus was presented for evaluation of corneal changes and a pendulous large abdomen. The only abnormality on urinalysis was glycosuria. Abnormalities on serum biochemistry were elevated fructosamine (648), amylase (1507), triglycerides (402) and PSL (405).

Image Interpretation

A right adrenal mass was noted with a pericapsular inflammatory pattern and measured 1.9 x 1.6 cm. This is strongly suggestive for carcinoma. The right adrenal gland mass did not appear to be invading the vena cava; however, the phrenic vein appeared to be occupied by expansive tissue. Immediate right adrenalectomy is recommended after medical staging. The left adrenal gland was uniform and measured 0.69 cm.

The right kidney measured 3.8 cm with irregular contour and mildly increased cortical echogenicity. This is consistent with interstitial nephrosis. The right kidney presented cortical infarcts. The left kidney measured 4.26 cm. 

DX

Right adrenal gland mass with early phrenic vein invasion.

Outcome

Stress left adrenal gland.
Renal remodeling with interstitial nephrosis pattern and cortical infarcts.

Comments

Usually in cats adrenal glands are associated with Conn’s syndrome. However, the sodium potassium ratio is not altered. Intermittent secretion could be an issue or non functional adenocarcinoma. Given the size, irregularity pericapsular inflammatory pattern, early phrenic vein invasion carcinoma is suspected. Very rarely cats can have pheochromocytoma, which is a technical possibility in this case. Serial blood pressure measurements and right adrenalectomy is recommended. Pancreatic biopsy may be opportune at this time for long term management.  Urine culture is warranted as urinary tract infection may be compromising the diabetic regulation.

Clinical Differential Diagnosis

Uncontrolled diabetes mellitus
Insulin resistant diabetes – adrenal gland disease, acromegaly
Pancreas – chronic pancreatitis, neoplasia

Video

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Patient Information

Patient Name : Hugo Conn
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 07_00199

Clinical Signs

  • Pendulous Abdomen

History

  • Diabetes, uncontrolled

Images

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Blood Chemistry

  • Amylase, High
  • Fructosamine, High
  • Hypertriglyceridemia

Clinical Signs

  • Pendulous Abdomen

Urinalysi

  • Glucose Present