Hi all, I have this case of a 12 yo JRT FS with Cushing’s disease (ocassional seizure) dx in feb 2011, First scan adrenal glands (AG) 2.1 x 0.78(left) and 2.3 x 0.79cm(right) treated with trilostane with good control at 45mg sid. Last month v+,d+,anorexia, seizuring again (today had one while scanning her) ACTH stim test showed escessive suppresion under normal range. so vets decrease dose 25mg sid last week. Scan today lt AG 2.98x 0.98cm and right 3.1 x 0.78cm hypoechoic but normal shape. (ill post images soon) What’s going on here? should we recommend MRI to check for brain tumor?
Hi all, I have this case of a 12 yo JRT FS with Cushing’s disease (ocassional seizure) dx in feb 2011, First scan adrenal glands (AG) 2.1 x 0.78(left) and 2.3 x 0.79cm(right) treated with trilostane with good control at 45mg sid. Last month v+,d+,anorexia, seizuring again (today had one while scanning her) ACTH stim test showed escessive suppresion under normal range. so vets decrease dose 25mg sid last week. Scan today lt AG 2.98x 0.98cm and right 3.1 x 0.78cm hypoechoic but normal shape. (ill post images soon) What’s going on here? should we recommend MRI to check for brain tumor? why is suppressing so much but adrenals are worse than first scan? any ideas will be appreciated.
Veronica
Comments
MRI yes especially with
MRI yes especially with seizure activity as it may be an expansive macroadenoma. Check a blood pressure too as Cushing’s dogs are often hypertensive. I think there was a report out there that showed adrenal hypertrophy after trilostane tx but honestly we really don’t know what happens to adrenals neither on lyseodren nor on trilostane.
remo?
MRI yes especially with
MRI yes especially with seizure activity as it may be an expansive macroadenoma. Check a blood pressure too as Cushing’s dogs are often hypertensive. I think there was a report out there that showed adrenal hypertrophy after trilostane tx but honestly we really don’t know what happens to adrenals neither on lyseodren nor on trilostane.
remo?
I agree with the MRI as the
I agree with the MRI as the seizures may be associated with a pituitary tumor.
With trilostane the adrenal glands enlarge despite the disease being under control. Here are two studies that have shown this:
Am J Vet Res. 2002 Apr;63(4):506-12. Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane.
Ruckstuhl NS, Nett CS, Reusch CE.
OBJECTIVE: To determine the efficacy of trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, in dogs with pituitary-dependent hyperadrenocorticism (PDH).
ANIMALS: 11 dogs with PDH.
PROCEDURE: The initial dose of trilostane was 30 mg, PO, q 24 h for dogs that weighed < 5 kg and 60 mg, PO, q 24 h for dogs that weighed > or = 5 kg. A CBC count, serum biochemical analyses, urinalysis, ACTH stimulation test, and ultrasonographic evaluation of the adrenal glands were performed in each dog 1, 3 to 4, 6 to 7, 12 to 16, and 24 to 28 weeks after initiation of treatment.
RESULTS: All dogs responded well to treatment. All had reductions in polyuria-polydipsia and panting and an increase in activity. Polyphagia decreased in 9 of 10 dogs, and 9 of 11 dogs had improvement of coat quality and skin condition. Concentration of cortisol after ACTH stimulation significantly decreased by 1 week after initiation of treatment. After treatment for 6 months, clinical signs resolved in 9 dogs. In the other 2 dogs, marked clinical improvement was reported for 1 dog, and moderate improvement was reported in the other dog. Ultrasonographically, there was a considerable change in the parenchyma and an increase in size of the adrenal glands. Adverse effects consisted of 1 dog with transient lethargy and 1 dog with anorexia.
CONCLUSIONS AND CLINICAL RELEVANCE: Trilostane is an efficacious and safe medication for treatment of dogs with PDH. Additional studies in a larger group of dogs and characterization of progressive changes in adrenal glands are needed.
Vet Radiol Ultrasound. 2003 Nov-Dec;44(6):682-5. Changes in ultrasonographic appearance of adrenal glands in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane. Mantis P, Lamb CR, Witt AL, Neiger R.
Trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, has been used successfully over the last few years for the treatment of canine pituitary-dependent hyperadrenocorticism. In a prospective study of 19 dogs with pituitary-dependent hyperadrenocorticism, the adrenal glands were measured before and at least 6 months after initiation of trilostane therapy. Right adrenal gland length and caudal pole thickness and left adrenal gland caudal pole thickness increased significantly (p < or = 0.05); there was no significant change in left adrenal gland length. Enlargement of adrenal glands during trilostane therapy may occur as a result of suppression of the negative feedback mechanism affecting cortisol production.
I agree with the MRI as the
I agree with the MRI as the seizures may be associated with a pituitary tumor.
With trilostane the adrenal glands enlarge despite the disease being under control. Here are two studies that have shown this:
Am J Vet Res. 2002 Apr;63(4):506-12. Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane.
Ruckstuhl NS, Nett CS, Reusch CE.
OBJECTIVE: To determine the efficacy of trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, in dogs with pituitary-dependent hyperadrenocorticism (PDH).
ANIMALS: 11 dogs with PDH.
PROCEDURE: The initial dose of trilostane was 30 mg, PO, q 24 h for dogs that weighed < 5 kg and 60 mg, PO, q 24 h for dogs that weighed > or = 5 kg. A CBC count, serum biochemical analyses, urinalysis, ACTH stimulation test, and ultrasonographic evaluation of the adrenal glands were performed in each dog 1, 3 to 4, 6 to 7, 12 to 16, and 24 to 28 weeks after initiation of treatment.
RESULTS: All dogs responded well to treatment. All had reductions in polyuria-polydipsia and panting and an increase in activity. Polyphagia decreased in 9 of 10 dogs, and 9 of 11 dogs had improvement of coat quality and skin condition. Concentration of cortisol after ACTH stimulation significantly decreased by 1 week after initiation of treatment. After treatment for 6 months, clinical signs resolved in 9 dogs. In the other 2 dogs, marked clinical improvement was reported for 1 dog, and moderate improvement was reported in the other dog. Ultrasonographically, there was a considerable change in the parenchyma and an increase in size of the adrenal glands. Adverse effects consisted of 1 dog with transient lethargy and 1 dog with anorexia.
CONCLUSIONS AND CLINICAL RELEVANCE: Trilostane is an efficacious and safe medication for treatment of dogs with PDH. Additional studies in a larger group of dogs and characterization of progressive changes in adrenal glands are needed.
Vet Radiol Ultrasound. 2003 Nov-Dec;44(6):682-5. Changes in ultrasonographic appearance of adrenal glands in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane. Mantis P, Lamb CR, Witt AL, Neiger R.
Trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, has been used successfully over the last few years for the treatment of canine pituitary-dependent hyperadrenocorticism. In a prospective study of 19 dogs with pituitary-dependent hyperadrenocorticism, the adrenal glands were measured before and at least 6 months after initiation of trilostane therapy. Right adrenal gland length and caudal pole thickness and left adrenal gland caudal pole thickness increased significantly (p < or = 0.05); there was no significant change in left adrenal gland length. Enlargement of adrenal glands during trilostane therapy may occur as a result of suppression of the negative feedback mechanism affecting cortisol production.
Boy those adrenals just keep
Boy those adrenals just keep on working don’t they:)
Boy those adrenals just keep
Boy those adrenals just keep on working don’t they:)
My goodness, how interesting!
My goodness, how interesting! Thanks a lot for these awesome comments! Yes, I think the owner is accepting taking this little one for MRI!
Thank you so much!!!!!!!!!!! I didnt post the images as the adrenals are just the classic enlarged ones and hypoechoic, preserving its shape, but should I post them anyway for the forum?
My goodness, how interesting!
My goodness, how interesting! Thanks a lot for these awesome comments! Yes, I think the owner is accepting taking this little one for MRI!
Thank you so much!!!!!!!!!!! I didnt post the images as the adrenals are just the classic enlarged ones and hypoechoic, preserving its shape, but should I post them anyway for the forum?
Yes please do upload the
Yes please do upload the images but if not handy i can put a couple of typical ones up but we like to stay true to the case. Great thread guys !!
Yes please do upload the
Yes please do upload the images but if not handy i can put a couple of typical ones up but we like to stay true to the case. Great thread guys !!