- This is a 16 year old, FS, Cockapoo with elevated cortisol levels on a LDDT, isosthenuria, urine protein to creatinine ratio>3.0, ALT=165.The dog is currently on amlodipine and enalapril for systemic hypertension.
- Abdominal ultrasound shows bilateral adrenal gland masses, splenic hilar thrombus, multiple, bilateral, renal cortical cysts, and heterogeneous hepatic parenchyma.
- The left adrenal gland mass is mineralzied. The right adrenal gland mass is >4.0cm in diameter. It is complex with multiple nodules and possible cysts.
- This is a 16 year old, FS, Cockapoo with elevated cortisol levels on a LDDT, isosthenuria, urine protein to creatinine ratio>3.0, ALT=165.The dog is currently on amlodipine and enalapril for systemic hypertension.
- Abdominal ultrasound shows bilateral adrenal gland masses, splenic hilar thrombus, multiple, bilateral, renal cortical cysts, and heterogeneous hepatic parenchyma.
- The left adrenal gland mass is mineralzied. The right adrenal gland mass is >4.0cm in diameter. It is complex with multiple nodules and possible cysts.
- The left adrenal gland does not show vascular invasion. Patient movement precluded full color flow Doppler evaluation of the right adrenal gland for local vascular invasion.
- Would it be safe to say that this is NOT pituitary based hyperadrenocorticism or is an FNA required? I have not seen such an atypical right adrenal gland with PDH.
- What treatment options are available if both adrenal glands have masses? Surgical debulking or just trilostane or mitotane with Plavix and blood pressure control?
Comments
Would agree that you are
Would agree that you are dealing with adrenal-dependent hyperadrenocorticism and not pituitary-dependent. The question is which one is causing the clinical signs as both are very abnormal and not sure that a FNA would help. With the patient’s age and involvement of both adrenals, may be better to go the medical route – I prefer to use mitotane with adrenal neoplasia.
Thank you so much for your
Thank you so much for your input! That is very helpful.
Riobetti- why do you prefer
Riobetti- why do you prefer Mitotane?
Hi Randy. I seem to have a
Hi Randy. I seem to have a better response with mitotane but is a personal preferance. Mitotane is indicated as palliative treatment of adrenal carcinoma in humans with a similar effect in dogs. Remo
consider myelolipoma as
consider myelolipoma as well… can rescan to see which one is growing, power doppler to assess vascularity and see which or if both are hot vascular.. and 27g fna on both..
re tx i say go wiht what you know mito or trilo.
Thanks Eric!
Thanks Eric!