Case Study

Adrenal mass with CVC invasion in a 13 year old MN DSH cat

A 13-year-old NM DSH cat was presented for evaluation of polyuria and polydypsia. The only abnormality on urinalysis was low urine specific gravity (1.015). Blood work was within normal limits. ACTH stimulation showed elevated pre and post cortisol (3.6 and 4.9 respectively).

A 13-year-old NM DSH cat was presented for evaluation of polyuria and polydypsia. The only abnormality on urinalysis was low urine specific gravity (1.015). Blood work was within normal limits. ACTH stimulation showed elevated pre and post cortisol (3.6 and 4.9 respectively).

Sonographic Differential Diagnosis

Heterogenic right adrenal gland tumor. Differential diagnoses include adenocarcinoma and pheochromocytoma. A fine needle aspirate would be warranted for a definitive diagnosis. It would also be prudent to send an adrenal panel to the University of Tennessee, a sodium:potassium ratio, and aldosterone levels in this patient. Given the observed changes with the right adrenal gland, this is the most likely cause of the patient’s PU/PD. A cytologic diagnosis should be obtained before surgical intervention is considered.

Image Interpretation

The left adrenal gland was visualized and recognized as having normal shape and size. The right adrenal gland deviated from the normal size and shape and appeared mass-like. The right adrenal gland was heterogenic and measured 1.69 x 2.40cm. Phrenic vein invasion was seen.

DX

Heterogenic right adrenal gland tumor

Outcome

Patient was lost to follow up.

Clinical Differential Diagnosis

Early renal disease. Hyperthyroidism. Adrenal gland dysfunction – functional adenoma, adenocarcinoma, pheochromocytoma Psychogenic polydypsia. Partial central diabetes insipidus.