Case Study

Adrenal Gland Nodule in a 9 year old FS Shih-poo dog

A 9-year-old FS Shih Poo was presented for evaluation of chronic cystitis with elevated ALP activity on blood work.

Sonographic Differential Diagnosis

Left adrenal gland nodules, likely adenoma, possible emerging adenocarcinoma or pheochromocytoma. Nodule in the right adrenal gland. This is likely a fatty nodule, potential concurrent adenoma.

Image Interpretation

The left adrenal gland presented a progressively enlarged nodule. The left adrenal gland was hyperechoic with capsular expansion, which is likely adenoma. The left adrenal gland nodule measured 1.22 x 0.81 cm. A second, heterogenous, nodular change was noted at the caudal pole of the left adrenal gland and measured 0.8 x 0.71 cm. The right adrenal gland revealed a hyperechoic nodule at the cranial pole. The right adrenal gland measured 2.74 x 1.05 cm.

DX

Adrenal gland nodules

Outcome

The owners have decided to medically watch this patient.

Comments

Serial blood pressures and adrenal gland panel are recommended. I recommend full adrenal gland panel in this patient. Justification towards removal of the adrenal gland could be decided based on the progressive changes noted especially if any evidence of PU/PD or elevated blood pressures are present. I strongly recommend left adrenalectomy. There was no evidence of metastatic disease noted.

Clinical Differential Diagnosis

Bladder pathology – resistant bacterial cystitis, neoplasia, uroliths, granulomatous cystitis, polyploid cystitis
Elevated ALP – Cushing’s disease, adrenal neoplasia, gallbladder pathology, hepatic neoplasia