Case Study

Bilateral adrenal enlargement in a 13 year old FS DLH cat

A 13-year-old FS DLH cat was presented to the clinic for the evaluation of a swollen abdomen, alopecia, and anorexia. The cat had a prior history of surgical correction of a corneal ulcer. The blood chemistry performed at the time of the corneal ulcer had shown a mild azotemia and hyperamylasemia. The CBC showed a low HCT, neutrophilia, and lymphopenia. The T4 was within normal limits. The urinalysis showed a pH within normal limits and a low specific gravity (1.013.) The urine had a clear, yellow appearance, but there was proteinuria (1+) and hematuria (3+) on the dipstick. The sediment confirmed hematuria with a RBC count of 4-10/HPF. Microalbuminuria was present. Repeat bloodwork revealed a marked azotemia, severely elevated creatinine, as well as hyperkalemia, hypermagnesemia, hyperamylasemia, and an elevated CPK. The CBC showed a thrombocytopenia and lymphopenia.

DX

Bilateral adrenal enlargement

Sonographic Differential Diagnosis

Bilateral adrenal enlargement.

Image Interpretation

The adrenal glands were bilaterally enlarged in this patient potentially due to stress or hypersecretion. An ACTH stimulation would be recommended if urine specific gravity is less than 1.020.

Outcome

Assessment of this patient’s metabolic status for diabetes and potential hyperadrenocorticism, as well as hypertension was advised. The patient was euthanized the following day.

Clinical Differential Diagnosis

Swollen abdomen – neoplasia (malignant lymphoma or adenocarcinoma), ascites (feline infectious peritonitis, heart disease). Azotemia – neoplastic infiltration of kidneys, chronic renal failure (acute on chronic episode), glomerulonephritis, pyelonephritis. Thrombocytopenia – lab error, early DIC, leptospirosis (which can cause renal failure as well as thrombocytopenia in both dogs and cats).