Cushing`s disease, diagnosed by ACTH stimulation test, in an 11 year old MN Schnauzer with sonographically normal adrenal glands

Case Study

Case Study

Cushing`s disease, diagnosed by ACTH stimulation test, in an 11 year old MN Schnauzer with sonographically normal adrenal glands

A 11-year-old MN Miniature Schnauzer that had been diagnosed and treated for hypothyroidism was presented for evaluation of suspected Cushing’s disease based on clinical findings of PU/PD, polypnea, and thin hair coat, suspicious CBC and serum biochemistry, and inconclusive blood dexamethasone suppression test.

A 11-year-old MN Miniature Schnauzer that had been diagnosed and treated for hypothyroidism was presented for evaluation of suspected Cushing’s disease based on clinical findings of PU/PD, polypnea, and thin hair coat, suspicious CBC and serum biochemistry, and inconclusive blood dexamethasone suppression test.

DX

Cushing`s disease

Sonographic Differential Diagnosis

Pituitary-dependent hyperadrenocorticism or stress could be the cause of bilaterally prominent adrenal glands. The abdomen was structurally unremarkable otherwise. If the urine specific gravity is less than 1.020, ACTH stimulation would be warranted as well as blood pressure measurements.

Image Interpretation

The adrenal glands appeared slightly prominent, mildly heterogenic and slightly nodular. The sonographer noted a more distinct separation of echogenicity between the adrenal cortices and surrounding fat. This is considered likely an age related change with the minimal potential of emerging neoplastic event. No evidence of capsular expansion or invasion in the phrenic veins was noted; no overt suspicion of neoplasia was noted. The left adrenal gland measured 0.67 cm. The right adrenal gland measured 0.62 cm.

Outcome

The ACTH stimulation test was positive, and the dog is being treated for Cushing`s disease.

Comments

Even though the adrenal gland size is on the upper limits of normal, the sonographer noted a more distinct separation of echogenicity between the adrenal cortices and surrounding fat as well as a generalized swollen contour. Given that the clinical presentation was consistent with Cushing`s disease (PU/PD, body conformation …etc), ACTH stimulation was performed. This is a case of “measurements may not tell the entire story.” It is therefore important to diagnose the patient and clinical-sonographic presentation and not necessarily the measurements that may not fall into the normal range available in the literature.

Clinical Differential Diagnosis

Adrenal-dependent hyperadrenocortism, pituitary-dependent hyperadrenocortism, iatrogenic Cushings

Sampling

None

Patient Information

Patient Name : Pepper B
Gender : Male, Neutered
Species : Canine
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 07_00098

Clinical Signs

  • Hair loss
  • PU-PD
  • Tachypnea

History

  • Hypothyroidism

Images

AdrenalsPepperBaumannosigCushings1_08182012120800AdrenalsPepperBaumannosigCushings2_08182012121158

Clinical Signs

  • Hair loss
  • PU-PD
  • Tachypnea
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