A 12-year-old NM Shepherd mix dog was presented for evaluation of generalized hair loss, abdominal distension, and PU/PD. Urine SG was 1.010. Abnormalities on serum biochemistry were elevated liver enzyme activity (ALP 475, ALT 213, GGT 21) and cholesterol (454). ACTH stimulation test showed high basal cortisol (6.7) and marginally elevated post cortisol (10.6).
Left adrenal gland mass, appears resectable. No obvious invasion in the vena cava.
Dystrophic mineralization of the spleen.
Vacuolar hepatopathy liver pattern with emerging mucocele.
Ideally CT would be performed for surgical planning in this patient as well as left adreanlectomy and expression of the gallbladder would be warranted. Serial blood pressure measurements would also be warranted prior to surgical intervention. No obvious vena cava invasion was noted from the right approach into the vena cava caudal to the right adrenal gland; however, the vena cava in the region of the left adrenal gland was difficult to ascertain owing to the dystrophic mineralization and acoustic shadowing. Therefore, the surgeon should be prepared for minor invasion into the vena cava. However, this appears to be resectable. CT evaluation could refine this interpretation further.
The right adrenal gland was uniform and measured 3.18 x 0.78 cm at the cranial pole and 0.59 cm at the caudal pole. The left adrenal gland was comprised of a mineralizing mass that measured 6.0 x 3.13 cm at the cranial pole and 1.25 cm at the caudal pole. This is strongly consistent with carcinoma. This may be intermittently functional explaining the normal ACTH stimulation in light of the clinical signs. The liver presented vacuolar hepatopathy pattern with uniform enlargement. This is consistent with steroid hepatopathy. There was no evident metastatic disease. The gallbladder presented some sand and debris in the cystic duct as well. This is consistent with emerging mucocele and bile calculi.
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Cushing’s disease – pituitary dependent, adrenal neoplasia (functional adenoma, adenocarcinoma), iatrogenic
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