Left adrenal mass in a 13 year old FS Shih Tzu dog

Case Study

Case Study

Left adrenal mass in a 13 year old FS Shih Tzu dog

A 13-year-old FS Shih Tzu dog was presented for a growth on the right flank and increased appetite. Previous echocardiography had shown mild mitral regurgitation, and mild but compensated tricuspid valve regurgitation. Abnormalities on physical examination were a growth on the right flank, a growth on the right eye, and generalized alopecia. No abnormalities were seen on urinalysis, and urine culture yielded no growth. Urine Cortisol/ Creatinine ratio and LDDS test results were elevated, CTSH results were high, and T-4 and free T-4 were within normal range. 

A 13-year-old FS Shih Tzu dog was presented for a growth on the right flank and increased appetite. Previous echocardiography had shown mild mitral regurgitation, and mild but compensated tricuspid valve regurgitation. Abnormalities on physical examination were a growth on the right flank, a growth on the right eye, and generalized alopecia. No abnormalities were seen on urinalysis, and urine culture yielded no growth. Urine Cortisol/ Creatinine ratio and LDDS test results were elevated, CTSH results were high, and T-4 and free T-4 were within normal range. 

DX

Left adrenal mass

Sonographic Differential Diagnosis

Left-sided adrenal gland mass. Cranial mesenteric lymphadenopathy.

Image Interpretation

There was a left adrenal gland mass that approached 2 cm in diameter. It appears to have a relatively uniform, rounded shape. However, there were some areas of the gland where the capsule was irregular.

Outcome

Due to concern regarding caudal vena cava invasion on the ultrasound, a CT scan was suggested for definitive assessment. The patient was treated with Trilostane. ACTH stimulation results were pre 2.1 and post 3.8. A follow-up ultrasound several days later showed no change. The patient was presented for difficulty breathing, decreased appetite, and decreased drinking. Physical examination found the patient QAR, pink mucous membranes with CRT<2, a grade V/VI systolic murmur with precardial thrill, and increased submandibular lymph nodes. The patient was treated with Clavamox and placed on low dose aspirin therapy for life.

Clinical Differential Diagnosis

Adrenal gland neoplasia/hyperplasia resulting in Cushing’s disease.

Sampling

US-guided Tru-cut biopsies of the left adrenal gland and a mesenteric lymph node revealed normal appearing adrenal tissue and lymphoid proliferation.

Video

Patient Information

Patient Name : Gizmo S
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 07_00072

Clinical Signs

  • Cutaneous mass
  • Polyphagia

History

  • Mitral insufficiency
  • Tricuspid insufficiency

Exam Finding

  • Alopecia
  • Masses

Images

Adrenalmass_07012012010948

Clinical Signs

  • Cutaneous mass
  • Polyphagia

Special Testing

  • LDDST Positive for Cushing's

Urinalysi

  • Culture negative
  • Urine Cortisol/Creatinine, High
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