A 14-year-old NM DSH was presented for evaluation of no hair regrowth, weight gain, and increased appetite. Urine SG was 1.018, blood pressure 160/85, and CBC and serum biochemistry within reference range.
A 14-year-old NM DSH was presented for evaluation of no hair regrowth, weight gain, and increased appetite. Urine SG was 1.018, blood pressure 160/85, and CBC and serum biochemistry within reference range.
: Enlarged, irregular left adrenal gland. Suspect left adrenal carcinoma. Age related renal changes
The left adrenal gland was enlarged and irregular measuring 1.5 cm with loss of corticomedullary definition. Focal areas of mineralization were noted within the left adrenal gland. Mild, excessive vascularity was noted on the left adrenal gland. This is strongly suggestive for carcinoma. This appears to be impinging upon the vena cava, yet no actual invasion was noted.
The kidneys revealed largely normal size and structure, corticomedullary definition and ratio (cortex 1/3 of medulla) were essentially maintained with some age related loss of curvilinear patterns. The cortices presented largely uniform texture with some age related echogenic changes that are not likely of clinical significance at this time unless inflammatory sediment or proteinuria is present. Medullary echogenicity differed distinctly from that of the cortex and no evidence or dilation could be seen. The capsules were acceptably uniform for this age patient without dramatic irregularities. Slight mineralization was noted in the kidneys. The left and right kidney measured 4.5 cm.
LDDST is recommended with induction at 0.1 mg/kg or direct left adrenalectomy would be recommended. Blood pressure measurements would also be warranted. Sodium potassium ratio would be recommended. If hypokalemia is present then aldosterone level would be warranted to assess for Conn’s syndrome.
Functional adrenal neoplasia
Primary skin – allergic dermatitis, parasites, psychological/behavioural
