Bilateral adrenal enlargement in a 13 year old FS DLH cat

History

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.

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.

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).

DX

Bilateral adrenal enlargement

Sampling

None taken

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.

UA Specific Gravity Range

1.013

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.

Video

Patient Information

Patient Name : Ashley I
Age : 13 Years
Gender : Female, Spayed
Species : Feline
Liz Wuz Here : Yes
Status : Complete
Code : 07_00017

Blood Chemistry

  • Amylase, High
  • Azotemia
  • CPK, High
  • Creatinine, High
  • Potassium, High

CBC

  • Hematocrit, Low
  • Lymphocytes, Low
  • Neutrophils, High
  • Platelet Count, Low

Clinical Signs

  • Abdominal Distension
  • Alopecia
  • Anorexia

History

  • Corneal ulcer

Urinalysi

  • Albumin Present
  • Blood Present
  • Protein Present

Images

power_doppler_LADRpower_Doppler_RADR_poss_FAT

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