Functional adrenal adenoma and renal amyloidosis in a 9 year old FS Labrador Retriever

History

A 9 year old FS Labrador was presented for anorexia. Previous laboratory work had shown an inappropriate urine SG, 3+ proteinuria, microalbuminuria, azotemia, thrombocytosis, and negative 4Dx. The only significant abnormality on physical examination was dehydration. Baseline androstenedione and estradiol were elevated and ACTH stimulation revealed elevated cortisol, elevated estradiol, and elevated progesterone.

Clinical Differential Diagnosis

Renal disease – chronic kidney disease, glomerulonephritis, chronic GI tract hemorrhage. Adrenal disease – neoplasia, adrenal sex hormone imbalance.

DX

Functional adrenocortical adenoma and renal amyloidosis and tubular atrophy

Sampling

Surgically obtained biopsies of the adrenal gland and kidney revealed adrenal adenoma and renal amyloidosis respectively.

Sonographic Differential Diagnosis

The left adrenal mass could be adenocarcinoma, pheochromocytoma, adenoma or hyperplasia, and it appears resectable. The appearance of the kidneys suggests interstitial nephrosis, amyloidosis, or degenerative cortical disease.

Image Interpretation

There is a left adrenal mass which is heterogenous with loss of internal architecture. No overt vascular invasion is noted imaging from both right and left sides. The kidneys revealed diffuse uniform hyperechoic cortical changes with minor loss of corticomedullary detail.

Outcome

The left adrenal mass was removed and a wedge biopsy of the left kidney taken, which showed an adrenocortical adenoma and renal amyloidosis. No further medication was recommended for the adrenal gland.