A 10-year-old spayed female Labradoodle, that had been recently been diagnosed with Cushing’s disease and treated with progressively increased doses of Vetoryl, was presented for evaluation of shaking, muscle tremors, and no improvement in the PU/PD and polyphagia.
Uncontrolled Cushing’s disease, adrenal neoplasia, reaction to trilostane
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Bilateral adrenal gland hypertrophy with loss of structural detail and phrenic vein thrombosis. This is likely a sequelum from an inflammatory event owing to degenerative or active inflammatory process. There is a potential for bilateral adrenal gland neoplasia with phrenic vein invasion. However, the contour of both adrenal glands appear to be uniform and would be more consistent with post Vetoryl complications. I recommend full coagulation panel, blood pressure measurements and Plavix therapy. Complete 24-hour care and anti thrombotic protocol would be recommended along with reassessment of the clinical signs and sonogram daily. Very guarded prognosis. Vascular surgeon may be necessary in this patient.
The left adrenal gland in this patient was moderately enlarged with a uniform, swollen pericapsular inflammatory pattern. The left adrenal gland measured 4.14 x 1.67 cm at the cranial pole and 1.6 cm at the caudal pole. Loss of structural detail was noted within the left adrenal gland. The right adrenal gland was also swollen and irregular. The right adrenal gland measured 3.1 x 1.84 cm cranial and 1.33 cm at the caudal pole. The left and right phrenic veins were occupied by hypoechoic tissue or thrombosis with pericapsular inflammatory pattern. This is a medical emergency. Regional inflammation and free fluid was noted in this area.
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