Pituitary dependant hyperadrenocorticism in a 13 year old FS mixed breed dog

History

A 13 year old, SF mixed breed dog was presented for polyuria, polydypsia, and loss of fur. On physical examination, she had a pot-bellied appearance. Urinalysis revealed 2+ proteinuria and positive microalbuminuria. Elevated ALP activity and hyperlipasemia were evident on blood chemistry. ACTH stimulation test showed normal baseline cortisol level with an elevated level post ACTH. Adrenal panel revealed increased baseline androstenedione with elevated level post ACTH, increased baseline estradiol with normal value post ACTH, and normal baseline progesterone with elevated level post ACTH.

A 13 year old, SF mixed breed dog was presented for polyuria, polydypsia, and loss of fur. On physical examination, she had a pot-bellied appearance. Urinalysis revealed 2+ proteinuria and positive microalbuminuria. Elevated ALP activity and hyperlipasemia were evident on blood chemistry. ACTH stimulation test showed normal baseline cortisol level with an elevated level post ACTH. Adrenal panel revealed increased baseline androstenedione with elevated level post ACTH, increased baseline estradiol with normal value post ACTH, and normal baseline progesterone with elevated level post ACTH. On dexamethasone suppression test, basal cortisol was 2.6 and the 8 hour value was 8.6. T4 was low.

Clinical Differential Diagnosis

Cushing’s disease, adrenal sex hormone imbalance.

DX

Pituitary dependant hyperadrenocorticism

Sampling

None

Sonographic Differential Diagnosis

Pituitary dependent hyperadrenocorticism versus bilateral adrenal enlargement due to concurrent disease or stress.

Image Interpretation

The adrenals are bilaterally enlarged, smooth in echogenicity and retaining normal shape and capsular integrity.

Outcome

The patient was started on Soloxine 0.5 mg once daily by mouth and trilostane 40 mg once daily by mouth.

Video

Patient Information

Patient Name : Noelle B
Age : 13 Years
Gender : Female, Spayed
Species : Canine
Book : yes
Liz Wuz Here : Yes
Status : Complete
Code : 07_00046

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • Hypothyroidism
  • Lipase, High

Clinical Signs

  • Alopecia
  • PU-PD

Exam Finding

  • Pot belly

Special Testing

  • ACTH Stim Positive for Cushing’s

Urinalysi

  • Albumin Present
  • Protein Present

Images

01090926140126_01112011071652

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