Suspected pituitary-dependent hyperadrenocorticism in an 11 year old FS dog

History

An 11-year-old FS dog was evaluated and presented for alopecia, panting, excessive water drinking, and polyphagia. Urinalysis and CBC were both within normal limits. Abnormalities on blood chemistry were hyperproteinemia, hyperphosphatemia, elevated GGT activity, elevated BUN:creatinine ratio, and hypercalcemia. An ACTH stimulation test was suggestive of hyperadrenocorticism.

An 11-year-old FS dog was evaluated and presented for alopecia, panting, excessive water drinking, and polyphagia. Urinalysis and CBC were both within normal limits. Abnormalities on blood chemistry were hyperproteinemia, hyperphosphatemia, elevated GGT activity, elevated BUN:creatinine ratio, and hypercalcemia. An ACTH stimulation test was suggestive of hyperadrenocorticism.

Clinical Differential Diagnosis

Hypercalcemia: lab error, neoplasia. Granulomatous disease, renal disease, primary/secondary Cushing’s disease, stress-related hypercortisolemia.

DX

Suspected pituitary-dependent hyperadrenocorticism.

Sampling

None

Sonographic Differential Diagnosis

Likely pituitary dependent hyperadrenocorticism with concurrent systemic hypertension.

Image Interpretation

The adrenal glands presented bilateral uniform hypertrophy for this size patient. The left adrenal gland measured 2.12 x 0.9cm and the right adrenal gland measured 1.92 x 1.42cm. Contour was swollen yet uniform. No evidence of vascular invasion or unilateral neoplasia was evident. These changes are consistent with, but not specific to, pituitary dependent hyperadrenocorticism (PDH). Dynamic function tests and ACTH plasma level would be necessary to confirm PDH.