Aldosterone and progesterone-secreting adrenocortical adenocarcinoma in a cat with a concurrent meningioma

Abstract

Case summaryA 12-year-old, male neutered domestic shorthair cat was referred for investigation of suspected hyperaldosteronism due to persistent hypokalaemia, hindlimb ataxia, weakness of 1 month’s duration and a left adrenal mass that was detected on abdominal ultrasound. Neurological examination findings at referral were suggestive of a concurrent left forebrain lesion. Hyperaldosteronism and concurrent hyperprogesteronism were confirmed on endocrine testing. On computed tomography (CT) of the abdomen and thorax there was no evidence of local vascular invasion by the adrenal mass or of metastatic disease. CT and magnetic resonance imaging featured a large, focal rim-enhancing extra-axial left forebrain lesion consistent with a meningioma. Surgical excision of the forebrain mass was followed by adrenalectomy 2 weeks later. The tumours were classified on histopathology as a psammomatous meningioma and an adrenocortical adenocarcinoma, respectively. Immunohistochemical staining of the meningioma confirmed the presence of progesterone receptors. The cat remains well 2 years later.Relevance and novel informationIn humans, elevated serum progesterone levels have been associated with rapid growth of meningiomas due to the presence of progesterone receptors on the tumour. This is the first report of a cat with a progesterone and aldosterone-secreting adrenocortical adenocarcinoma and a concurrent meningioma. Clinicians should be aware of the potential effect of elevated progesterone on meningiomas in cats.

Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment

“…35,70,[79][80][81]83 in some cats, clinical signs may be predominantly attributed to one hormone despite hypersecretion of multiple hormones. 83 overproduction of sex steroids without glucocorticoid effects has also been reported, resulting in clinical signs of oestrus or development of male secondary sexual physical characteristics in neutered animals; for example, urine spraying, aggression, skin thickening and penile spines. 72,82,[84][85][86] Reported feline sex steroid-producing adrenal tumours are listed in Table 4.…”

“…70,72,80,83 Affected cats usually have low serum cortisol levels on ACTH stimulation tests despite clinical signs suggestive of hypercortisolism. 70,79,[81][82][83] Possible causes include a lack of enzymes within the adrenal tumour to convert progesterone to cortisol, or hypothalamic-pituitary-adrenal axis suppression by other hormones. Cats with sex steroidproducing adrenal tumours typically have high basal hormone levels and post-ACTH stimulation measurements may not be required for diagnosis.…”

“…Cats with sex steroidproducing adrenal tumours typically have high basal hormone levels and post-ACTH stimulation measurements may not be required for diagnosis. 20,70,[79][80][81][82][83][84][85]88 Steroid synthesis pathways within the adrenal cortex Sex steroid-producing adrenocortical tumours can be challenging to diagnose, especially when clinical signs are due to multiple hormone types, and thus may be underrecognised. one study detected marked elevations in corticosterone and progesterone in some cats with marked elevations of aldosterone (>3000 pmol/l) on sera submitted for aldosterone assay.…”

“…Adrenal ectomy is the treatment of choice and has led to resolution of clinical signs and return of sex steroid hormone concentrations to within reference intervals in weeks to months. 70,79,[81][82][83][84][85] Table 4 Feline sex steroid-producing adrenal tumours reported in the veterinary literature…”

Acute adrenal haemorrhage in two cats with aldosterone-secreting adenocarcinomas

“…As in case 1, aldosterone-secreting adrenal tumours producing excesses of one or more adrenocortical hormones (often progesterone) have been reported previously, caused by paraneoplastic aberrant steroid synthesis pathways or enzyme deficiencies resulting in proximal hormone precursors accumulating, or being redirected to other pathways. 8,13–16 A tumour secreting aldosterone may also secrete increased levels of aldosterone intermediates such as progesterone due to an enhanced biosynthetic pathway. 14 Case 1 exhibited abdominal distension, PUPD and was polyphagic initially, so baseline progesterone levels were performed.…”