Concurrent pituitary and adrenocortical lesions on computed tomography imaging in dogs with spontaneous hypercortisolism

Bokhorst, Kirsten L van; Kooistra, Hans S.; Boroffka, Susanne A.E.B.; Galac, Sara

doi:10.1111/jvim.15378

Cited by 19 publications

(22 citation statements)

References 43 publications

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“…Interestingly, the reduced size of the CC together with the strong positive ACTH staining observed in this work differ from previous reports that have shown that dexamethasone resistance occurs in large pituitary tumours, especially those originating in the intermediate pars, since these usually have a slight staining for ACTH in IHC 1 12–14. Moreover, it was ruled out that a corticoadrenal tumour was the cause of the resistance to dexamethasone in this case 15. In this sense, the dexamethasone resistance could be related to the large size of the metastasis.…”

Section: Discussioncontrasting

confidence: 97%

Vestibular dysfunction due to thalamic metastasis of a corticotropic carcinoma in a dog

Arias

Trigo

Alvarez³

et al. 2020

Vet Record Case Reports

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Metastatic pituitary carcinoma and central vestibular syndrome originating in the thalamus are not common disorders in dogs. An 11-year-old Maltese dog with pituitary-dependent hypercortisolism presented signs of central vestibular dysfunction after trilostane treatment. Interestingly, the patient showed remission of vestibular signs after drug withdrawal, but two weeks later, with a new administration of trilostane, these signs reappeared after 48 hours. Postmortem, two neoplasms were found: one in the pituitary gland and the other in the thalamus, both with intense positivity for adrenocorticotropic hormone. Findings were conclusive of a functional corticotropic pituitary carcinoma with thalamic metastasis. Altogether, the vestibular dysfunction in this case was attributed to the effect of the mass in the thalamus, and the remission and reappearance of vestibular signs were associated with the level and the effect of cortisol, which depend on the trilostane therapy. Consequently, thalamic metastasis should be considered as a differential diagnosis in dogs with central vestibular dysfunction.

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Section: Discussioncontrasting

confidence: 97%

Vestibular dysfunction due to thalamic metastasis of a corticotropic carcinoma in a dog

Arias

Trigo

Alvarez³

et al. 2020

Vet Record Case Reports

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“…Consequently, distinguishing between PDH and FAT in ultrasound images is sometimes difficult due to EAA 13 . Also, dogs with HAC may present concurrent conditions including metastatic adrenal lesions, non‐functional adrenal tumour, other functional tumours such as pheochromocytoma, 21–23 or concurrent PDH and FAT leading to EAA 24 . Furthermore, bilateral adrenal adenoma or adenocarcinoma can occur and might also result in EAA 25…”

Section: Discussionmentioning

confidence: 99%

Ultrasound evaluation of adrenal gland size in clinically healthy dogs and in dogs with hyperadrenocorticism

Melián

Pérez-López²,

Saavedra

et al. 2021

Veterinary Record

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Background: Precise reference intervals of adrenal gland thickness are required for detection of adrenomegaly in dogs with hyperadrenocorticism (HAC). Methods: Eighty‐six clinically healthy dogs were prospectively included, and 91 dogs with untreated HAC were retrospectively evaluated. Dorso‐ventral adrenal gland thickness was ultrasonographically measured on the sagittal plane. Dogs were classified into four body weight categories, and those with HAC were also ultrasonographically classified as consistent with pituitary‐dependent HAC (PDH), adrenal‐dependent HAC (FAT), equivocal adrenal asymmetry (EAA), or normal adrenal thickness. Results: The upper limits for left adrenal gland in clinically healthy dogs were 5.1 mm (≥2.5–5 kg), 5.5 mm (>5–10 kg), 6.4 mm (>10–20 kg), and 7.3 mm (>20–40 kg), and for right adrenal gland the upper limits were 5.3 mm (≥2.5–5 kg), 6.8 mm (>5–10 kg), 7.5 mm (>10–20 kg), and 8.7 mm (>20–40 kg). The sensitivity of ultrasound to detect adrenomegaly in dogs with HAC was 95.6%. Most dogs with HAC (56.0%) had ultrasound findings consistent with either PDH or FAT; however, EAA was commonly occurring in 39.6% of dogs with HAC. Conclusions: The sensitivity of ultrasonography to detect adrenomegaly in dogs with HAC is high when using four weight categories. EAA is common in dogs with HAC.

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“…A diagnosis of ADH was made if the following criteria were met: low or undetectable eACTH (≤5 pg/mL) and an ultrasonographically observed unilateral adrenal enlargement with atrophy of the contralateral adrenal gland. A diagnosis of concurrent PDH and the adrenal tumor was made if there was pituitary enlargement on CT or MRI, not suppressed eACTH (>5 pg/mL), and the presence of an asymmetrically enlarged adrenal gland on CT or MRI with the contralateral gland within the normal limit 25‐30 …”

Section: Methodsmentioning

confidence: 99%

Comparison of methods to monitor dogs with hypercortisolism treated with trilostane

Golinelli

Marco²,

Leal

et al. 2021

Veterinary Internal Medicne

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Background The use of adrenocorticotropic hormone stimulation test as method to monitor efficacy of trilostane treatment of hypercortisolism (HC) in dogs has been questioned. Objectives To evaluate and compare 12 methods with which to monitor efficacy of trilostane treatment in dogs with HC. Animals Forty‐five client‐owned dogs with HC treated with trilostane q12h. Methods Prospective cross‐sectional observational study. The dogs were categorized as well‐controlled, undercontrolled, and unwell through a clinical score obtained from an owner questionnaire. The ability to correctly identify trilostane‐treatment control of dogs with HC with the following variables was evaluated: before trilostane serum cortisol (prepill), before‐ACTH serum cortisol, post‐ACTH serum cortisol, plasma endogenous ACTH concentrations, prepill/eACTH ratio, serum haptoglobin (Hp) concentration, serum alanine aminotransferase (ALT), gamma‐glutamyl transferase (γGT) and alkaline phosphatase activity, urine specific gravity, and urinary cortisol : creatinine ratio. Results Ninety‐four re‐evaluations of 44 dogs were included; 5 re‐evaluations of 5 unwell dogs were excluded. Haptoglobin was significantly associated with the clinical score (P < .001) and in the receiver operating characteristic analysis, Hp cutoff of 151 mg/dL correctly identified 90.0% of well‐controlled dogs (specificity) and 65.6% of undercontrolled dogs (sensitivity). Alanine aminotransferase (P = .01) and γGT (P = .009) were significantly higher in undercontrolled dogs. Cutoff of ALT and γGT greater than or equal to 86 U/L and 5.8 U/L, respectively, were significantly associated with poor control of HC by trilostane. Conclusions and Clinical Importance Of all the 12 variables, Hp, and to a lesser degree ALT and γGT, could be considered additional tools to the clinical picture to identify well‐controlled and undercontrolled trilostane‐treated dogs.

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Concurrent pituitary and adrenocortical lesions on computed tomography imaging in dogs with spontaneous hypercortisolism

Cited by 19 publications

References 43 publications

Vestibular dysfunction due to thalamic metastasis of a corticotropic carcinoma in a dog

Vestibular dysfunction due to thalamic metastasis of a corticotropic carcinoma in a dog

Ultrasound evaluation of adrenal gland size in clinically healthy dogs and in dogs with hyperadrenocorticism

Comparison of methods to monitor dogs with hypercortisolism treated with trilostane

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