Suspected bilateral adrenal gland tumour causing primary Addison’s disease in a dog

Abstract

A 13-year old miniature poodle presented with a 3-day episode of vomiting, anorexia, and lethargy. Lack of micturition had been noted for 2 days. Clinical examination indicated dehydration and a tense, painful abdomen. Laboratory parameters (severe azotaemia, hyperkalaemia, severe hyponatraemia, hypochloraemia, and hyperphosphataemia with glucosuria and proteinuria) were consistent with anuric acute kidney injury (AKI). Abdominal ultrasound revealed bilateral adrenal masses. ACTH stimulation test was diagnostic for Addison’s disease. Computed tomography confirmed bilateral adrenal masses and indicated multifocal liver nodules. Additionally, infiltration of the caudal vena cava with partial luminal occlusion was demonstrated. Surgical removal of the adrenal masses with venous plasty intervention and stenting of the vessels deemed unrewarding in this patient in respect to progressed tumour growth with assumed metastatic spread. The dog was treated for Addison’s disease and discharged with good overall condition. Eight weeks later, the dog was euthanized due to progressive caudal vena cava occlusion. Whilst hypoadrenocoticism typically affects young to middle aged dogs, in old dogs primary Addison’s disease might be caused by neoplastic bilateral adrenal gland destruction. This is the first case report of hypovolaemia leading to AKI secondary to bilateral adrenal masses causing Addison’s disease in a dog.

Hypocortisolism in a dog caused by bilateral pheochromocytoma

“…In humans, bilateral infiltrative adrenal disease has been described as a cause of primary adrenal insufficiency, with bilateral metastatic breast and lung cancer, bilateral lymphoma, granulomatous infectious disease (tuberculosis, cryptococcosis, histoplasmosis) and histiocytosis being the reported causes 17 . In dogs, adrenocortical destruction due to malignant and anaplastic adrenal neoplasia and bilateral intravascular lymphoma have been described as a cause of adrenocortical insufficiency 2–4 . In our case, breast, lung and other types of cancer were excluded by chest and abdominal CT and physical examination.…”

“…17 In dogs, adrenocortical destruction due to malignant and anaplastic adrenal neoplasia and bilateral intravascular lymphoma have been described as a cause of adrenocortical insufficiency. [2][3][4] In our case, breast, lung and other types of cancer were excluded by chest and abdominal CT and physical examination. Likewise, the possibility of an infectious disease was ruled out, as there was no worsening of clinical signs in the absence of specific pharmacological therapy (antibiotics or antifungal agents) and there were no compatible clinical signs or changes in the complete blood count.…”

“…Exceptionally, two cases of HA have been reported in dogs by destruction of the adrenal cortex due to bilateral malignant and anaplastic adrenal neoplasia 2,3 . Moreover, a case with isolated glucocorticoid‐deficient HA (eunatraemic and eukalemic) has also been reported in a dog with bilateral adrenal gland infiltration by lymphoma 4 .…”