Trilostane Therapy for Treatment of Spontaneous Hyperadrenocorticism in Cats: 15 Cases (2004–2012)

Abstract

Background: Medical treatment with trilostane improves clinical signs, causes unclear insulin requirement changes, and variable survival times in cats.Objectives/Hypothesis: To characterize the long-term efficacy of trilostane in treating cats with hyperadrenocorticism (HAC).Animals: Fifteen client-owned cats with spontaneous HAC. Methods: Multicenter descriptive retrospective study with a search performed on all medical records for cats diagnosed with spontaneous HAC.Results: Clinical signs (13 of 15 cats) and ACTH stimulation testing results (13 of 15) improved with trilostane therapy. Diabetes mellitus was reported in 9/15 cases. Insulin requirements decreased by 36% within 2 months in 6/9 diabetic cats. Median survival time was 617 days for all cats (range 80-1,278 days). Complications included weight loss, urinary tract infections, chronic kidney disease, seizures, and recurrent pancreatitis. Hypocortisolemia was documented in 1 case. Cause of death occurred as a result of nonadrenal or nondiabetic illnesses (renal failure, seizures [caused by hypoglycemia or unknown]), or lymphoma.Conclusions and Clinical Importance: Trilostane ameliorates clinical signs of HAC in cats, is tolerated well in the long term, and can lead to improved regulation of diabetes.

Feline comorbidities: Recognition, diagnosis and management of the cushingoid diabetic

“…Most cats with HAC are over 10 years of age, although one case series included a 4 year old. 12,13 There does not appear to be a breed or sex predisposition.…”

“…However, most cats with spontaneous HAC are first diagnosed with DM; concurrent HAC is often identified many months later. 12–15 Although obvious insulin resistance may trigger consideration of HAC, practitioners should not exclude this possibility simply because a cat achieves glycemic control on an unremarkable insulin dose.…”

“…The majority of cats with HAC (85–90%) have an underlying pituitary tumor, most often an adenoma, causing inappropriate secretion of adrenocorticotropic hormone (ACTH). 12–15 Less commonly, HAC may be adrenal dependent (ADH); affected cats have a functional cortical adenoma or carcinoma. 12,16 Adrenal tumors account for only 0.2% of all feline neoplasms, and more often result in hyperaldosteronism, rather than HAC.…”

“…Non-pruritic alopecia affecting the ventrum and flanks and/or thinning of skin were documented in almost 100% of cases in some reports. 12,13,15,25–27 Bruising may be noted, particularly following venipuncture. In some instances, cats develop extreme skin fragility, and are prone to tearing during normal handling and self-grooming activities (Figure 4).…”

Fisiopatología del Hiperadrenocorticismo en felinos. Presentación de caso clínico

“…Pueden hallarse neoformaciones del tipo macroadenomas como también microadenomas, en felinos esta última presentación es la más frecuente. Aproximadamente en un 85% de los casos el hiperadrenocorticismo es de origen hipofisario (Mellet Keith et al 2013) y el restante 15% de origen adrenal (Saltiveri, 2011;Caney, 2007).…”