Trilostane treatment of a dog with functional adrenocortical neoplasia

Abstract

A 13-year-old, crossbreed dog presented with a history of recent onset polydipsia, progressive lethargy, weakness and reduced appetite. Blood tests showed raised concentrations of alkaline phosphatase and alanine aminotransferase with marginally low serum potassium. There was a leucocytosis with a mature neutrophilia and no eosinophils. Endocrine tests showed a normal aldosterone concentration and an exaggerated adrenocorticotropic hormone (ACTH) stimulation test, consistent with a diagnosis of hyperadrenocorticism (HAC). A diagnosis of adrenal-dependent HAC was made, based on the presence of a calcified mass involving the left adrenal gland, and hepatomegaly, on radiography and ultrasonography. The owners declined surgical adrenalectomy. Medical management with trilostane rapidly improved the clinical signs and normalised the serum chemistry. ACTH stimulation tests showed an improvement in post-ACTH cortisol concentrations and were used to make dose adjustments where necessary. At the time of writing, no adverse side effects had been seen and the dog remained well after 80 weeks of treatment.

Long‐Term Survival of Dogs with Adrenal‐Dependent Hyperadrenocorticism: A Comparison between Mitotane and Twice Daily Trilostane Treatment

“…Alternatively, it has been proposed that nonselective adrenocorticolysis (NSAP) with mitotane might be useful in dogs with ADH,8 but there are no studies involving a large number of treated dogs. In the last decade, some studies have indicated that trilostane, a competitive inhibitor of 3ß‐hydroxysteroid dehydrogenase (3ß‐HSD), is a good option for the treatment of canine ADH 9, 10. There is only 1 published study that compares the survival time of dogs with ADH treated either with mitotane or trilostane 11.…”

Aldosterone-, Corticosterone- and Cortisol-Secreting Adrenocortical Carcinoma in a Dog: Case Report

“…One report has discussed its prescription for functional adrenocortical neoplasm [3]. In this case, a temporary lull state was observed, as the present adrenocortical carcinoma showed cortisol, aldosterone and corticosterone secretion.…”

“…After a discussion with the owner, medication rather than surgery was selected, and trilostane administration was initiated (60 mg/head, orally at 7 a.m., once daily). The dose of trilostane administration was based on previous reports [3,4,7,9].…”

Selecting The Best Treatment Option For A Dog With Cushing’S Syndrome

“…If there is metastasis of a functional AT or if neither adrenalectomy nor adrenocortical destruction with mitotane is an option, trilostane therapy can be used as a palliative treatment [67,68]. Although the manufacturer's recommended dose of trilostane does not differentiate between treatment of pituitary and adrenal hypercortisolism, experience has shown that ATs are more sensitive to trilostane than are hyperplastic adrenal glands.…”