Peer-reviewed veterinary case report
Adrenocortical hypoperfusion detected by contrast-enhanced ultrasound in a dog with trilostane-induced hypoadrenocorticism.
- Journal:
- The Journal of small animal practice
- Year:
- 2023
- Authors:
- Nagata, N et al.
- Affiliation:
- Joint Department of Veterinary Medicine · Japan
- Species:
- dog
Plain-English summary
A 12-year-old neutered male Chihuahua was being treated for a condition called pituitary-dependent hypercortisolism, which means he had too much cortisol in his body. After about three months of treatment with a medication called trilostane, he became very tired and had low sodium and high potassium levels in his blood. This led to a suspicion of a related condition called hypoadrenocorticism (where the adrenal glands don't produce enough hormones), but a specific test didn't give clear results. A special ultrasound showed that blood flow to his adrenal glands was reduced, confirming the diagnosis. He was treated with another medication, which helped improve his condition for a while, but 13 months later, he developed hair loss and tests showed that his hypercortisolism had returned. Unfortunately, he passed away about 22 months after his first visit, and a post-mortem examination revealed severe damage to his adrenal glands. The treatment initially worked, but the dog ultimately experienced a recurrence of his condition and deteriorated over time.
Abstract
A 12-year-old neutered male Chihuahua dog was diagnosed with pituitary-dependent hypercortisolism and treated with trilostane. Eighty-nine days later, the dog showed lethargy accompanied by hyponatraemia and hyperkalaemia. Hypoadrenocorticism due to trilostane was suspected, but the result of the adrenocorticotropic hormone stimulation test was not conclusive. Contrast-enhanced ultrasound showed loss of adrenocortical blood flow in both adrenal glands, indicating adrenocortical hypoperfusion and isolated hypoadrenocorticism. Treatment with fludrocortisone acetate improved the condition and electrolyte abnormalities. Thirteen months later, the dog showed alopecia, and an adrenocorticotropic hormone stimulation test revealed increased cortisol concentration, indicating hypercortisolism recurrence. The dog died due to progressive deterioration 22 months after the initial presentation. Post-mortem examination revealed focally extensive necrosis with marked calcification in the parenchyma of the adrenal glands and regeneration of the cells in the zona fasciculata with severe fibrosis. Adrenocortical hypoperfusion detected by contrast-enhanced ultrasound can support the diagnosis of adrenal necrosis and hypoadrenocorticism.
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Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/37340686/