Peer-reviewed veterinary case report
Persistent isolated hypocortisolism following brief treatment with trilostane.
- Journal:
- Australian veterinary journal
- Year:
- 2008
- Authors:
- Ramsey, I K et al.
- Affiliation:
- Faculty of Veterinary Medicine · United Kingdom
- Species:
- dog
Plain-English summary
A 12-year-old male neutered Miniature Poodle was diagnosed with a condition called pituitary-dependent hyperadrenocorticism, which means his body was producing too much cortisol. After receiving just three doses of a medication called trilostane, he started showing signs of low cortisol levels, a condition known as isolated hypocortisolism, which lasted for over three months even after stopping the medication. Fortunately, the signs of his original condition improved without further trilostane, but he needed to start taking another medication called prednisolone to address the low cortisol levels, which he continued for more than a year. This case is unusual because such a severe reaction to trilostane happened after such a short treatment period, highlighting the need for veterinarians to monitor for potential complications even early in treatment. Ultimately, the treatment with prednisolone was effective in resolving the low cortisol symptoms.
Abstract
A 12-year-old male neutered Miniature Poodle with confirmed pituitary-dependent hyperadrenocorticism was treated with trilostane. After three doses, it developed clinical and laboratory changes suggestive of isolated hypocortisolism ('atypical hypoadrenocorticism'), which persisted and progressed for more than 3 months despite immediate withdrawal of the trilostane. The clinical signs of hyperadrenocorticism resolved without further trilostane. After 3 months, prednisolone treatment was started and the clinical signs of hypocortisolism resolved. Prednisolone therapy was required for more than 1 year. Ultrasonography initially demonstrated large hypoechoic adrenal cortices, typical of dogs with hyperadrenocorticism, which then became small and heteroechoic, consistent with the development of adrenal necrosis. Persistent isolated hypocortisolism has not been reported previously as a complication of trilostane therapy. The case is also remarkable for the very short duration of trilostane therapy that elicited this complication. Clinicians should be aware that trilostane therapy may result in adrenal necrosis, even in the very earliest stages of therapy, but prompt action can prevent a life-threatening situation.
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Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/19076773/