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Diagnosis and Management of Hyperadrenocorticism in an Older Schipperke Mix

Chasee is a 12-year-old female Schipperke mix presenting with increased appetite, polydipsia, and polyuria. Diagnostic tests show hepatomegaly, elevated liver enzymes, hypercholesterolemia, and proteinuria. Ultrasound reveals hepatic changes, bilateral adrenomegaly, and prominent lymph nodes. ACTH stimulation indicates possible hyperadrenocorticism. Assessments suggest the adrenal tumor as a likely cause, though other conditions were ruled out. Recommendations for further management include monitoring and potential treatment to address her symptoms and underlying condition.

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Diagnosis and Management of Hyperadrenocorticism in an Older Schipperke Mix

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  1. Chasee Parker

  2. Signalment • Canine, Schipperke mix • Female, Spayed • 12 years old

  3. History • Significantly increased appetite over past year • PU/PD

  4. Physical Exam • Abdomen: Hepatomegaly palpated • PLN: Prominent axillary lymph nodes • Integument: Scaling noted • All other parameters within normal limits

  5. Diagnostic Tests • CBC: plasma protein lipemic, no other abnormalities noted • Biochemistry: hypercholesterolemia (397 MG/DL, rr=138-317), elevated alkaline phosphatase (637 IU/L, rr=14-120), ALT (204 IU/L, rr=16-73), elevated creatine kinase (1314 IU/L, rr=48-380) • Urinalysis: 3+ protein, specific gravity 1.022 (rr=1.015-1.045)

  6. Diagnostics continued • Elevated urine cortisol/creatinine ratio • Urine culture • Triglyceride level: mildly elevated (218 MG/DL, rr=19-133) • ACTH Stimulation Test: -base line=7.5 UG/DL, post=27.3 UG/DL • FNA of right axillary lymph node

  7. Radiographs • Spine-Lumbosacral: • bilateral hip dysplasia with secondary degenerative joint disease • L6-7 and L7-S1 spondylosis deformans

  8. Hip Dysplasia

  9. Spondylosis Deformans

  10. Radiographs • Thoracic: • spondylosis deformans • shoulder degenerative joint disease • no evidence of pulmonary metastatic disease

  11. Lateral Thorax

  12. Ventral-Dorsal Thorax

  13. Abdominal Ultrasound • Hepatic hyperechogenicity, as with pronounced vacuolar changes • Hyperechoic nodule in midregion of spleen • Bilateral adrenomegaly • Small splenic nodules, likely benign • Gallbladder sediment

  14. Left Adrenal Gland

  15. Left Adrenal Gland

  16. Left Adrenal Gland

  17. Spleen

  18. Liver

  19. Right Liver

  20. Gallbladder

  21. Gallbladder

  22. Right Adrenal Gland

  23. Right Adrenal Gland

  24. Measurements

  25. Diagnoses • Polyphasia • Possible hyperadrenocorticism -elevated ALT, ALKP and hypercholesteraolemia • Lipemia despite fasting –elevated triglycerides and cholesterol • Proteinuria • Abdominal/thoracic masses/prominent lymph nodes

  26. Assessment • Clinical signs of polyphagia and polyuria in conjunction with elevated liver enzymes (ALT and ALKP), hypercholesterolemia, ACTH stim. test and the ultrasound findings are suggestive of hyperadrenaocorticism • Leads to hyperactivity of adrenal gland • Benign tumor of pituitary or tumor of adrenal gland

  27. Assessment continued • Persistant proteinuria and lipemic plasma protein causing an elevated triglyceride level is also consistant with hyperadrenocorticism • Elevated urine cortisol/creatinine ratio also supportive of hyperadrenocorticism, but also consistant with neoplasia, hyperthyroidism and stress

  28. Assessment continued • Abdominal ultrasound is supportive of hyperadrenocorticism as the primary ruleout • No evidence of neoplasia or metastatic disease on either the ultrasound or radiographs • Thoracic and abdominal radiographs revealed orthopedic disease including spondylosis and DJD of shoulders and hip dysplasia with secondary DJD

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