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Diagnosing Adrenal Tumors and Retinal Detachment in a Shih Tzu via Ultrasound

This case study discusses an 8.5-year-old male castrated Shih Tzu, Wojo, presented with acute blindness and exercise intolerance. The emergency evaluation at NCSU revealed significant clinical findings, including distended abdomen and hypertension. Radiographic and ultrasound examinations indicated bilateral adrenal gland enlargement and retinal detachment. The differential diagnosis included Cushing's disease and possible pheochromocytoma. Despite exploring diagnostic options, Wojo's condition led his owners to elect euthanasia after three days post-discharge.

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Diagnosing Adrenal Tumors and Retinal Detachment in a Shih Tzu via Ultrasound

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  1. Wojo Alcala Diagnosing Adrenal Tumors and Retinal Detachment via Ultrasound

  2. Signalment • 8 ½ year old male castrated Shih Tzu

  3. History • NCSU Emergency Service • For evaluation of acute blindness • Episodes of exercise intolerance • No V, D, Coughing, Sneezing • Previous Hx of patellar luxation (treated with Rimadyl

  4. Pertinent Clinical and Laboratory Findings • Distended abdomen, difficult to palpate • BP on admission 220 (systolic), later no BP>170 was reported • Elevated ALP (579) • USG 1.041, 3+ protein • Urine Protein:Creatinine Ratio=slightly elevated • ACTH Stim: 50 ug/dl (very suggestive of Cushings)

  5. Wojo headed to Radiology for … • Abdominal and Chest Radiographs • Abdominal Ultrasound

  6. Here is what we found…

  7. Radiographic Findings

  8. Ultrasound Findings

  9. Ultrasound Findings

  10. Ultrasound Findings

  11. Ultrasound Findings

  12. Ultrasound Findings

  13. Ultrasound Findings

  14. Ultrasound Findings

  15. Problems Identified • Radiographs 1. Hepatomegaly • Abdominal Ultrasound 1. Bilaterally enlarged adrenal glands (each adrenal appears to contain a nodule) 2. Bilateral retinal detachment

  16. Differentials • Cushings • Due to presence of nodules= may be more consistent with • Adenoma, adenocarcinoma or pheochromocytoma • Rather than pituitary dependent Cushings (in which we would see bilateral uniform hypertrophy more likely)

  17. Differentials • Signs consistent with Cushings (Incr. ALP and hepatomegaly) • However, dogs with Cushings do not typically experience hypertension great enough to cause bilateral retinal detachment • Therefore why we suspect pheochromocytoma may be involved

  18. Ultrasound • Could not differentiate which type of adrenal tumor Wojo had • We needed to explore other options…

  19. Wojo’s Options • Nuclear Scintigraphy with MIBG (metaiodobenzylguanidine) • Can be used to localize pheochromocytomas, • Better surgical plan • Possible Lysodren treatment and evaluation of response.

  20. What happened? • I called Wojo’s parents three days after discharge to see how he was adapting to his blindness at home. • They had elected Euthanasia the previous night at the rDVM.

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