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Adrenal/Thyroid (Feline HAC (PDH>>>>AT, rare, mid/older,…

- - - - Signalment
        
        6살 이상, 암컷, 푸들에서 호발
        
        Size
        
        75% of PDH < 20kg
        
        50% of AT > 20kg
      - C/S : PU/PD(80~91%), alopecia(60~74%), pendulous abdomen(67~73%), hepatomegaly(51~67%), polyphagia(46~57%), muscle weakness(14~57%), anestrus(54%), comedones(25~34%), panting(30%), hyperpigmentation(23~30%), calcinosis cutis(8~15%), DM(5%), hypertension
      - General tests
        
        CBC/Chemistry : stress leukogram(neutrophilia, lymphopenia, right shift), thrombocytosis, increased ALP&ALT(ALP가 더 증가), hyperlipidemia, hypercholesterolemia, mild hyerglycemia, decreased BUN
        
        UA : low USG(<1.020), UTI, glucosuria, proteinuria
        
        Radiographs : hepatomegaly, potbelly, distended bladder, osteoporosis, dystrophic calcification
        
        Urine culture, Blood pressure
      - Complications : systemic hypertension, pyelonephritis, DM, pancreatitis pulmonary thromboembolism(PTE), hypothyroidism, etc.
    - - Screening tests
        
        민감도가 높은 검사법들. 하지만, 높다고 해서 쿠싱은 아님. 낮으면 쿠싱이 아닌 것
        
        Urine cortisol to creatinine ratio(UCCR) : very sensitive(~100%), not specific ← 병원에 오는 것만으로 cortisol 수치가 오를 수 있으므로 주의
        
        Cortisol-induced ALP(C-ALP) : UCCR만큼 민감하지x, not specific ← 사용하지 않음.
      - Diagnosing tests
        
        ACTH stimulation
        
        Sensitivity : 80~85% PDH; 60% AT ← HAC r/o에 사용 못함.
        
        Specificity : 85%
        
        only test for iatrogenic HAC ← post-stimulation에서 cortisol이 상승x
        
        therapeutic monitoring ← 유일
        
        Low dose dexamethasone suppression test(LDDST)
        
        Dexamethasone 투여(0.01mg/kg) → low ACTH → low cortisol.
        
        8시간 후에 no suppression → HAC
        
        Dexamethasone doesn't cross-react w/ the cortisol assay.
        
        Sensitivity : 97% PDH; ~100% AT
        
        Specificity 70%
      - Localizing tests
        
        PDH인지 AT인지 구분
        
        LDDST
        
        4hr : localizing
        
        complete suppression=PDH(60%)
        
        failure to suppress=PDH(40%) or AT → HDDST or eACTH
        
        High dose mexamethasone suppression(HDDST)
        
        진단이 된 개체에 적용
        
        higher dose(0.1mg/kg) → more suppression
        
        only need pre and 8hr
        
        75% or complete suppression=PDH
        
        no suppression=PDH(25%) or AT(~100%)
        
        Endogenous ACTH(eACTH)
        
        high=PDH, low=AT
        
        but lots of overlap in the middle
        
        Imaging
        
        Atypical HAC
        
        다른 호르몬(steroid)이 증가하여 HAC 비슷한 증상을
        
        ACTH stimulation → adrenal panel(다른 호르몬 수치도 확인)
        
        treat as typical HAC
  - - - Mitotane(adrenal necrosis)
      - Trilostane(enzyme blocker)
        
        요즘은 이것만 사용, 일반적으로 하루에 2번 권장, daily for life
        
        3β-OH steroid dehydrogenase의 경쟁적 억제제(가역적이므로 약을 끊으면 다시 합성됨.)
        
        cortisol&aldosterone 합성 억제(cortisol>>aldosterone in dogs)
      - Ketoconazole(enzyme blocker)