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Canine Hyperadrenocorticism (Cushing's disease) ((Cortisol increase…
Canine Hyperadrenocorticism
(Cushing's disease)
Endogenous form
Involves a tumor on the pituitary gland that over secretes adrenocortocotropic hormone (ACTH)
Occurs in Small dogs
Iatrogenic Hyperadrenocorticism (exogenous form)
Chronic exposure to glucocorticoids that leads to suppressed ACTH levels and adrenal gland atrophy.
Adrenal-Dependent Hyperadrenocortism (ADH)
Involves a functional adenoma / carcinoma of the adrenal gland
Occurs in middle and large breed dogs
Cortisol increase the appetite, leading to
Polyphagia
Weight gain (may be weight loss due to concurrent diabetes mellitus)
Cortisol interfering with antidiuretic hormones action at the renal tubules. Water is not reabsorbed, leading to
Polyuria
Polydipsia
"Potbellied" appearance due to catabolic effect of cortosol
Abdominal weakness
Hepatomegaly
Increased abdominal fat stores
Respiratroy effects
Panting / tachypnea
Pulmonary thromboembolism due to hypercoagulable state.
CBC
Neutrophilia
Monocytosis
Lymphopnia
Eosinopenia
Regeneration response (nucleated RBC)
Urinalysis
Reduced urine specific gravity (dilute urine) due to cortisol's effects on antidiuretic hormone
Serum biochemistry
Hypercholesterolemia (due to steroid stimulation of lipolysis)
Increased serum ALT and AST (hepatocellular necrosis)
Decreased serum phosphorus (increased urinary excretion due to polyuria)
Hyperglycemia (due to increased glyconeogenesis and decreased peripheral tissue utilzation through insulin antagonists)
ACTH Stimulation test
Surgical
Adrenalectomy with absence of predetermined complicating factors (Eg: uncontrolled diabetes, hypercoagubility)
Radiation
On patient with neurologic signs and a macroadenoma (taking several months for PDH to subside)
Adrenolytic agent mitotane
Causes cell necrosis in Zona fasciculata and Zona reticularis
Treat ADH and PDH
40 - 50 mg/kg, PO with food (given 7-10 days)
Concurrent prednisolone to help alleviate side effect of mitotane
Types
Pituitary-Dependent Hyperadrenocortism (PDH)
Clinical signs
Medical
Diagnosis
Treatment
Lye Yi Yan D17A0014