Please enable JavaScript.
Coggle requires JavaScript to display documents.
Diagnosing Hyperadrenocorticism - Coggle Diagram
Diagnosing Hyperadrenocorticism
urine cortisol:creatinine (UCCR)
rule out
test
high sensitivity
can be confident a negative is truly negative
low specificity
false + are common
need more tests to confirm
ACTH stimulation
steps
administer synthetic ACTH
take another sample
baseline cortisol
Cushing's dog exhibit exaggerated response
best for pituitary dependent cases
low dose dexamethasone suppression test (LDDSTT)
preferred HAC screening test
steps
baseline cortisol
administer dex
cortisol 4h post
cortisol 8h post
positive dogs have blunted/absent suppression in response
as in, remains high
65% have partial suppression though so...that's cool
defined as...
<1.4ug/dL at 4hr
more than 50% baseline at 4-8 hours
high sensitivity
moderate specificity
differentiation tests
high dose dexamethasone (HDDST)
most cases will suppress
only for differentiation of PDH
specificity poor
10x dose
endogenous ACTH
PDH
ACTH normal to high
tumor constantly producing ACTH regardless of feedback
ADH
ACTH normal to low
abdominal imaging
PDH
bilateral adrenomegaly
ADH
unilateral adrenal mass
small contralateral adrenal
maybe go with this test first
brain MRI if neurologic