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Managing hyperadrenocorticism - Coggle Diagram
Managing hyperadrenocorticism
when to start? do you have to treat?
considerations
expense and intensity of medication and monitoring
side effects of meds
decreasing QoL?
longer overall survival the earlier you treat
drugs
mitotane
DDT derivative
BID induction phase of 7-10d
followed by weekly maintenance dose
causes toxicity and necrosis of adrenal cortex
ACTH stim test
4-6 post pill
monitoring
trilostane
brand name Vetoryl
superior survival
inhibits enzymes in cortisol production
generally harder better faster stronger
don't compound
ACTH stim stest does NOT correlate with control of disease
can lead to...
adrenal hyperplasia
adrenal necrosis
%5 risk for permanent hypoadrenocorticism
prescribe prednisone in case of medication-related illness
monitoring
ACTH stim test
mostly for diagnosis
best for iatrogenic cases
pre-pill cortisol levels
imperfect
can differentiate well control and poorly control
inappropriate for stress or sick dogs
survival with medical management
PDH
median 2y
trilostane assocaited with longer survival
ADH
9-12 months
no difference in survival between drug options