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Hyperadrenocorticism :grimacing: - Coggle Diagram
Hyperadrenocorticism :grimacing:
Clinical Signs :sneezing_face:
:one:Very Common
Excessive panting
Thin hair coat
Polyphagia
Abdominal distension :pregnant_woman:
PU/PD
Hepatomegaly
Muscle weakness
hypertension
mild-mod (30-86% HAC :dog:)
Treat: BP >180mmHG
Resolves often
Proteinuria
20-40% persists w/ tx
Corticosteroid damages kidney
1+ on dipstick
:three:Less common
Comedones
Poor hair regrowth :woman-getting-haircut::skin-tone-5:
Thin skin :cry:
Urine leakage
Hyperpigmentation :black_small_square:
Lethargy :tired_face:
:two:Uncommon
Neurological abnormalities
Myopathy
Thromboembolism
🧪
CBC :syringe:
Eosinopenia
Thrombocytosis
Lymphopenia
Mild erythrocytosis
Neutrophilia
Serum Biochem
:arrow_up: Triglycerides
Mild hyperglycemia
:arrow_up: cholesterol
:arrow_up: ALP/ALT (ALP>ALT)
Rx Pancreatitis (ALT>ALP)
Bile Duct pancreatitis (ALP>ALT)
Reactive (2nd) (ALT>ALP)
Neoplasia (ALP,ALT)
Inflammation (ALT>ALP)
Benign Hepatic dz (ALP>>ALT)
Induction (Gluc,pheno) (ALP>>ALT)
UA
Proteinuria
+/- UTI indicators
USG <1.020
Screening Tests :tv:
ACTH Stim
MOA
Cortisal :point_up::skin-tone-5: w/ ACTH
HAC = Exaggerated
Measure before & 1-2hr after
LDDST
MOA
Normal: :chart_with_downwards_trend: ACTH = :chart_with_downwards_trend: Cortisol for 48hr
HAC
ADH: no effect
PDH: Transient :chart_with_downwards_trend:
40nmol/L = HAC
Supression
4hr cortisol >40nmol/L
4hr cortisol <50% of baseline cortisol (0hr)
8hr cortisol <50% of the baseline (but still >40)
UCCR
92% sn; Poor sp
Normal ratio = :red_cross:hyperadrenocorticism
Differentiating test :apple::banana:
HDDST
Normal: Cortisol suppression (4-8hr)
ADH: No suppression
PDH: ~suppression at 4 & 8hrs
Endogenous ACTH
LDDST
U/S
ADH: usually 1 enlarged/ 1 atrophied
PDH: Symmetrical adrenals
Etiology :scroll:
Signalment :vertical_traffic_light:
Types
Pituitary Dependent
85% (75% <20kg)
Breeds
Dachshunds
Terries
Poodles
Adrenal Dependent
Breeds
Dachshunds
GSD
Labs
Terries
Poodles
15%
Age: 9-11yr
Prognosis
Skin/haircoat = 3+m
Survival: 30m w/ tx
Resolution of PU/PD = 1m
:hospital:
Trilostane :pill:
Dosing
Recc: 0.5-2mg/kg BID
DO NOT exceed 30mg/dose
Manu: 2.2-6.7 mg/kg
Adverse Effects
Mild lethargy
Mild GI signs
Hypoadrenocorticism
ACTH Stim rechecks
When :question:
@ 10-14d
Monthly
@ 3m then 3-6month (stable)
How :question:3-5h after trilostane
:dart:
50-150nmol/L
Pre-pill cortisol
:two: day 10 Hx, clinical exam
:three: day 28 = Hx, clinical exam, pre-pill cortisol
No cs, cortisol 40-140 = continue, recheck 3m
No cs, cortisol >140 = change BID? lower dose (5-10mg)
CS, cortisol 40-140 = BID, smaller dose
No cs, cortisol <40 = lower dose
cs, cortisol >140 = BID, lower dose
Unwell = stop trilostane, ACTH stim
:one:Start therapy
:four: no c/s, cortisol ideal = 3m then 3-6m rechecks
:dart:40-140nmol/L