Introduction
- Relatively common endocrine disease.
- Cause : syndrome resulting from excessive production or administration of glucocorticoids.
- Signs : polydipsia, polyuria, polyphagia, alopecia, lethargy.
- Diagnosis : screening lab tests and dynamic tests of adrenal function.
- Treatment : trilostane, mitotane.
- Prognosis : good with adequate monitoring.
Print out owner factsheet entitled "Cushing's disease (hyperadrenocorticism)"
to give to your client.
Diagnosis
Clinical signs
- Palpable liver enlargement.
- Muscle wasting/weakness
. - Skin: thin and inelastic, striae, superficial veins visible, comedones, calcinosis cutis , excessive bruising, poor wound healing, breakdown of scars .
- Hair: bilaterally symmetrical non-pruritic alopecia affecting flanks, trunk and neck first, and feet and tail late
. - Anestrus/testicular atrophy.
- Hair: becomes lighter in color and finer in texture.
- Myotonia (mainly seen in poodles for reasons that are unknown).
Sequelae
Prognosis
- Generally good - most treated animals have a good quality of life.
Expected response to treatment
- Water intake drops rapidly.
- Other clinical signs should resolve over weeks to months.
Reasons for treatment failure
- Owner refuses treatment (cost may be a factor).
- Adrenal tumor non-operable and not responsive to medical therapy.
Sources
Publications
Refereed papers
- Recent references from PubMed.
- Ramsey I & Ristic J (2007) The diagnosis of canine hyperadrenocorticism. In Practice 29 , 446-454.
- Ramsey I & Neiger R (2007) The treatment of canine hyperadrenocorticism. In Practice 29 , 512-519.
- Bell R, Neiger R, McGrotty Y & Ramsey I K (2006) Effects of once daily trilostane administration on cortisol concentrations and ACTH responsiveness in hyperadrenocorticoid dogs. Vet Rec 159 , 277-281 PubMed.
- Ramsey I (2006) Treatment of canine hyperadrenocorticism. UK Vet 11 (2), 27-32.
- Ramsey I (2006) Diagnosis of canine hyperadrenocorticism. UK Vet 11 (1), 21-28.
- Barker E, Campbell S, Tebb A, Neiger R, Herrtage M E & Ramsey I K (2005) A comparison of the survival times of dogs treated for hyperadrenocorticism with trilostane or mitotane. J Vet Intern Med 19 , 810-815 PubMed.
- Ramsey I (2006) Pathophysiology of hyperadrenocorticism. UK Vet 10 (8), 31-37.
- Ramsey I K, Tebb A, Harris E, Evans H & Herrtage M E (2005) Hyperparathyroidism in dogs with hyperadrenocorticism. JSAP 46 , 531-536.
- Tebb A J, Arteaga A, Evans H & Ramsey I K (2005) Canine hyperadrenocorticism: effects of trilostane on parathyroid hormone, calcium and phosphate concentrations. JSAP 46 , 537-542.
- Wenger M, Sieber-Ruckstuhl N S, Muller C & Reusch C E (2004) Effect of trilostane on serum concentrations of aldosterone, cortisol, and potassium in dogs with pituitary-dependent hyperadrenocorticism. Am J Vet Res 65 , 1245-1250.
- Neiger R (2003) Treatment of canine hyperadrenocorticism (Cushing's Disease) with trilostane. UK Vet 8 (2) 19-22.
- Neiger R, Ramsey I K, O'Connor J, Hurley K & Mooney C T (2002) Trilostane treatment of 78 dogs with pituitary dependent hyperadrenocorticism. Vet Rec 150, 799-804 PubMed.
- Ruckstuhl N S, Nett C S & Reusch C E (2002) Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane. Am J Vet Res 63 , 506-512.
- Frank L A, DeNovo R C, Kraje A C et al(2000) Cortisol concentrations following stimulation of healthy and adrenopathic dogs with two doses of tetracosactrin. JSAP 41 , 308-311.
- Gould S M, Baines E A, Mannion P A, Evans H & Herrtage M E (2001) Use of endogenous ACTH concentration and adrenal ultrasonography to distinguish the cause of canine hyperadrenocorticism. JSAP 42 , 113-121.
- Reusch C E, Steffen T & Hoerauf A (1999) The efficacy of L-Deprenyl in dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 13 , 291-301.
- Zerbe C A et al(1999) The Hypothalamic-Pituitary-Adrenal Axis and Pathophysiology of Hyperadrenocorticism. Comp Contin Educ Pract Vet 21 , (12) 1134-1137.
- Hess R S, Kass P H & Ward C R (1998) Association between hyperadrenocorticism and development of calcium-containing uroliths in dogs with urolithiasis. JAVMA 212 , 1889-1891.
- Theon A P & Feldman E C (1998) Megavoltage irradiation of pituitary macrotumors in dogs with neurologic signs. JAVMA 213 , 225-231.
- Thuroczy J, van Sluijs F J, Kooistra H S et al(1998) Multiple endocrine neoplasms in a dog - corticotrophic tumor, bilateral adrenocortical tumors, and pheochromocytoma. Vet Q 20 , 56-61.
- Angles J M, Feldman E C, Nelson R W et al(1997) Use of urine cortisol-creatinine ratio versus adrenocorticotropic hormone stimulation testing for monitoring mitotane treatment of pituitary-dependent hyperadrenocorticism in dogs. JAVMA 211 , 1002-1004.
- Dunn K J (1996) Complications associated with the diagnosis and management of canine hyperadrenocorticism. In Practice 19 (5), 246. (Review of up to date techniques for diagnosis and common complications of treatment.)
- Grooters A M, Theisen S K et al(1996) Ultrasonographic characteristics of the adrenal glands in dogs with PDH - comparison with normal dogs. JVIM 10 , 110-115.
- Bertoy E H, Feldman E C, Nelson R W et al(1995) MRI of the brain of dogs with recently diagnosed but untreated pituitary dependent hyperadrenocorticism. JAVMA 206 , 651-656.
- Sluijs F J, Sjollema B E, Voorhout G, van der Ingh T S G A M & Rijnberk A (1995) Results of adrenalectomy in 36 dogs with HAC caused by adrenocortical tumor. Vet Q 17 , 113-116.
- Kintzer P P & Peterson M E (1994) Mitotane treatment of 32 dogs with cortisol-secreting adrenocortical neoplasms. JAVMA 205 , 54-61.
- Kintzer P P & Peterson M E (1991) Mitotane (o,p'-DDD) treatment of 200 dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 5 , 182-190.
