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Lopes DJ, De Jesus L, Rivas BB, De Oliveira MC, Furtado PV, Cattaruzzi D, Poppl ÁG. Safety and efficacy assessment of a synthetic porcine recombinant corticotrophin for the ACTH stimulation test in healthy cats. Domest Anim Endocrinol 2024; 89:106880. [PMID: 39163657 DOI: 10.1016/j.domaniend.2024.106880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 08/22/2024]
Abstract
Porcine adrenocorticotrophic hormone (ACTH) has been considered valid for the ACTH stimulation test (ACTHST) in humans and dogs; however, its safety and efficacy for use in cats are unknown. Also, the equivalence between 5 µg/kg and 125 µg/cat dose of synthetic corticotropin (1-24 ACTH - cosyntropin/tetracosactide) is assumed for ACTHST in cats. This study evaluated the safety and effectiveness of different porcine recombinant ACTH doses for the ACTHST in healthy cats and its equivalence with tetracosactide. The study was divided into two arms. The first evaluated safety and equivalence of intravenous 1 µg/kg, 5 µg/kg, or 125 µg/cat porcine ACTH in seven healthy cats for the ACTHST evaluating basal and post-ACTH androstenedione, aldosterone, cortisol, and progesterone concentrations. In the second arm, the equivalence of the 125 µg/cat porcine ACTH dose was evaluated compared to results obtained using 125 µg/cat of tetracosactide in ten healthy cats regarding cortisol responses. In all tests, several cat-friendly strategies were adopted, and the ACTHST protocol involved basal and 60-minute post-ACTH blood sampling and intravenous ACTH injection. No adverse reactions were documented, and no tested cat showed any complications during the study. No porcine ACTH tested dose significantly increased androstenedione secretion. In contrast, all tested doses were able to increase progesterone concentration significantly (P < 0.05), and Δ-progesterone in response to 5 µg/kg or 125 µg/cat was considered equivalent (P > 0.99). The 125 µg/cat dose promoted greater responses for both cortisol and aldosterone, characterized by Δ-cortisol (P = 0.009) and Δ-aldosterone (P = 0.004). Despite equivalent Δ-cortisol results in response to 5 µg/kg or 125 µg/cat (P = 0.18); post-ACTH results of cortisol in response to 5 µg/kg only approximate statistical significance when compared with basal (P = 0.07). Porcine ACTH and tetracosactide significantly increased post-ACTH cortisol concentration (P < 0.0001) while the Δ-cortisol was slightly greater in response to the porcine ACTH (P = 0.006). These results suggest porcine ACTH could be an alternative source of corticotropin for the ACTHST in cats; however, maximum corticoadrenal stimulation seemed more reliable in response to a 125 µg/cat regarding cortisol and aldosterone.
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Affiliation(s)
- Daniela J Lopes
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana De Jesus
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Barbara B Rivas
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Milena C De Oliveira
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Priscila V Furtado
- Hormone Laboratory, Provet - Medicina Veterinária Diagnóstica, São Paulo, Brazil
| | - Debora Cattaruzzi
- Hormone Laboratory, Provet - Medicina Veterinária Diagnóstica, São Paulo, Brazil
| | - Álan G Poppl
- Veterinary Sciences Post-Graduation Program (PPGCV), Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Animal Medicine Departament, Veterinary Faculty, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Radosta L. Behavior Changes Associated with Metabolic Disease of Dogs and Cats. Vet Clin North Am Small Anim Pract 2024; 54:17-28. [PMID: 37734960 DOI: 10.1016/j.cvsm.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Like many physical disorders, the clinical signs associated with metabolic diseases affecting thyroid, adrenal, and pancreatic function are reflective of nonspecific changes in behavior. Additionally, patients who have underlying disorders associated with fear, anxiety, stress, conflict, and/or panic may be under treatment with medications that alter basal thyroid, glucose, and cortisol levels. Through reinforcement and punishment of behaviors associated with clinical signs caused by organic or iatrogenic endocrine disease, behaviors can be perpetuated and become persistent patterns. Screening all patients presenting with a primary behavior complaint or those with behavioral clinical signs of endocrine diseases is essential. Alleviating stress immediately while working up or treating metabolic disease reduces suffering and may stave off the adoption of behavior patterns more permanently.
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Affiliation(s)
- Lisa Radosta
- Florida Veterinary Behavior Service, West Palm Beach, FL, USA.
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Erger CG, Gerras AL, Conley AJ, Gilor C, Burns DeMarle K, Refsal KR, Fleming JM, Sledge DG, Langlois DK. Case report: Androgen-secreting adrenocortical tumors in eight cats. Front Vet Sci 2023; 10:1158142. [PMID: 37383353 PMCID: PMC10293747 DOI: 10.3389/fvets.2023.1158142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
Urine marking, aggression, and other behavioral concerns are common reasons for cat owners to seek veterinary care. Empiric treatment for lower urinary tract disease or primary behavior disorders are commonly pursued, especially in those cases with normal routine laboratory evaluations. Herein, we report the clinicopathologic findings in eight sexually altered cats that were diagnosed with androgen-secreting adrenocortical tumors. Nearly all cats (n = 7) initially were evaluated for inappropriate urination and pungent urine, with additional behavioral concerns including aggression (n = 3) and excess vocalization (n = 4) commonly reported. Penile barbs (n = 5) were identified in all five male cats, and an enlarged clitoris was observed in one female cat. Testing of serum androgen concentrations revealed abnormally high androstenedione (n = 1) or testosterone (n = 7) concentrations. In the five cases with available adrenal tissue, histopathologic evaluation identified either an adrenocortical adenoma (n = 3) or adrenocortical carcinoma (n = 2). Hormonal abnormalities resolved and clinical signs improved in the four cats that underwent surgical adrenalectomy, with each of these cats surviving >1 year. However, clinical signs were minimally impacted with medical treatments, including one cat in which trilostane treatment failed to improve clinical signs or testosterone concentrations. This collection of cases underscores the importance of a detailed physical examination as well as the consideration of endocrine disturbances in cats undergoing evaluation for inappropriate urination or aggression. Furthermore, this report adds to the growing body of evidence that sex-hormone secreting adrenal tumors in cats may be an under-recognized syndrome.
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Affiliation(s)
- Caylen G. Erger
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Allison L. Gerras
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Alan J. Conley
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Karah Burns DeMarle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Kent R. Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | | | - Dodd G. Sledge
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | - Daniel K. Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Prego MT, Dias MJ, Mestrinho L, Englar R, Grinwis G, Galac S, Leal RO. Diagnosis, treatment and outcome of pheochromocytoma in a cat. J Small Anim Pract 2023; 64:415-420. [PMID: 36977649 DOI: 10.1111/jsap.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 03/30/2023]
Abstract
Pheochromocytoma in cats is a rare clinical condition characterised by the development of a secretory endocrine tumour that arises from the adrenal medulla. An 8-year-old castrated male, domestic shorthair cat was referred for further investigation of a 4-month history of progressive weight loss with normal appetite, polyuria/polydipsia, generalised weakness, and severe hypertension. Sonography and computed tomography of the abdomen disclosed a mass arising from the left adrenal gland. The contralateral adrenal gland was normal in size and shape. Results from a low dose dexamethasone suppression test and measurements of plasma aldosterone concentration and plasma renin activity ruled out a cortisol-secreting tumour and aldosteronoma. The clinical presentation made a sex-steroid secreting tumour unlikely. Increased plasma metanephrine and normetanephrine concentrations prioritised the differential diagnosis of pheochromocytoma. The cat underwent adrenalectomy of the left gland and histopathological diagnosis with immunohistochemical markers confirmed the diagnosis.
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Affiliation(s)
- M T Prego
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
| | - M J Dias
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - L Mestrinho
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - R Englar
- College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd, Oro Valley, Arizona, 85737, USA
| | - G Grinwis
- Veterinair Pathologisch Diagnostisch Centrum - Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R O Leal
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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Yu J, Lenord J, Lau M, Brunel L, Gray R, Donahoe SL, Boland L. Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism. JFMS Open Rep 2021; 7:20551169211045640. [PMID: 34616560 PMCID: PMC8488528 DOI: 10.1177/20551169211045640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Case summary A 7-year-old male neutered domestic longhair cat was presented with chronic progressive gynaecomastia, polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behavioural changes were not reported and virilisation was not present on physical examination. Pertinent haematology, biochemistry and urinalysis findings at the time of referral included mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation of adrenal hormones with a low-dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hyperaldosteronism and hypercortisolism. Adrenalectomy was performed and histopathology was consistent with an adrenocortical tumour. Clinical signs and hormone elevations resolved postoperatively. Relevance and novel information To our knowledge, this is the second report of gynaecomastia secondary to an adrenal tumour in a male neutered cat and the first associated with hyperprogesteronism.
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Affiliation(s)
- Jane Yu
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Jason Lenord
- Balmain Veterinary Hospital, Rozelle, NSW, Australia
| | - Michelle Lau
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Rachael Gray
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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Reche Junior A, Ramos D, Ferreira M, da Silva LAG, Hirai Y, Horta PV. A case of behavioral changes in a castrated male cat due to a functional adrenocortical adenoma producing testosterone and androstenedione. JFMS Open Rep 2021; 7:2055116920981247. [PMID: 33489305 PMCID: PMC7809526 DOI: 10.1177/2055116920981247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary This case report describes a 9-year-old neutered male cat with a functional adrenal tumor showing aggression toward other cats in the household, excessive meowing and urine spraying. The diagnosis was made based on the clinical signs, an enlarged right adrenal gland on ultrasound, penile spines and elevated sex hormones on an adrenocorticotropic hormone stimulation test. The cat was submitted to celiotomy and adrenalectomy. Histopathological examination confirmed the adrenocortical adenoma. Three months after surgery the penile spines disappeared and urine spraying, as well as excessive meowing, had greatly decreased; however, aggressive behavior took much longer to stop and required behavior therapy. Relevance and novel information Functional adrenal tumors producing only sex hormones and behavioral changes are uncommon. The cat reported herein started showing behavioral changes before spines appeared on the penis, and structural alterations in the adrenal gland at the abdominal ultrasonography were detected. Considering all the possible implications resulting from severe behavior problems such as cat-cat aggression, from a permanent separation of the cats to relinquishment, a detailed investigation of underlying medical mechanisms in these animals is crucial from the start. Examinations may need to be repeated later in the course.
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Affiliation(s)
- Archivaldo Reche Junior
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil.,Vetmasters and 4 Cats Hospital, São Paulo, Brazil
| | | | | | | | - Yumi Hirai
- Vetmasters and 4 Cats Hospital, São Paulo, Brazil
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- BVSc, Ce666rtAVP, DipECVDI, Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Jones SA, Owens SL, Birchard SJ. Hyperandrogenism associated with an ovarian remnant in a spayed female cat. JFMS Open Rep 2019; 5:2055116919885698. [PMID: 31763051 PMCID: PMC6856978 DOI: 10.1177/2055116919885698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary An 11-year-old female, reportedly spayed, domestic shorthair cat was examined for a 4-month history of weight loss, aggression, urine spraying, malodorous urine and estrus-like behavior. Physical examination revealed thickened skin, a mildly prominent vulva and confirmed malodorous urine. On abdominal ultrasonography, a 6 mm hypoechoic nodule was found in the left cranial abdomen. An adrenocorticotropic hormone (ACTH) stimulation test with adrenal panel revealed elevated serum concentrations of androstenedione and testosterone pre- and post-cosyntropin stimulation, mildly decreased cortisol pre- and post-cosyntropin stimulation, and decreased resting aldosterone. Exploratory laparotomy was performed and a cystic, nodular mass was found in the region of the left ovary. The mass was surgically removed and submitted for histopathology; results were conclusive for an ovarian remnant with an intact corpus luteum and non-neoplastic parovarian cysts. Previously observed clinical signs resolved within two weeks of ovariectomy. A follow-up ACTH stimulation test with adrenal panel 6 weeks postoperatively revealed normalization of serum androstenedione, testosterone and cortisol concentrations. Four years postoperatively, at the time of writing, the cat remains free of clinical signs. Relevance and novel information We are unaware of any previously reported cases of non-neoplastic ovarian remnants associated with clinically relevant hyperandrogenism. A non-neoplastic ovarian-dependent hyperandrogenism should be included as a differential diagnosis of spayed female cats showing aggression and urine spraying behavior.
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Affiliation(s)
- Sarah A Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Scott L Owens
- Department of Internal Medicine, MedVet Indianapolis, Carmel, IN, USA
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Boland LA, Barrs VR. Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment. J Feline Med Surg 2017; 19:933-947. [PMID: 28838299 PMCID: PMC11128894 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).
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Affiliation(s)
- Lara A Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, 2006, Australia
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Daniel G, Mahony OM, Markovich JE, Appleman E, Monaghan KN, Lawrence YA, Fiocchi EH, Weaver K, Johnston A, Barton B. Clinical findings, diagnostics and outcome in 33 cats with adrenal neoplasia (2002-2013). J Feline Med Surg 2016; 18:77-84. [PMID: 25714105 PMCID: PMC11149020 DOI: 10.1177/1098612x15572035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES The objective of this retrospective study was to describe the clinical signs and diagnostic findings in cats with histopathologically confirmed adrenal neoplasms, and to assess correlations with survival data. METHODS Study data were acquired by reviewing medical records for all cats diagnosed with adrenal neoplasms at seven referral institutions between 2002 and 2013. Inclusion criteria required a histopathologic diagnosis of an adrenal neoplasm (ante-mortem or on necropsy). RESULTS Thirty-three cats met the inclusion criteria for the study. The most common presenting complaints included weakness (n = 12), respiratory signs (n = 4), blindness (n = 4) or gastrointestinal signs (n = 3). Laboratory abnormalities included hypokalemia (n = 18), alkalemia (n = 12), elevated creatine kinase (>3000, n = 5) and azotemia (n = 4). In addition, hypertension was noted in 13 cats. Thirty cats were diagnosed with cortical tumors (17 carcinomas, 13 adenomas) and three cats were diagnosed with pheochromocytomas. Twenty-five cats underwent tests to evaluate the function of the adrenal tumors; 19/25 cats had functional tumors (hyperaldosteronism [n = 16], hypercortisolemia [n = 1], high estradiol [n = 1], and hypersecretion of aldosterone, estradiol and progesterone [n = 1]). Twenty-six cats underwent adrenalectomy, one cat was medically managed and six were euthanized without treatment. Long-term survival postoperatively ranged from 4-540 weeks, with 20 (77%) cats surviving the perioperative period of 2 weeks. The only variable that was found to be negatively associated with survival was female sex. The most common complications noted during the perioperative period were hemorrhage and progressive lethargy and anorexia. CONCLUSIONS AND RELEVANCE Surgical treatment for feline adrenal tumors (regardless of tumor type) resulted in good long-term survival. Given that pre- and postoperative hypocortisolemia was identified in this study, and, in addition, hypersecretion of more than one adrenal hormone occurred in one cat, adrenal panels prior to surgery may be beneficial as part of the preoperative work-up.
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Affiliation(s)
- Gideon Daniel
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Orla M Mahony
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Jessica E Markovich
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Elizabeth Appleman
- Department of Internal Medicine, Animal Medical Center, USA; VCA Fifth Avenue Veterinary Specialists, USA
| | - Kelly N Monaghan
- Department of Medical Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri A Lawrence
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Kelli Weaver
- Tampa Bay Veterinary Specialists, Largo, FL, USA
| | - Andrea Johnston
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine Companion Animal Hospital, NY, USA
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts, Worcester, MA, USA
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Leshinsky J, Beatty JA, Fawcett A, Voss K, Makara M, Krockenberger MB, Barrs VR. Aldosterone and progesterone-secreting adrenocortical adenocarcinoma in a cat with a concurrent meningioma. JFMS Open Rep 2016; 2:2055116915624448. [PMID: 28491405 PMCID: PMC5359794 DOI: 10.1177/2055116915624448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/22/2022] Open
Abstract
CASE SUMMARY A 12-year-old, male neutered domestic shorthair cat was referred for investigation of suspected hyperaldosteronism due to persistent hypokalaemia, hindlimb ataxia, weakness of 1 month's duration and a left adrenal mass that was detected on abdominal ultrasound. Neurological examination findings at referral were suggestive of a concurrent left forebrain lesion. Hyperaldosteronism and concurrent hyperprogesteronism were confirmed on endocrine testing. On computed tomography (CT) of the abdomen and thorax there was no evidence of local vascular invasion by the adrenal mass or of metastatic disease. CT and magnetic resonance imaging featured a large, focal rim-enhancing extra-axial left forebrain lesion consistent with a meningioma. Surgical excision of the forebrain mass was followed by adrenalectomy 2 weeks later. The tumours were classified on histopathology as a psammomatous meningioma and an adrenocortical adenocarcinoma, respectively. Immunohistochemical staining of the meningioma confirmed the presence of progesterone receptors. The cat remains well 2 years later. RELEVANCE AND NOVEL INFORMATION In humans, elevated serum progesterone levels have been associated with rapid growth of meningiomas due to the presence of progesterone receptors on the tumour. This is the first report of a cat with a progesterone and aldosterone-secreting adrenocortical adenocarcinoma and a concurrent meningioma. Clinicians should be aware of the potential effect of elevated progesterone on meningiomas in cats.
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Affiliation(s)
- Jana Leshinsky
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Julia A Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Anne Fawcett
- Sydney Animal Hospitals – Inner West, Stanmore, NSW, Australia
| | - Katja Voss
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Mariano Makara
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Mark B Krockenberger
- Veterinary Pathology Diagnostic Services, Faculty of Veterinary Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW, Australia
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Valentin SY, Cortright CC, Nelson RW, Pressler BM, Rosenberg D, Moore GE, Scott-Moncrieff JC. Clinical findings, diagnostic test results, and treatment outcome in cats with spontaneous hyperadrenocorticism: 30 cases. J Vet Intern Med 2014; 28:481-7. [PMID: 24433386 PMCID: PMC4858028 DOI: 10.1111/jvim.12298] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/07/2013] [Accepted: 12/05/2013] [Indexed: 12/25/2022] Open
Abstract
Background Spontaneous hyperadrenocorticism (HAC) is rare in cats. Clinical findings, diagnostic test results, and response to various treatment options must be better characterized. Objectives To report the clinical presentation, clinicopathologic findings, diagnostic imaging results, and response to treatment of cats with HAC. Animals Cats with spontaneous HAC. Methods Retrospective descriptive case series. Results Thirty cats (15 neutered males, 15 spayed females; age, 4.0–17.6 years [median, 13.0 years]) were identified from 10 veterinary referral institutions. The most common reason for referral was unregulated diabetes mellitus; dermatologic abnormalities were the most frequent physical examination finding. Low‐dose dexamethasone suppression test results were consistent with HAC in 27 of 28 cats (96%), whereas ACTH stimulation testing was suggestive of HAC in only 9 of 16 cats (56%). Ultrasonographic appearance of the adrenal glands was consistent with the final clinical diagnosis of PDH or ADH in 28 of 30 cats (93%). Of the 17 cats available for follow‐up at least 1 month beyond initial diagnosis of HAC, improved quality of life was reported most commonly in cats with PDH treated with trilostane. Conclusions and Clinical Importance Dermatologic abnormalities or unregulated diabetes mellitus are the most likely reasons for initial referral of cats with HAC. The dexamethasone suppression test is recommended over ACTH stimulation for initial screening of cats with suspected HAC. Diagnostic imaging of the adrenal glands may allow rapid and accurate differentiation of PDH from ADH in cats with confirmed disease, but additional prospective studies are needed.
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Affiliation(s)
- S Y Valentin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Hypersomatotropism, Acromegaly, and Hyperadrenocorticism and Feline Diabetes Mellitus. Vet Clin North Am Small Anim Pract 2013; 43:319-50. [DOI: 10.1016/j.cvsm.2012.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Benchekroun G, Fornel-Thibaud P, Dubord M, Dossin O, Fracassi F, Rannou B, Garnier F, Maurey-Guenec C, Daminet S, Rosenberg D. Plasma ACTH Precursors in Cats with Pituitary-Dependent Hyperadrenocorticism. J Vet Intern Med 2012; 26:575-81. [DOI: 10.1111/j.1939-1676.2012.00924.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 02/07/2012] [Accepted: 03/02/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- G. Benchekroun
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | | | - M. Dubord
- Biochemistry Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | - O. Dossin
- Department of Clinical Sciences and Clinical Research Unit; Ecole Nationale Vétérinaire de Toulouse; Toulouse; France
| | - F. Fracassi
- Department of Veterinary Medical Sciences; Università di Bologna; Ozzano dell'Emilia; Italia
| | - B. Rannou
- Biochemistry Unit; Vetagro Sup; Campus Vétérinaire de Lyon; Marcy l'Etoile; France
| | - F. Garnier
- Biochemistry Unit; Vetagro Sup; Campus Vétérinaire de Lyon; Marcy l'Etoile; France
| | - C. Maurey-Guenec
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
| | - S. Daminet
- Department of Small Animal Medicine; Ghent University; Merelbeke; Belgium
| | - D. Rosenberg
- Internal Medicine Unit; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort; France
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Combes A, Vandermeulen E, Duchateau L, Peremans K, Daminet S, Saunders J. ULTRASONOGRAPHIC MEASUREMENTS OF ADRENAL GLANDS IN CATS WITH HYPERTHYROIDISM. Vet Radiol Ultrasound 2011; 53:210-6. [DOI: 10.1111/j.1740-8261.2011.01888.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anaïs Combes
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Eva Vandermeulen
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Luc Duchateau
- Department of Comparative Physiology and Biometry; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Kathelijne Peremans
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Sylvie Daminet
- Department of Small Animal Internal Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Jimmy Saunders
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
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Meler EN, Scott-Moncrieff JC, Peter AT, Bennett S, Ramos-Vara J, Salisbury SK, Naughton JF. Cyclic estrous-like behavior in a spayed cat associated with excessive sex-hormone production by an adrenocortical carcinoma. J Feline Med Surg 2011; 13:473-8. [PMID: 21498101 PMCID: PMC10832713 DOI: 10.1016/j.jfms.2011.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2011] [Indexed: 11/23/2022]
Abstract
A 15-year-old, spayed female domestic shorthair cat was evaluated for 1-year duration of cyclic intermittent estrous behavior. Diagnostic testing performed before referral, including baseline progesterone concentration, human chorionic gonadotropin (hCG) hormone stimulation test and surgical exploratory laparotomy, had remained inconclusive for a remnant ovary. Evaluation of sex hormones before and after adrenocorticotropic hormone (ACTH) administration revealed increased basal concentrations of androstenedione, estradiol, progesterone, and 17α-hydroxyprogesterone and normal ACTH-stimulated hormone concentrations. Enlargement of the right adrenal gland was identified by abdominal ultrasound. The cat underwent an adrenalectomy and histopathology of the excised adrenal gland was consistent with an adrenocortical carcinoma. Clinical signs resolved immediately following surgery, and most hormone concentrations declined to within or below the reference interval (RI) by 2 months after surgery.
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Affiliation(s)
- Erika N. Meler
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - J. Catharine Scott-Moncrieff
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - Augustine T. Peter
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - Sara Bennett
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - Jose Ramos-Vara
- Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - S. Kathleen Salisbury
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
| | - James F. Naughton
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West-Lafayette, IN 47907, USA
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DeClue AE, Martin LG, Behrend EN, Cohn LA, Dismukes DI, Lee HP. Cortisol and aldosterone response to various doses of cosyntropin in healthy cats. J Am Vet Med Assoc 2011; 238:176-82. [DOI: 10.2460/javma.238.2.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Abstract
Over the last 10 years, trilostane, a competitive inhibitor of steroid synthesis, is being widely used for the treatment of canine hyperadrenocorticism. Trilostane causes a significant but reversible decrease in cortisol production and a concomitant improvement in clinical signs in most dogs with this common condition. Side effects, though infrequent, can be serious: dogs treated with this drug require regular monitoring. This review summarizes current knowledge of the use of this drug with particular emphasis on its efficacy, safety, adverse reactions, and effects on endocrine parameters. Brief mention is made of its other uses in dogs and other species.
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Affiliation(s)
- Ian K Ramsey
- Faculty of Veterinary Medicine, University of Glasgow, Bearsden, Bearsden Road Glasgow, Glasgow G61 1QH, UK.
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22
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Abstract
UNLABELLED CLINICAL FINDINGS AND INVESTIGATIONS: A 14-year-old female neutered domestic shorthair cat was referred for investigation of progressive hair loss, muscle wasting and hind limb weakness. Diabetes mellitus had been diagnosed 8 months earlier and was well controlled. Abnormalities on serum biochemistry included persistent mild azotaemia, hypochloridaemia, hypokalaemia, metabolic alkalosis and elevated creatine kinase. Physical examination revealed a pot-bellied appearance, with muscle wasting, marked thinning and fragility of the skin, bilaterally symmetrical alopecia, a gallop rhythm and systolic hypertension (173 mmHg). A large, lobulated left adrenal mass was identified using abdominal ultrasound. CONFIRMATION OF DIAGNOSIS: Primary hyperaldosteronism was diagnosed based on an elevated plasma aldosterone concentration and normal plasma renin activity. Hyperprogesteronism was confirmed by adrenocorticotrophic hormone stimulation test. PRACTICAL RELEVANCE This is only the second reported case of hyperaldosteronism and hyperprogesteronism in the cat. Clinicians should be alert to the possibility of concurrent hyperaldosteronism and hyperprogesteronism in cats with adrenal tumours showing clinical signs referable to both conditions. The putative mechanism is either increased secretion of aldosterone and progesterone from neoplastic cells of the zona glomerulosa and fasciculata/reticularis, respectively, or increased production of progesterone, as an intermediate in the synthesis of aldosterone, from neoplastic cells of the zona glomerulosa alone.
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Affiliation(s)
- Katherine Briscoe
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
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Abstract
Although only recently discovered, feline adrenal disorders are becoming increasingly more recognized. Feline adrenal disorders include diseases such as hyperadrenocorticism (Cushing's syndrome) and hyperaldosteronism (Conn's syndrome). The clinical signs of feline hyperadrenocorticism, which include unregulated diabetes mellitus and severe skin atrophy, are unique to the cat. Other signs of feline hyperadrenocorticism, such as potbellied appearance, polydipsia, polyuria, and susceptibility to infections are also seen in dogs with hyperadrenocorticism. Conn's syndrome has only recently been described in the cat and is in fact more common in cats than in dogs. Characterized by severe hypokalemia, hypertension, and muscle weakness, Conn's syndrome may be misdiagnosed as renal failure. The clinician should become familiar with the clinical signs of adrenal disorders in cats and the common diagnostic tests used to diagnose these syndromes in cats as they differ from those in the dog. Treatment of feline adrenal disorders may be challenging; the clinician should become familiar with common drugs used to treat adrenal disorders in cats.
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Malouitre SDM, Barker S, Puddefoot JR, Jalili J, Glover HR, Vinson GP. Regulation of hepatic steroid receptors and enzymes by the 3beta-hydroxysteroid dehydrogenase inhibitor trilostane. J Steroid Biochem Mol Biol 2006; 101:97-105. [PMID: 16893643 DOI: 10.1016/j.jsbmb.2006.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Therapies designed to treat hypercortisolism have usually sought to reduce circulating glucocorticoid concentrations, however the local tissue endocrine environment could be an alternative target. The 3beta-hydroxysteroid dehydrogenase Delta5-4 isomerase (3beta-HSD) inhibitor trilostane is of interest, since, although it is only moderately and transiently effective in reducing circulating steroid, it is remarkably effective in alleviating Cushing's symptoms in veterinary applications. To seek alternative modes of action, male Wistar rats were treated with trilostane. Although final circulating corticosteroid concentrations were unaffected, liver 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) transcription and translation was significantly increased, whereas 3beta-HSD was not affected either in liver or adrenal. Glucocorticoid receptor (GR) mRNA was down-regulated, and mineralocorticoid receptor (MR) up-regulated by trilostane treatment: no changes in 11beta-HSD1 mRNA were observed. Trilostane also had no direct effect on GR response element-mediated gene transcription. The results show that the tissue endocrine environment is affected by trilostane treatment in the absence of sustained changes in circulating corticosteroid. The combination of increased 11beta-HSD2 and reduced GR expression in target organs could be expected to ameliorate the effects of excess glucocorticoid, suggesting new therapeutic approaches.
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Affiliation(s)
- S D M Malouitre
- School of Biological and Chemical Sciences, Queen Mary, University of London, Mile End Road, London E1 4NS, UK
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