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Appleman E, Schrage A, Lamb KE, Langston C. Evaluation of Iatrogenic Hypocortisolemia Following Trilostane Therapy in 48 Dogs with Pituitary-Dependent Hyperadrenocorticism. J Am Anim Hosp Assoc 2021; 57:217-224. [PMID: 34370857 DOI: 10.5326/jaaha-ms-7076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
This study aimed to retrospectively describe the clinical progression following diagnosis of iatrogenic hypocortisolemia (iHC) in 48 dogs receiving trilostane for pituitary-dependent hyperadrenocorticism. Cortisol concentrations were ≥1.5 mg/dL within 6 mo following diagnosis of iHC in 76.3% of dogs (95% confidence interval [CI] 59.8-88.6%). At the time of study completion, 25% of dogs (95% CI 13.6-39.6%) were receiving either glucocorticoids or mineralocorticoids or both; 42% of dogs (95% CI 27.6-56.8%) were on no adrenal-related medications; and the remaining 33% of dogs (95% CI 20.4-48.4%) were receiving trilostane. No patient-, clinicopathologic-, or trilostane-associated factors were identified to influence adrenal recovery following diagnosis of iHC, and it remains difficult to predict the clinical progression in this population of dogs.
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Nam S, Kim TW, Song KH, Feldman EC, Seo KW. Evaluation of compounded trilostane packets for dogs with naturally occurring hyperadrenocorticism. J Vet Intern Med 2021; 35:1729-1732. [PMID: 34114230 PMCID: PMC8295693 DOI: 10.1111/jvim.16197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dogs treated for naturally occurring hyperadrenocorticism (NOH) in Korea often appear to require higher doses of trilostane than recommended by authors in the United States, Europe, or the United Kingdom. This phenomenon may be related to compounding trilostane into packets, which is a common practice among veterinary clinics in Korea. Objective Analyze packets filled by hand and others filled using a semi‐automatic packing device for accuracy of trilostane strength. Animals Medication packets prepared for 3 dogs with preexisting prescriptions for NOH were analyzed. Method A trilostane assay was developed for analysis. Trilostane (Vetoryl) capsules were used as clinical controls. Forty‐four medication packets containing trilostane (Vetoryl), prepared by 3 clinicians for 3 dogs with NOH were analyzed. Results Of 44 trilostane‐containing packets, only 40.9% (18 packets) had acceptable strength of trilostane. Conclusions and Clinical Importance Clinicians should be aware that compounding trilostane into packets fails to consistently provide measured amounts of trilostane, potentially interfering with response to treatment for NOH in dogs.
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Affiliation(s)
- Sookin Nam
- College of Veterinary Medicine, Chungnam National University, Deajeon, South Korea
| | - Tae-Won Kim
- College of Veterinary Medicine, Chungnam National University, Deajeon, South Korea
| | - Kun-Ho Song
- College of Veterinary Medicine, Chungnam National University, Deajeon, South Korea
| | - Edward C Feldman
- School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kyoung-Won Seo
- VMTH of College of Veterinary Medicine, Seoul National University, Seoul, South Korea
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Kim H, Kang JH, Heo TY, Kang BT, Kim G, Chang D, Na KJ, Yang MP. Evaluation of Hypertriglyceridemia as a Mediator Between Endocrine Diseases and Pancreatitis in Dogs. J Am Anim Hosp Assoc 2019; 55:92-100. [DOI: 10.5326/jaaha-ms-6791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
The role of hypertriglyceridemia (HTG) secondary to endocrine diseases in the occurrence of pancreatitis in dogs has not been fully investigated. The objective of the present study was to evaluate HTG as a mediator between endocrine diseases and pancreatitis in dogs. The study design was a retrospective case-control study. Medical records of dogs newly diagnosed with acutely presenting pancreatitis between 2012 and 2014 were reviewed for the presence or absence of hyperadrenocorticism (HAC), diabetes mellitus (DM), and hypothyroidism. A matched case-control analysis was performed, and the association between endocrine diseases and pancreatitis was evaluated using multiple logistic regression analysis. In dogs with pancreatitis, the odds of HAC (P < .001) and DM (P < .001) were 4.5 and 12.4 times that of dogs without pancreatitis, respectively. HTG significantly mediated the association between DM and pancreatitis but not between HAC and pancreatitis. Additional studies will be necessary to confirm these findings and to further elucidate the associations between endocrine diseases and pancreatitis.
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Affiliation(s)
- Hakhyun Kim
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Ji-Houn Kang
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Tae-Young Heo
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Byeong-Teck Kang
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Gonhyung Kim
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Dongwoo Chang
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Ki-Jeong Na
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
| | - Mhan-Pyo Yang
- Veterinary Medical Center, College of Veterinary Medicine (H.K., J-H.K., B-T.K., G.K., D.C., K-J.N., M-P.Y.), and Department of Information and Statistics, College of Natural Science (T-Y.H.), Chungbuk National University, Cheongju, South Korea
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Kim KH, Han SM, Jeon KO, Kim HT, Li Q, Ryu MO, Song WJ, Park SC, Youn HY. Clinical Relationship between Cholestatic Disease and Pituitary-Dependent Hyperadrenocorticism in Dogs: A Retrospective Case Series. J Vet Intern Med 2017; 31:335-342. [PMID: 28064467 PMCID: PMC5354004 DOI: 10.1111/jvim.14608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/29/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
Background A high prevalence of cholestatic disease, including gallbladder mucocele (GBM), has been reported in dogs with naturally occurring pituitary‐dependent hyperadrenocorticism (PDH). Hypothesis/Objectives Differences exist in the clinical features of dogs with PDH and concurrent cholestatic disease, and also is the management of these dogs with trilostane. Animals Sixty‐five client‐owned dogs with naturally occurring PDH. Methods This was a retrospective, observational case series. Each dog was treated with trilostane for at least 3 months before the study, and had a good clinical response, as determined by owners. Statistical comparisons of clinical signs, results of routine blood tests, basal and post‐ACTH cortisol concentration, and optimal trilostane dosage were made after dogs were separated into the following 3 groups by ultrasonographic imaging: normal on ultrasound (NOU) group, cholestasis group, and GBM group. Results The GBM group had more severe clinical signs and significantly different total serum cholesterol concentration and post‐ACTH stimulation cortisol concentration at the time of diagnosis. Dogs that weighed <6 kg had a significantly higher prevalence of cholestatic disease than did the other dogs (P = .003). The optimal trilostane dosages for the GBM and cholestasis groups were 2.5 and 1.5 times the dosage of the NOU group, respectively (P < .001). Conclusions and Clinical Importance Gallbladder disease associated with cholestatic disease is correlated with PDH in dogs, in both its clinical features and drug management. These findings may be associated with hypercholesterolemia, unidentified genetic factors, and the hydrophobic nature of trilostane.
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Affiliation(s)
- K-H Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - S-M Han
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - K-O Jeon
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - H-T Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Q Li
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - M-O Ryu
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - W-J Song
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - S-C Park
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - H-Y Youn
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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