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Nagata N, Aoshima K, Nakamura K, Takiguchi M. Adrenocortical hypoperfusion detected by contrast-enhanced ultrasound in a dog with trilostane-induced hypoadrenocorticism. J Small Anim Pract 2023; 64:722-726. [PMID: 37340686 DOI: 10.1111/jsap.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023]
Abstract
A 12-year-old neutered male Chihuahua dog was diagnosed with pituitary-dependent hypercortisolism and treated with trilostane. Eighty-nine days later, the dog showed lethargy accompanied by hyponatraemia and hyperkalaemia. Hypoadrenocorticism due to trilostane was suspected, but the result of the adrenocorticotropic hormone stimulation test was not conclusive. Contrast-enhanced ultrasound showed loss of adrenocortical blood flow in both adrenal glands, indicating adrenocortical hypoperfusion and isolated hypoadrenocorticism. Treatment with fludrocortisone acetate improved the condition and electrolyte abnormalities. Thirteen months later, the dog showed alopecia, and an adrenocorticotropic hormone stimulation test revealed increased cortisol concentration, indicating hypercortisolism recurrence. The dog died due to progressive deterioration 22 months after the initial presentation. Post-mortem examination revealed focally extensive necrosis with marked calcification in the parenchyma of the adrenal glands and regeneration of the cells in the zona fasciculata with severe fibrosis. Adrenocortical hypoperfusion detected by contrast-enhanced ultrasound can support the diagnosis of adrenal necrosis and hypoadrenocorticism.
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Affiliation(s)
- N Nagata
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818, Japan
| | - K Aoshima
- Laboratory of Comparative Pathology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818, Japan
| | - K Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818, Japan
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2
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Tinted N, Pongcharoenwanit S, Ongvisespaibool T, Wachirodom V, Jumnansilp T, Buckland N, Chuchalermporn P, Soontararak S, Pairor S, Steiner JM, Thengchaisri N, Assawarachan SN. Serum Bile Acids Concentrations and Liver Enzyme Activities after Low-Dose Trilostane in Dogs with Hyperadrenocorticism. Animals (Basel) 2023; 13:3244. [PMID: 37893969 PMCID: PMC10603711 DOI: 10.3390/ani13203244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Hyperadrenocorticism (HAC) often leads to vacuolar hepatopathy. The impact of trilostane treatment on serum total bile acids (SBAs) concentrations in dogs with HAC remains unknown. This study investigated SBAs concentrations in healthy dogs and those with HAC following trilostane therapy. Ten healthy dogs and fifteen dogs with HAC were prospectively enrolled. A biochemistry profile and pre- and post-prandial SBAs concentrations were determined in each dog. Dogs with HAC were reassessed at 1 and 3 months after the initiation of trilostane treatment. Dogs with HAC had significantly higher serum ALT, ALP, and GGT activities, and cholesterol, triglyceride, and pre-prandial SBAs concentrations compared to healthy dogs. After 3 months of trilostane treatment, polyuria/polydipsia and polyphagia were completely resolved in 42.8% and 35.7%, respectively. Significant improvements in serum ALT and ALP activities and cholesterol concentrations were observed within 1-3 months of trilostane treatment. However, pre- and post-prandial SBAs concentrations did not significantly decrease. These findings suggest that treatment with low-dose trilostane for 3 months appears to reduce serum liver enzyme activities, but not SBAs concentrations. Further investigation is warranted to explore the effects of low-dose trilostane treatment on SBAs concentrations for a longer duration or after achieving appropriate post-ACTH cortisol levels.
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Affiliation(s)
- Nannicha Tinted
- Internal Medicine Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand;
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.S.); (S.P.); (N.T.)
| | - Smith Pongcharoenwanit
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Thodsapol Ongvisespaibool
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Veerada Wachirodom
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Taksaon Jumnansilp
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Narinthip Buckland
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Piyathip Chuchalermporn
- Radiology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand;
| | - Sirikul Soontararak
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.S.); (S.P.); (N.T.)
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Selapoom Pairor
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.S.); (S.P.); (N.T.)
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
| | - Jörg M. Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.S.); (S.P.); (N.T.)
| | - Sathidpak Nantasanti Assawarachan
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.S.); (S.P.); (N.T.)
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan Rd., Lat Yao, Jatujak, Bangkok 10900, Thailand; (S.P.); (T.O.); (V.W.); (T.J.); (N.B.)
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3
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Park S, An J, Kim N, Oh Y, Seo K, Youn H. Isolated hypoaldosteronism managed by DOCP in a dog with chronic kidney disease and hypercortisolism. Vet Med Sci 2022; 8:2292-2296. [DOI: 10.1002/vms3.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Su‐Min Park
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science Seoul National University Seoul Republic of Korea
| | - Ju‐Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary Science, College of Veterinary Medicine Kangwon National University Chuncheon‐siRepublic of Korea
| | - Na‐Hyeong Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science Seoul National University Seoul Republic of Korea
| | - Ye‐In Oh
- Department of Veterinary Internal Medicine, College of Veterinary MedicineKyungpook National University DaeguRepublic of Korea
| | - Kyoung‐won Seo
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science Seoul National University Seoul Republic of Korea
| | - Hwa‐Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science Seoul National University Seoul Republic of Korea
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Golinelli S, de Marco V, Leal RO, Barbarossa A, Aniballi C, Maietti E, Tardo AM, Galac S, Fracassi F. Comparison of methods to monitor dogs with hypercortisolism treated with trilostane. J Vet Intern Med 2021; 35:2616-2627. [PMID: 34672018 PMCID: PMC8692213 DOI: 10.1111/jvim.16269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background The use of adrenocorticotropic hormone stimulation test as method to monitor efficacy of trilostane treatment of hypercortisolism (HC) in dogs has been questioned. Objectives To evaluate and compare 12 methods with which to monitor efficacy of trilostane treatment in dogs with HC. Animals Forty‐five client‐owned dogs with HC treated with trilostane q12h. Methods Prospective cross‐sectional observational study. The dogs were categorized as well‐controlled, undercontrolled, and unwell through a clinical score obtained from an owner questionnaire. The ability to correctly identify trilostane‐treatment control of dogs with HC with the following variables was evaluated: before trilostane serum cortisol (prepill), before‐ACTH serum cortisol, post‐ACTH serum cortisol, plasma endogenous ACTH concentrations, prepill/eACTH ratio, serum haptoglobin (Hp) concentration, serum alanine aminotransferase (ALT), gamma‐glutamyl transferase (γGT) and alkaline phosphatase activity, urine specific gravity, and urinary cortisol : creatinine ratio. Results Ninety‐four re‐evaluations of 44 dogs were included; 5 re‐evaluations of 5 unwell dogs were excluded. Haptoglobin was significantly associated with the clinical score (P < .001) and in the receiver operating characteristic analysis, Hp cutoff of 151 mg/dL correctly identified 90.0% of well‐controlled dogs (specificity) and 65.6% of undercontrolled dogs (sensitivity). Alanine aminotransferase (P = .01) and γGT (P = .009) were significantly higher in undercontrolled dogs. Cutoff of ALT and γGT greater than or equal to 86 U/L and 5.8 U/L, respectively, were significantly associated with poor control of HC by trilostane. Conclusions and Clinical Importance Of all the 12 variables, Hp, and to a lesser degree ALT and γGT, could be considered additional tools to the clinical picture to identify well‐controlled and undercontrolled trilostane‐treated dogs.
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Affiliation(s)
- Stefania Golinelli
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | | | - Rodolfo Oliveira Leal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Andrea Barbarossa
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Camilla Aniballi
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Antonio Maria Tardo
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Sara Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Federico Fracassi
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
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Wehner A, Glöckner S, Weiss B, Ballhausen D, Stockhaus C, Zablotski Y, Hartmann K. Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane. Vet J 2021; 276:105740. [PMID: 34416401 DOI: 10.1016/j.tvjl.2021.105740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.
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Affiliation(s)
- A Wehner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany.
| | - S Glöckner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - B Weiss
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - D Ballhausen
- Veterinay Clinic for Small Animals, Haar, Germany
| | - C Stockhaus
- Veterinay Clinic for Small Animals, Haar, Germany
| | - Y Zablotski
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - K Hartmann
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
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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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Arenas Bermejo C, Pérez Alenza D, García San José P, Llauet L, Pérez-López L, Melián C, C Feldman E. Laboratory assessment of trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 2020; 34:1413-1422. [PMID: 32533623 PMCID: PMC7379015 DOI: 10.1111/jvim.15830] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022] Open
Abstract
Background Results of ACTH stimulation test (ACTHst), pre‐ and post‐trilostane serum cortisol concentrations (SCCs), urine concentration (urine‐specific gravity [USG]), and urine cortisol : creatinine ratios (UCCRs) are common variables used to monitor trilostane treatment of dogs with pituitary‐dependent hyperadrenocorticism (PDH). However, none has consistently discriminated dogs receiving an adequate dose (A) from those overdosed (O) or underdosed (U). Objectives To assess and compare recommended monitoring variables, including serial SCCs in a cohort of dogs with PDH treated with trilostane. Animals Privately owned dogs with PDH (n = 22) and 3 healthy dogs (controls). Methods Prospective, multicenter, 2‐day study. On day “a” (randomized): ACTHst was completed. Day “b” (>2 to <7 days later): SCCs were assessed −0.5 hours, immediately before, and 1, 2, 2.5, 3, 3.5, 4, 6, 8, and 12 hours after trilostane administration. On the first study day, urine collected at home was assessed for USG, UCCR and owner opinions regarding PDH were categorized as: A (clinical signs resolved), U (remains symptomatic), or ill (possible O). Results At 27 pairs of evaluations, 7 dogs were categorized as A, 19 U, and 1 possible O (excluded from the study). There was overlap in SCC results from the A and U dogs at every time point. Results of USG, UCCR, and ACTHst did not discriminate A from U dogs. Trilostane suppresses SCC within 1 hour of administration and its duration of action in most PDH dogs is <8 hours. Conclusions and Clinical Importance No single variable or group of variables reliably discriminated A dogs from U dogs during trilostane treatment for PDH.
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Affiliation(s)
| | - Dolores Pérez Alenza
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Paula García San José
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Lidia Llauet
- Internal Medicine Service, Hospital Veterinari Catalunya, Odena, Spain
| | - Laura Pérez-López
- Department of Animal Pathology, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos Melián
- Department of Animal Pathology, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Edward C Feldman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Boretti F, Musella C, Burkhardt W, Kuemmerle-Fraune C, Riond B, Reusch C, Sieber-Ruckstuhl N. Comparison of two prepill cortisol concentrations in dogs with hypercortisolism treated with trilostane. BMC Vet Res 2018; 14:417. [PMID: 30591042 PMCID: PMC6307252 DOI: 10.1186/s12917-018-1750-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background The ideal method for monitoring trilostane therapy in dogs with hypercortisolism is still open to debate. Recently, determination of the pre-trilostane (prepill) cortisol concentration has been proposed to be more repeatable than either post-trilostane or post-ACTH cortisol. The aim of this study was to compare two prepill cortisol concentrations in dogs with hypercortisolism during trilostane therapy. Sixteen client-owned dogs with naturally occurring hypercortisolism were prospectively included and cortisol concentrations were measured twice, 1 h apart, before the morning trilostane dose (prepill 1 and 2 cortisol). Results A total of 47 prepill cortisol measurement pairs were included. Compared to prepill 1, prepill 2 cortisol was higher in 15, equal in 8 and lower in 24 pairs. Group agreement between prepill 1 and 2 cortisol was 70% (moderate agreement - weighted kappa 0.55). In 30% of the pairs, group assignment was discrepant, implying a different therapeutic decision. In some dogs certain circumstances (e.g. excessive barking, difficulties during blood collection, excitement at arrival) were identified as potential factors explaining the discrepancy between prepill 1 and 2 cortisol measurements. Conclusions In a substantial number of dogs treated with trilostane, the two prepill cortisol concentrations differed. Part of this difference might be ascribable to stressful events during test performance. When using prepill cortisol measurements to monitor trilostane therapy, recording of any incident during handling that might affect cortisol release might be helpful to make a reliable decision about a trilostane dose adaptation.
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Affiliation(s)
- Felicitas Boretti
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Caterina Musella
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Wanda Burkhardt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Claudia Kuemmerle-Fraune
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Barbara Riond
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Claudia Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Sieber-Ruckstuhl
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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9
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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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Lemetayer J, Blois S. Update on the use of trilostane in dogs. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2018; 59:397-407. [PMID: 29606727 PMCID: PMC5855282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many articles published in the past few years have contributed to a better understanding of the use of trilostane in dogs. Trilostane is a competitive inhibitor of 3β-hydroxysteroid dehydrogenase, the enzyme essential for synthesis of cortisol and all other steroids. Trilostane is reported to be safe and effective in the treatment of pituitary-dependent hyperadrenocorticism (HAC), adrenal-dependent HAC, and alopecia X. While trilostane controls most of the clinical signs associated with HAC, abnormalities such as hypertension, hypercoagulability, and proteinuria may persist despite therapy. Because the duration of cortisol suppression after a dose of trilostane is often less than 12 hours, many dogs with HAC could benefit from low dose trilostane treatment every 12 hours. Many controversies regarding trilostane still exist. This review provides a comprehensive commentary on trilostane's indications, mode of action, dose, monitoring, efficacy, and adverse effects.
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Affiliation(s)
- Julie Lemetayer
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1C 1G9
| | - Shauna Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1C 1G9
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11
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King J, Morton J. Incidence and risk factors for hypoadrenocorticism in dogs treated with trilostane. Vet J 2017; 230:24-29. [DOI: 10.1016/j.tvjl.2017.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022]
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12
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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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Johnson CM, Kass PH, Cohen TA, Feldman EC. Effect of Intravenous or Perivascular Injection of Synthetic Adrenocorticotropic Hormone on Stimulation Test Results in Dogs. J Vet Intern Med 2017; 31:730-733. [PMID: 28407319 PMCID: PMC5435047 DOI: 10.1111/jvim.14708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Standard protocols for adrenocorticotropic hormone (ACTH) stimulation testing (ACTHst) often involve intravenous (IV) injection of corticotropin. ACTH might be unintentionally injected into the perivascular (PV) space. Objective To compare stimulation test results after IV and PV injections of ACTH. Animals Twenty privately owned dogs were studied: 10 healthy and 10 with trilostane‐treated naturally occurring hyperadrenocorticism (HAC). Methods Prospective study. Each of 20 dogs underwent 2 ACTHst not <4 nor more than 14 days apart. Five healthy and 5 HAC dogs had an IV ACTHst first and PV second; 5 healthy and 5 HAC dogs had a PV ACTHst first and IV second. Blood samples for measurement of serum cortisol concentration were collected before and 1 hour after ACTH administration. Results No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in all 20 dogs (median μg/dL; interval μg/dL: 8.2; 1.4–17.4 versus 7.8; 0.9–16.9; P = .23). No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in the 10 healthy dogs (median μg/dL; interval μg/dL: 10.9; 7.3–17.4 versus 10.6; 7.1–16.9; P = .54) or in the 10 HAC dogs (median μg/dL; interval μg/dL: 6.3; 1.4–8.6 versus 5.2; 0.9–8.7; P = .061). Conclusions and Clinical Importance Perivascular administration of ACTH does not significantly alter stimulation test results in healthy dogs or in dogs with HAC undergoing therapy with trilostane.
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Affiliation(s)
- C M Johnson
- Department of Small Animal Internal Medicine, Animal Specialty and Emergency Center, Los Angeles, CA
| | - P H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine and School of Medicine, University of California, Davis, CA
| | - T A Cohen
- Department of Small Animal Internal Medicine, Animal Specialty and Emergency Center, Los Angeles, CA
| | - E C Feldman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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Jopp M, Becker J, Lerch M, Miska A, Hausmann H, Neiger R, Schindler S. Crystallographic Characterization of Trilostane and Derivatives. ChemistrySelect 2017. [DOI: 10.1002/slct.201601976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Melanie Jopp
- Institut für Anorganische und Analytische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
| | - Jonathan Becker
- Institut für Anorganische und Analytische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
| | - Markus Lerch
- Institut für Anorganische und Analytische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
| | - Andreas Miska
- Institut für Anorganische und Analytische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
| | - Heike Hausmann
- Institut für Organische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
| | - Reto Neiger
- Klinik für Kleintiere, Innere Medizin und Chirurgie; Justus-Liebig-Universität Gießen; Frankfurter Straße 126 35392 Gießen Germany
| | - Siegfried Schindler
- Institut für Anorganische und Analytische Chemie; Justus-Liebig-Universität Gießen; Heinrich-Buff-Ring 17 35392 Gießen Germany
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15
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Macfarlane L, Parkin T, Ramsey I. Pre-trilostane and three-hour post-trilostane cortisol to monitor trilostane therapy in dogs. Vet Rec 2016; 179:597. [PMID: 27803375 PMCID: PMC5256409 DOI: 10.1136/vr.103744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/18/2022]
Abstract
It is recommended that trilostane therapy of canine hyperadrenocorticism is monitored using an ACTH stimulation test, however this has never been validated. Three cortisol concentrations (pre-trilostane, 3-hour posttrilostane and 1-hour post-ACTH stimulation) were compared to a clinical score obtained from an owner questionnaire. There were 110 sets of 3 cortisol measurements and questionnaires obtained from 67 trilostane treated dogs. Questionnaire results were used to classify each dog as well or unwell. Well dogs were then categorised as having excellent, moderate or poor hyperadrenocorticism control, using thresholds produced by 14 independent veterinarians. Correlation co-efficients were used to compare the three cortisol concentrations to the owner score and the Kruskal Wallis and Mann-Whitney U tests were used to compare the three cortisol concentrations between categories of control. Cortisol cut-off values between significantly different categories were determined using ROC curves. Pre-trilostane and 3-hour post-trilostane cortisol were better correlated to the owner score and had cut-offs to differentiate between categories of control that had superior sensitivity and specificity results, than the post-ACTH cortisol. Iatrogenic hypoadrenocorticism was not detected in any unwell dog. This study shows that the pre-trilostane and 3-hour post-trilostane cortisol are potentially better monitoring methods than the ACTH stimulation test.
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Affiliation(s)
- L Macfarlane
- North Downs Specialist Referral, Friesian Buildings 3&4, The Brewerstreet Dairy Business Park, Brewer Street, Bletchingley, Surrey RH1 4QP, UK
| | - T Parkin
- Weipers Centre Equine Hospital, University of Glasgow, Glasgow, UK
| | - I Ramsey
- Small Animal Hospital, University of Glasgow, Glasgow, UK
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Woolcock AD, Bugbee AC, Creevy KE. Evaluation of baseline cortisol concentration to monitor efficacy of twice-daily administration of trilostane to dogs with pituitary-dependent hyperadrenocorticism: 22 cases (2008-2012). J Am Vet Med Assoc 2016; 248:814-21. [PMID: 27003023 DOI: 10.2460/javma.248.7.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate use of cortisol concentration prior to ACTH stimulation (baseline) to monitor efficacy of twice-daily administration of trilostane to dogs with pituitary-dependent hyperadrenocorticism (PDH). DESIGN Retrospective case series. ANIMALS 22 dogs with PDH. PROCEDURES The database of a veterinary hospital was searched to identify dogs with PDH that were treated with the FDA-approved veterinary formulation of trilostane twice daily between January 1, 2008, and December 31, 2012. For each dog, signalment and details regarding each hospital visit including comorbidities, electrolyte concentrations, and clinical signs were extracted from the record. For each ACTH stimulation test performed, the respective correlations between baseline cortisol concentration and the cortisol concentration after ACTH stimulation (ACTH-stimulated cortisol concentration) and resultant decision regarding trilostane dose adjustment were determined. Excessive suppression of cortisol production was defined as an ACTH-stimulated cortisol concentration < 2.0 μg/dL. The ability of various baseline cortisol concentrations to predict whether a dog had excessive suppression of cortisol production was determined. RESULTS 109 ACTH stimulation tests were performed for the 22 dogs. A baseline cortisol concentration > 3.2 μg/dL predicted that ACTH-stimulated cortisol concentration would be ≥ 2.0 μg/dL with 100% certainty; however, 14 of 64 tests with a baseline cortisol concentration > 3.2 μg/dL had an ACTH-stimulated cortisol concentration ≤ 3.2 μg/dL, which was suggestive of inadequate adrenocortical cortisol reserves. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that baseline cortisol concentration should not be used as the sole monitoring tool for management of dogs with PDH treated with trilostane twice daily.
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