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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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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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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: 8] [Impact Index Per Article: 2.0] [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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Carotenuto G, Malerba E, Dolfini C, Brugnoli F, Giannuzzi P, Semprini G, Tosolini P, Fracassi F. Cushing's syndrome-an epidemiological study based on a canine population of 21,281 dogs. Open Vet J 2019; 9:27-32. [PMID: 31086762 PMCID: PMC6500859 DOI: 10.4314/ovj.v9i1.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/23/2019] [Indexed: 11/24/2022] Open
Abstract
The epidemiological characteristics of spontaneous hypercortisolism (HC) were derived from 21,281 client-owned dogs selected from four private veterinary clinics and one university reference center for endocrinology. The odds ratio (OR) method was employed to investigate the risk of developing HC related to breed, gender, and sexual status. The estimated prevalence of HC in the four private clinics was 0.20% [95% confidence interval (CI), 0.13–0.27] and was significantly different compared to the university reference center (1.46%; 95% CI, 1.12–1.80). Sex, breed, and age resulted in risk factors for HC. Mean (± SD) age for dogs with HC was 9.8 (± 2.5) yr. Females had higher risk for HC compared to males (OR 1.85; 95% CI, 1.24–2.75); all neutered dogs (both males and females) had higher risk than intact dogs (OR 2.54; 95% CI, 1.72–3.73); and neutered females had higher risk compared to intact females (OR 2.61; 95% CI, 1.54–4.42). Using the mixed breed dogs as a control population (OR = 1), the risk of developing HC was significantly higher in the Standard Schnauzer (OR 58.1; p < 0.0001) and Fox Terrier (OR 20.33; p < 0.0001). With regard to HC, this study identified an overall prevalence of 0.20%. The data support the existence of sex predisposition, with the highest risk for neutered females.
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Affiliation(s)
- Gaia Carotenuto
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Eleonora Malerba
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Costanza Dolfini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
| | - Francesca Brugnoli
- Ospedale Veterinario I Portoni Rossi, Zola Predosa, Bologna 40069, Italy
| | | | | | | | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna 40064, Italy
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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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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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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: 20] [Impact Index Per Article: 2.5] [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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Carbenoxolone Disodium Treatment for Canine Pituitary-Dependent Hyperadrenocorticism. PLoS One 2016; 11:e0166267. [PMID: 27824928 PMCID: PMC5100902 DOI: 10.1371/journal.pone.0166267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022] Open
Abstract
Pituitary-dependent hyperadrenocorticism (PDH) is mainly caused by pituitary corticotroph tumors in dogs. A characteristic feature of corticotroph tumors is their resistance to negative feedback by glucocorticoids. In some animal species, including dogs, the aberrant expression of 11β-hydroxysteroid dehydrogenase (11HSD), a cortisol metabolic enzyme, is observed in corticotroph tumors. We previously reported that carbenoxolone (CBX), an inhibitor of 11HSD, suppressed ACTH secretion from the pituitary gland, and decreased cortisol concentrations in healthy dogs. Therefore, the aim of this study was to investigate the therapeutic effects of CBX on dogs with PDH. Six dogs with PDH were treated with 60 to 80 mg/kg/day of CBX for 6 weeks, followed by trilostane, which is a commonly used agent for canine PDH. CBX treatment led to a gradual decrease in both basal and in corticotropic releasing hormone (CRH)-stimulated plasma ACTH concentrations and CRH-stimulated serum cortisol concentrations, without side effects. However, basal and stimulated ACTH and cortisol concentrations remained higher than those of healthy dogs, and clinical symptoms such as polydipsia and polyuria were not ameliorated. After a 2-week wash-out interval, trilostane was administered for 2 weeks. Although basal plasma ACTH concentrations were higher after trilostane treatment than CBX treatment, polydipsia and polyuria resolved in all six dogs. The reason for the lack of improvement in polydipsia and polyuria with CBX treatment is unclear. Other mechanisms, in addition to a partial decrease in ACTH secretion, are likely to be involved. In conclusion, this is the first study to report the in vivo effects of CBX in dogs with PDH. The findings suggest that CBX inhibits ACTH secretion from canine pituitary tumors, resulting in lower cortisol concentrations.
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Midence JN, Drobatz KJ, Hess RS. Cortisol Concentrations in Well-Regulated Dogs with Hyperadrenocorticism Treated with Trilostane. J Vet Intern Med 2015; 29:1529-33. [PMID: 26374943 PMCID: PMC4895678 DOI: 10.1111/jvim.13615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/29/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are no clear treatment guidelines for dogs with clinically well-regulated hyperadrenocorticism in which serum cortisol concentrations before and after an ACTH stimulation test performed 3-6 hours after trilostane administration are < 2.0 μg/dL. OBJECTIVE To determine if serum cortisol concentrations measured before (Pre1) and after (Post1) ACTH stimulation at 3-6 hours after trilostane administration are significantly lower than cortisol concentrations measured before (Pre2) and after (Post2) ACTH stimulation 9-12 hours after trilostane administration, in a specific population of dogs with clinically well-regulated hyperadrenocorticism and Pre1 and Post1 <2 μg/dL. ANIMALS Thirteen client-owned dogs with clinically well-regulated hyperadrenocorticism and Pre1 and Post1 serum cortisol concentrations <2.0 μg/dL 3-6 hours after trilostane administration. METHODS Prospective study. Dogs had a second ACTH stimulation test performed 9-12 hours after trilostane administration, on the same day of the first ACTH stimulation test. Cortisol concentrations before and after ACTH stimulation were compared using a paired t-test. RESULTS Cortisol concentrations before (1.4 ± 0.3 μg/dL) and after the first stimulation (1.5 ± 0.3 μg/dL, mean ± SD) were significantly lower than cortisol concentration before the second stimulation (3.3 ± 1.6 μg/dL, P = .0012 each). Cortisol concentration before the first stimulation was also significantly lower than cortisol concentration after the second stimulation (5.3 ± 2.4 μg/dL, P = .0001). CONCLUSIONS AND CLINICAL IMPORTANCE In dogs with clinically well-regulated, trilostane-treated, hyperadrenocorticism, and cortisol concentrations <2 μg/dL before and after the first stimulation, a second ACTH stimulation test performed 9-12 hours after treatment can result in higher cortisol concentrations that could support continued trilostane treatment.
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Affiliation(s)
- J N Midence
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - K J Drobatz
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - R S Hess
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Teshima T, Matsumoto H, Okusa T, Nakamura Y, Koyama H. Effects of Carbenoxolone on the Canine Pituitary-Adrenal Axis. PLoS One 2015; 10:e0135516. [PMID: 26262685 PMCID: PMC4532459 DOI: 10.1371/journal.pone.0135516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/13/2015] [Indexed: 11/25/2022] Open
Abstract
Cushing’s disease caused by pituitary corticotroph adenoma is a common endocrine disease in dogs. A characteristic biochemical feature of corticotroph adenomas is their relative resistance to suppressive negative feedback by glucocorticoids. The abnormal expression of 11beta-hydroxysteroid dehydrogenase (11HSD), which is a cortisol metabolic enzyme, is found in human and murine corticotroph adenomas. Our recent studies demonstrated that canine corticotroph adenomas also have abnormal expression of 11HSD. 11HSD has two isoforms in dogs, 11HSD type1 (HSD11B1), which converts cortisone into active cortisol, and 11HSD type2 (HSD11B2), which converts cortisol into inactive cortisone. It has been suggested that glucocorticoid resistance in corticotroph tumors is related to the overexpression of HSD11B2. Therefore it was our aim to investigate the effects of carbenoxolone (CBX), an 11HSD inhibitor, on the healthy dog’s pituitary-adrenal axis. Dogs were administered 50 mg/kg of CBX twice each day for 15 days. During CBX administration, no adverse effects were observed in any dogs. The plasma adrenocorticotropic hormone (ACTH), and serum cortisol and cortisone concentrations were significantly lower at day 7 and 15 following corticotropin releasing hormone stimulation. After completion of CBX administration, the HSD11B1 mRNA expression was higher, and HSD11B2 mRNA expression was significantly lower in the pituitaries. Moreover, proopiomelanocortin mRNA expression was lower, and the ratio of ACTH-positive cells in the anterior pituitary was also significantly lower after CBX treatment. In adrenal glands treated with CBX, HSD11B1 and HSD11B2 mRNA expression were both lower compared to normal canine adrenal glands. The results of this study suggested that CBX inhibits ACTH secretion from pituitary due to altered 11HSD expressions, and is potentially useful for the treatment of canine Cushing’s disease.
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Affiliation(s)
- Takahiro Teshima
- Division of Therapeutic Science I, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
- * E-mail:
| | - Hirotaka Matsumoto
- Division of Therapeutic Science I, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Tomoko Okusa
- Division of Therapeutic Science I, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Yumi Nakamura
- Division of Therapeutic Science I, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Hidekazu Koyama
- Division of Therapeutic Science I, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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11
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Bonadio CM, Feldman EC, Cohen TA, Kass PH. Comparison of adrenocorticotropic hormone stimulation test results started 2 versus 4 hours after trilostane administration in dogs with naturally occurring hyperadrenocorticism. J Vet Intern Med 2014; 28:1239-43. [PMID: 24863172 PMCID: PMC4857938 DOI: 10.1111/jvim.12357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/09/2014] [Accepted: 03/11/2014] [Indexed: 11/26/2022] Open
Abstract
Background Trilostane medical treatment of naturally occurring hyperadrenocorticism (NOH) in dogs is common, as is use of the adrenocorticotropic hormone (ACTH) stimulation test (ACTHst) in monitoring response to treatment. There is uncertainty regarding when the ACTHst should be started relative to time of trilostane administration. Objective To compare ACTHst results in dogs being treated for NOH with trilostane when the test is begun 2 versus 4 hours after trilostane administration. Animals Twenty‐one privately owned dogs with NOH, each treated with trilostane for at least 30 days. Methods Each dog had 2 ACTHst completed, 1 started 2 hours and the other 4 hours after trilostane administration. The second test was started no sooner than 46 hours and no later than 74 hours after the first. Results For all 21 dogs, the mean post‐ACTH serum cortisol concentration from tests started 2 hours after trilostane administration (5.4 ± 3.7 μg/dL) was significantly lower (P = .03) as compared with results from the tests started 4 hours after administration (6.5 ± 4.5 μg/dL). Conclusions Results of ACTHst started at different times yield significantly different results. Dogs with NOH, treated with trilostane, and monitored with ACTHst results should have all of their subsequent ACTHst tests begun at or about the same time after trilostane administration.
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Affiliation(s)
- C M Bonadio
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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Griebsch C, Lehnert C, Williams GJ, Failing K, Neiger R. Effect of trilostane on hormone and serum electrolyte concentrations in dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 2013; 28:160-5. [PMID: 24341822 PMCID: PMC4895538 DOI: 10.1111/jvim.12268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 09/03/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022] Open
Abstract
Background The effects of trilostane on key hormones and electrolytes over 24 hours in dogs with pituitary‐dependent hyperadrenocorticism (PDH) are unknown. Objectives To determine the plasma concentration of cortisol, endogenous adrenocorticotropic hormone (ACTH), aldosterone, sodium, potassium, and ionized calcium concentrations, and plasma renin activity over a 24‐hour period after administration of trilostane to dogs with well‐controlled PDH. Animals Nine dogs (mean age 9.3 ± 0.67 years, mean weight 31.9 ± 6.4 kg) with confirmed PDH. Methods Prospective study. Thirty days after the first administration of trilostane, blood samples were taken at −30, 0 (baseline), 15, 30, 60, and 90 minutes, and 2, 3, 4, 6, 8, 12, 16, 20, and 24 hours after administration of trilostane and plasma concentration of cortisol, endogenous ACTH, aldosterone, sodium, potassium, ionized calcium, and renin activity were determined. Results Cortisol concentrations decreased significantly (P < .001) 2–4 hours after trilostane administration. From baseline, there was a significant (P < .001) increase in endogenous ACTH concentrations between hours 3–12, a significant increase (P < .001) in aldosterone concentration between hours 16–20, and a significant (P < .001) increase in renin activity between hours 6–20. Potassium concentration decreased significantly (P < .05) between hours 0.5–2. Conclusion and Clinical Importance Treatment with trilostane did not cause clinically relevant alterations in plasma aldosterone and potassium concentration. Results suggest that in dogs with PDH, the optimal time point for an ACTH‐stimulation test to be performed is 2–4 hours after trilostane dosing. Future studies are necessary to establish interpretation criteria for a 2‐ to 4‐hour postpill ACTH‐stimulation test.
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Affiliation(s)
- C Griebsch
- Small Animal Clinic (Internal Medicine), Justus-Liebig University Giessen, Giessen, Germany
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13
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Arenas C, Melián C, Pérez-Alenza M. Evaluation of 2 Trilostane Protocols for the Treatment of Canine Pituitary-Dependent Hyperadrenocorticism: Twice Daily versus Once Daily. J Vet Intern Med 2013; 27:1478-85. [DOI: 10.1111/jvim.12207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- C. Arenas
- Department of Small Animal Medicine and Surgery Clinical Sciences; School of Veterinary Medicine; Complutense University of Madrid; Madrid Spain
| | - C. Melián
- Clínica Veterinaria Atlántico; Las Palmas Gran Canaria Spain
| | - M.D. Pérez-Alenza
- Department of Small Animal Medicine and Surgery Clinical Sciences; School of Veterinary Medicine; Complutense University of Madrid; Madrid Spain
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14
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Mellett Keith AM, Bruyette D, Stanley S. Trilostane therapy for treatment of spontaneous hyperadrenocorticism in cats: 15 cases (2004-2012). J Vet Intern Med 2013; 27:1471-7. [PMID: 24011349 DOI: 10.1111/jvim.12178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 06/16/2013] [Accepted: 07/29/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical treatment with trilostane improves clinical signs, causes unclear insulin requirement changes, and variable survival times in cats. OBJECTIVES/HYPOTHESIS To characterize the long-term efficacy of trilostane in treating cats with hyperadrenocorticism (HAC). ANIMALS Fifteen client-owned cats with spontaneous HAC. METHODS Multicenter descriptive retrospective study with a search performed on all medical records for cats diagnosed with spontaneous HAC. RESULTS Clinical signs (13 of 15 cats) and ACTH stimulation testing results (13 of 15) improved with trilostane therapy. Diabetes mellitus was reported in 9/15 cases. Insulin requirements decreased by 36% within 2 months in 6/9 diabetic cats. Median survival time was 617 days for all cats (range 80-1,278 days). Complications included weight loss, urinary tract infections, chronic kidney disease, seizures, and recurrent pancreatitis. Hypocortisolemia was documented in 1 case. Cause of death occurred as a result of nonadrenal or nondiabetic illnesses (renal failure, seizures [caused by hypoglycemia or unknown]), or lymphoma. CONCLUSIONS AND CLINICAL IMPORTANCE Trilostane ameliorates clinical signs of HAC in cats, is tolerated well in the long term, and can lead to improved regulation of diabetes.
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Affiliation(s)
- A M Mellett Keith
- Section of Internal Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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15
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Park F, Blois S, Abrams-Ogg A, Wood R, Allen D, Nykamp S, Downie A. Hypercoagulability and ACTH-Dependent Hyperadrenocorticism in Dogs. J Vet Intern Med 2013; 27:1136-42. [DOI: 10.1111/jvim.12162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/23/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- F.M. Park
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - S.L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - A.C.G. Abrams-Ogg
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - R.D. Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON
| | - D.G. Allen
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - S.G. Nykamp
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON
| | - A. Downie
- Health Sciences Center (Downie); Ontario Veterinary College; University of Guelph; Guelph ON
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16
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Cho KD, Kang JH, Chang D, Na KJ, Yang MP. Efficacy of Low- and High-Dose Trilostane Treatment in Dogs (< 5 kg) with Pituitary-Dependent Hyperadrenocorticism. J Vet Intern Med 2012; 27:91-8. [DOI: 10.1111/jvim.12007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/25/2012] [Accepted: 09/25/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- K.-D. Cho
- Laboratory of Veterinary Internal Medicine; Veterinary Medicine; Chungbuk National University; Cheongju Chungbuk Republic of Korea
| | - J.-H. Kang
- Laboratory of Veterinary Internal Medicine; Veterinary Medicine; Chungbuk National University; Cheongju Chungbuk Republic of Korea
| | - D. Chang
- Laboratory of Veterinary Diagnostic Imaging; College of Veterinary Medicine; Chungbuk National University; Cheongju Chungbuk Republic of Korea
| | - K.-J. Na
- Laboratory of Veterinary Laboratory Medicine; College of Veterinary Medicine; Chungbuk National University; Cheongju Chungbuk Republic of Korea
| | - M.-P. Yang
- Laboratory of Veterinary Internal Medicine; Veterinary Medicine; Chungbuk National University; Cheongju Chungbuk Republic of Korea
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17
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Feldman EC, Kass PH. Trilostane dose versus body weight in the treatment of naturally occurring pituitary-dependent hyperadrenocorticism in dogs. J Vet Intern Med 2012; 26:1078-80. [PMID: 22708554 DOI: 10.1111/j.1939-1676.2012.00956.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/10/2012] [Accepted: 05/09/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Trilostane is commonly used in the treatment of dogs with naturally occurring pituitary-dependent hyperadrenocorticism (PDH). Dose recommendations have varied from the manufacturer and the literature. HYPOTHESIS As body weight increases, dose/kg or dosage/day of trilostane required to control the clinical signs of PDH decreases. ANIMALS 70 dogs with naturally occurring hyperadrenocorticism. METHODS Retrospective study. Each dog must have been treated for at least 6 months and should have shown a "good response" to trilostane, as determined by owners. Statistical comparisons of dose and dosage were made after the dogs were separated into groups weighing <15 or >15 kg; groups weighing ≤10, 10.1-20, 20.1-30, and ≥30 kg; and then groups based on body surface area versus dose/kg and total amount of trilostane required to control the condition. RESULTS There was no significant difference in trilostane dose in mg/kg of body weight or in the total amount of trilostane required daily to control clinical signs, except when the dose for dogs weighing >30 kg was compared with that for the other groups. However, despite lack of statistical significance when comparing groups, there was a significant trend using polynomial regression analysis, suggesting that as body weight increases, the amount of trilostane (mg/kg/dose as well as mg/kg/daily dosage) required to control clinical signs decreases. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs weighing >30 kg, and possibly those weighing >15 kg, might require smaller amounts of trilostane per dose or per day than those weighing less, to control PDH-associated clinical signs.
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Affiliation(s)
- E C Feldman
- Department of Medicine and Epidemiology, Davis, CA, USA.
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18
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Ouschan C, Lepschy M, Zeugswetter F, Möstl E. The influence of trilostane on steroid hormone metabolism in canine adrenal glands and corpora lutea—an in vitro study. Vet Res Commun 2011; 36:35-40. [DOI: 10.1007/s11259-011-9509-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
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19
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Feldman EC. Evaluation of twice-daily lower-dose trilostane treatment administered orally in dogs with naturally occurring hyperadrenocorticism. J Am Vet Med Assoc 2011; 238:1441-51. [DOI: 10.2460/javma.238.11.1441] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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McLauchlan G, Knottenbelt C, Augusto M, Helm J, McGrotty Y, Ramsey I. Retrospective evaluation of the effect of trilostane on insulin requirement and fructosamine concentration in eight diabetic dogs with hyperadrenocorticism. J Small Anim Pract 2010; 51:642-8. [DOI: 10.1111/j.1748-5827.2010.01005.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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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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Hara Y, Teshima T, Taoda T, Ishino H, Nezu Y, Harada Y, Yogo T, Masuda H, Teramoto A, Tagawa M. Efficacy of transsphenoidal surgery on endocrinological status and serum chemistry parameters in dogs with Cushing's disease. J Vet Med Sci 2009; 72:397-404. [PMID: 19996557 DOI: 10.1292/jvms.09-0367] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Postoperative changes in endocrinological status and serum chemistry during the 4 years after transsphenoidal surgery (TSS) in 25 dogs with Cushing's disease were investigated in a prospective study. In all 25 dogs, Cushing's disease was diagnosed from resected pituitary tissues as a corticotroph adenoma in the anterior lobe of the pituitary. Prior to TSS, all 25 dogs showed hypercortisolemia. After TSS, the ACTH stimulation test showed continued low serum cortisol concentrations in 21 dogs (84%). In addition, the serum thyroid stimulating hormone concentrations decreased sequentially, while the serum T4 concentrations tended to increase due to the postoperative hormone substitution therapy utilized to avoid secondary hypothyroidism. In regard to serum chemistry, alkaline phosphatase (ALP), alanine aminotransferase (ALT) and total cholesterol are commonly increased in canine Cushing's disease. In this study, ALP, ALT and total cholesterol were increased in 23 cases (92%), 19 cases (76%) and 20 cases (80%), respectively. However, postoperatively, these concentrations gradually decreased. The postoperative serum concentrations of ALP at 1 year, that of ALT at six months to 2 years and that of total cholesterol over the course of the 4 years decreased significantly compared with the concentrations before TSS. These results show that TSS is an effective treatment for canine Cushing's disease and for long-term improvement of hypercortisolemia. Moreover, TSS is effective in improvement of hypercortisolism, such as increased concentrations of serum ALP, ALT and total cholesterol.
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Affiliation(s)
- Yasushi Hara
- Division of Veterinary Surgery, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo.
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23
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Galac S, Buijtels JJCWM, Kooistra HS. Urinary corticoid: creatinine ratios in dogs with pituitary-dependent hypercortisolism during trilostane treatment. J Vet Intern Med 2009; 23:1214-9. [PMID: 19709356 DOI: 10.1111/j.1939-1676.2009.0374.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The adrenocorticotropic hormone (ACTH) stimulation test is used to evaluate trilostane treatment in dogs with hypercortisolism. HYPOTHESIS The urinary corticoid : creatinine ratio (UCCR) is a good alternative to the ACTH stimulation test to determine optimal trilostane dose. ANIMALS Eighteen dogs with pituitary-dependent hypercortisolism. METHODS In this prospective study, the dose of trilostane was judged to be optimal on the basis of resolution of clinical signs of hypercortisolism and results of an ACTH stimulation test. The owners collected urine for determination of UCCR at 2-week intervals for at least 8 weeks after achieving the optimal trilostane dose. RESULTS The UCCRs were significantly higher before treatment (11.5-202.0 x 10(-6); median, 42.0 x 10(-6)) than at rechecks 2 months after optimal dosing, but they did not decrease below the upper limit of the reference range in the majority of dogs. The UCCRs of 11 dogs that initially were dosed insufficiently (range, 7.5-79.0 x 10(-6); median, 31.0 x 10(-6)) did not differ significantly from UCCRs when the dosage was optimal (8.2-72.0 x 10(-6); median, 33.0 x 10(-6)). Post-ACTH cortisol concentrations did not correlate significantly with UCCRs at rechecks during trilostane treatment. Long-term follow-up indicated that the decrease in UCCR below the upper limit of the reference was associated with hypocortisolism. CONCLUSION AND CLINICAL IMPORTANCE The UCCR cannot be used as an alternative to the ACTH stimulation test to determine the optimal dose of trilostane, but might be helpful in detecting dogs at risk for developing hypocortisolism during trilostane treatment.
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Affiliation(s)
- S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
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24
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Teshima T, Hara Y, Takekoshi S, Nezu Y, Harada Y, Yogo T, Teramoto A, Osamura RY, Tagawa M. Trilostane-induced inhibition of cortisol secretion results in reduced negative feedback at the hypothalamic-pituitary axis. Domest Anim Endocrinol 2009; 36:32-44. [PMID: 19041802 DOI: 10.1016/j.domaniend.2008.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 09/28/2008] [Accepted: 10/01/2008] [Indexed: 11/24/2022]
Abstract
Cushing's disease caused by pituitary corticotroph adenoma in dogs is usually treated by medical treatment, and the efficacy of this treatment has been reported. However, controversy remains as to whether reduced negative feedback through the inhibition of cortisol secretion, similar to Nelson's syndrome, may appear as an adverse effect. The purpose of this study was to investigate the effect of reduced negative feedback through the inhibition of cortisol secretion by daily trilostane administration on the pituitary-adrenal axis in clinically normal dogs. Dogs were administered 5mg/kg trilostane twice a day every day for 8 weeks (n=8) or 16 weeks (n=3). After the initiation of trilostane administration, plasma adrenocorticotropic hormone (ACTH) concentrations were increased remarkably. As assessed by magnetic resonance imaging (MRI) during administration, the pituitary became enlarged. After trilostane administration, the cytoplasmic areas of the pituitary corticotrophs were increased and the ratio of pituitary corticotrophs to all cells in the anterior lobe was greater in the trilostane-treated dogs than that in untreated animals. In addition, histological examinations revealed bilateral adrenal cortical hyperplasia. Using real-time PCR quantification, the expression of proopiomelanocortin (POMC) mRNA in the pituitary and ACTH receptor (ACTH-R) mRNA in the adrenal gland was greater in the dogs treated with trilostane than in untreated dogs. These results indicate that reduced negative feedback induced hyperfunction of the pituitary corticotrophs and pituitary enlargement in healthy dogs. These changes suggest that the inhibition of cortisol secretion by trilostane may increase the risk for accelerating the growth of corticotroph adenomas in dogs with Cushing's disease.
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Affiliation(s)
- Takahiro Teshima
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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25
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Ramsey IK, Richardson J, Lenard Z, Tebb AJ, Irwin PJ. Persistent isolated hypocortisolism following brief treatment with trilostane. Aust Vet J 2008; 86:491-5. [DOI: 10.1111/j.1751-0813.2008.00373.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Galac S, Buijtels JJCWM, Mol JA, Kooistra HS. Effects of trilostane on the pituitary-adrenocortical and renin-aldosterone axis in dogs with pituitary-dependent hypercortisolism. Vet J 2008; 183:75-80. [PMID: 19042143 DOI: 10.1016/j.tvjl.2008.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 10/02/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
Abstract
The medical records of 63 dogs with pituitary-dependent hypercortisolism (PDH) before and during treatment with trilostane were reviewed retrospectively. The correct trilostane dosage in dogs with PDH was based on the resolution of clinical signs and the results of an adrenocorticotropic hormone (ACTH) stimulation test. The mean (+/-SD) dose rate of trilostane to achieve good clinical control was 2.8+/-1.0mg/kg bodyweight. Trilostane treatment resulted in a significant decline in basal plasma cortisol concentrations. The median plasma ACTH concentration (39 pmol/L, range 7-132 pmol/L; n=60) at the optimal trilostane dosage time was significantly higher (P<0.001) than before treatment (13 pmol/L, range 2-102 pmol/L). These values did not overlap with plasma ACTH concentrations (range 212-307 pmol/L) of five PDH dogs with trilostane-induced hypocortisolism. The median cortisol/ACTH ratio in well-controlled dogs (0.23, range 0.03-2.5; n=46) was significantly lower (P<0.001) than before treatment (2.59, range 0.27-13.25). Trilostane treatment resulted in an insignificant decrease in plasma aldosterone concentration (PAC), but the median plasma renin activity (PRA) at the time the trilostane dosage was considered optimal (265 fmol/L/s, range 70-3280 fmol/L/s; n=18) was significantly higher (P<0.001) than prior to treatment (115 fmol/L/s, range 15-1330 fmol/L/s). Similarly, the median PAC/PRA ratio during trilostane treatment (0.16, range 0.003-0.92; n=17) was significantly lower (P<0.001) than before treatment (median 0.44, range 0.04-1.33). Trilostane affected both the hypothalamic-pituitary-adrenocortical and the renin-aldosterone axes. The results also suggested that basal plasma ACTH concentration may be used to detect trilostane overdosage.
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Affiliation(s)
- Sara Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Jenny J C W M Buijtels
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jan A Mol
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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27
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Vaughan MA, Feldman EC, Hoar BR, Nelson RW. Evaluation of twice-daily, low-dose trilostane treatment administered orally in dogs with naturally occurring hyperadrenocorticism. J Am Vet Med Assoc 2008; 232:1321-8. [DOI: 10.2460/javma.232.9.1321] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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