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Erger CG, Gerras AL, Conley AJ, Gilor C, Burns DeMarle K, Refsal KR, Fleming JM, Sledge DG, Langlois DK. Case report: Androgen-secreting adrenocortical tumors in eight cats. Front Vet Sci 2023; 10:1158142. [PMID: 37383353 PMCID: PMC10293747 DOI: 10.3389/fvets.2023.1158142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023] Open
Abstract
Urine marking, aggression, and other behavioral concerns are common reasons for cat owners to seek veterinary care. Empiric treatment for lower urinary tract disease or primary behavior disorders are commonly pursued, especially in those cases with normal routine laboratory evaluations. Herein, we report the clinicopathologic findings in eight sexually altered cats that were diagnosed with androgen-secreting adrenocortical tumors. Nearly all cats (n = 7) initially were evaluated for inappropriate urination and pungent urine, with additional behavioral concerns including aggression (n = 3) and excess vocalization (n = 4) commonly reported. Penile barbs (n = 5) were identified in all five male cats, and an enlarged clitoris was observed in one female cat. Testing of serum androgen concentrations revealed abnormally high androstenedione (n = 1) or testosterone (n = 7) concentrations. In the five cases with available adrenal tissue, histopathologic evaluation identified either an adrenocortical adenoma (n = 3) or adrenocortical carcinoma (n = 2). Hormonal abnormalities resolved and clinical signs improved in the four cats that underwent surgical adrenalectomy, with each of these cats surviving >1 year. However, clinical signs were minimally impacted with medical treatments, including one cat in which trilostane treatment failed to improve clinical signs or testosterone concentrations. This collection of cases underscores the importance of a detailed physical examination as well as the consideration of endocrine disturbances in cats undergoing evaluation for inappropriate urination or aggression. Furthermore, this report adds to the growing body of evidence that sex-hormone secreting adrenal tumors in cats may be an under-recognized syndrome.
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Affiliation(s)
- Caylen G. Erger
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Allison L. Gerras
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Alan J. Conley
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Karah Burns DeMarle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Kent R. Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | | | - Dodd G. Sledge
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | - Daniel K. Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Yu J, Lenord J, Lau M, Brunel L, Gray R, Donahoe SL, Boland L. Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism. JFMS Open Rep 2021; 7:20551169211045640. [PMID: 34616560 PMCID: PMC8488528 DOI: 10.1177/20551169211045640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Case summary A 7-year-old male neutered domestic longhair cat was presented with chronic progressive gynaecomastia, polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behavioural changes were not reported and virilisation was not present on physical examination. Pertinent haematology, biochemistry and urinalysis findings at the time of referral included mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation of adrenal hormones with a low-dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hyperaldosteronism and hypercortisolism. Adrenalectomy was performed and histopathology was consistent with an adrenocortical tumour. Clinical signs and hormone elevations resolved postoperatively. Relevance and novel information To our knowledge, this is the second report of gynaecomastia secondary to an adrenal tumour in a male neutered cat and the first associated with hyperprogesteronism.
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Affiliation(s)
- Jane Yu
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Jason Lenord
- Balmain Veterinary Hospital, Rozelle, NSW, Australia
| | - Michelle Lau
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Rachael Gray
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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Harro CC, Refsal KR, Shaw N, Alston SM, Folger W, Gross C, Cousins WM, Monahan CF, Mazaki-Tovi M, Langlois DK. Retrospective study of aldosterone and progesterone secreting adrenal tumors in 10 cats. J Vet Intern Med 2021; 35:2159-2166. [PMID: 34473866 PMCID: PMC8478046 DOI: 10.1111/jvim.16256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Primary hyperaldosteronism caused by adrenal neoplasia has been well described in cats. Multiple corticosteroid abnormalities occur in a subset of affected cats, but characterizations of this syndrome are limited to several case reports. Objectives To describe a series of cats with adrenal tumors secreting aldosterone and additional corticosteroids. Animals Ten cats with multiple corticosteroid secreting adrenocortical tumors. Methods Retrospective case series. Medical records of cats with adrenal tumors secreting both aldosterone and progesterone were identified. Data concerning historical findings, clinicopathologic features, treatments, and outcomes were retrieved from medical records. Results All 10 cats had diabetes mellitus in addition to biochemical features of hyperaldosteronism such as hypokalemia. High corticosterone concentrations were observed in all 3 cats in which this corticosteroid was measured. Ultrasound examinations revealed unilateral adrenal tumors in all 10 cases, and the contralateral adrenal gland was either atrophied or not identified in 5 cats. Three of 4 cats developed hypoadrenocorticism after surgical adrenalectomy. Three cats achieved diabetic remission after adrenalectomy. Two cats treated with adrenalectomy survived >1 year, 1 cat survived 6.5 months, and 1 cat was alive 5.5 months after diagnosis. Survival >1 year occurred in 2 of 4 cats treated with medical management alone. Two cats were not treated. Conclusions and Clinical Importance The presence of multiple corticosteroid abnormalities should be considered in cats with aldosterone secreting adrenal tumors, especially those with concurrent diabetes mellitus. Both surgical and medical management can result in long‐term survival, although diabetic remission was documented only in cats undergoing adrenalectomy.
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Affiliation(s)
- Cailin C Harro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kent R Refsal
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nicole Shaw
- Veterinary Emergency and Referral Group, Brooklyn, New York, USA
| | | | | | - Carolyn Gross
- Central Hospital for Veterinary Medicine, Guilford, Connecticut, USA
| | - W Mark Cousins
- The Cat Practice Veterinary Hospital, New Orleans, Louisiana, USA
| | - Colleen F Monahan
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Michal Mazaki-Tovi
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Daniel K Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- BVSc, Ce666rtAVP, DipECVDI, Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Kirkwood N, Boland L, Brunel L, Wardman A, Barrs VR. Acute adrenal haemorrhage in two cats with aldosterone-secreting adenocarcinomas. JFMS Open Rep 2019; 5:2055116919840828. [PMID: 30992996 PMCID: PMC6449812 DOI: 10.1177/2055116919840828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary Two 13-year-old domestic shorthair cats were diagnosed with unilateral right
adrenocortical carcinomas (ACCs) and primary hyperaldosteronism (PHA). Both
had polyuria, polydipsia and weight loss, and developed severe anaemia from
an episode of acute adrenal haemorrhage. In one case, this occurred during
hospitalisation and treatment of severe muscle weakness with cervical
ventroflexion, while the other cat had acute collapse at home. A diagnosis
of PHA was confirmed in both cases based on measurement of plasma
aldosterone and renin activity. In one case, basal progesterone was also
measured and was elevated. On ultrasonography and CT in one case,
haemorrhage into the right retroperitoneal space was identified. Unilateral
adrenalectomy was performed in both cases and there was no evidence of
venous tumoral invasion in either. On histopathology of the excised adrenal
glands both were ACCs with tumour necrosis, and one had extensive
intratumoral haemorrhage. Both cats were diagnosed with International Renal
Interest Society stage 2 or 3 chronic kidney disease postoperatively; one
survived for 18 months and the other was well 8 months postoperatively. Relevance and novel information Acute adrenal haemorrhage secondary to adrenal neoplasia has been reported in
only one other cat, in which tumour type and function were not specified.
Acute adrenal haemorrhage can occur as a consequence of tumour necrosis and
rupture and can cause severe hypovolaemia and anaemia in cats with primary
hyperaldosteronism.
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Affiliation(s)
- Nicolle Kirkwood
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Alison Wardman
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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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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