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Kang J, Cheon J, Yoon H, Kim N, Heo S. Adrenalectomy for the treatment of hypotension in a cat with phaeochromocytoma associated with caudal vena cava syndrome. J Small Anim Pract 2024; 65:352-356. [PMID: 38169034 DOI: 10.1111/jsap.13696] [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: 05/11/2023] [Revised: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
An 11-year-old spayed female, Persian cat was referred to the Jeonbuk Animal Medical Center for evaluation of a 2-month history of lethargy and anorexia. Physical examination revealed tachycardia and hypotension. Abdominal imaging via sonography and CT identified a right adrenal gland mass causing severe deviation and compression of the caudal vena cava. After stabilising the blood pressure and heart rate through positive inotropes and fluid therapy, right adrenalectomy was performed. Surgery confirmed the adrenal gland mass was severely compressing the caudal vena cava. Histopathological examination revealed that the mass was a pheochromocytoma. After adrenalectomy, blood pressure and heart rate stabilised and remained unaffected 8 months postsurgery. This report describes a rare case of an adrenal pheochromocytoma leading to caudal vena cava compression in a cat presenting with hypotension.
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Affiliation(s)
- J Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, 54596, South Korea
| | - J Cheon
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, 54596, South Korea
| | - H Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, 54596, South Korea
| | - N Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, 54596, South Korea
| | - S Heo
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, 54596, South Korea
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Mishra AK, Gupta P, Yadav R, Parajuli N. Adrenal adenoma associated with raised metanephrine level: A case report. Int J Surg Case Rep 2023; 109:108498. [PMID: 37453323 PMCID: PMC10366464 DOI: 10.1016/j.ijscr.2023.108498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Adrenal adenomas are benign neoplasms of the adrenal cortex which can be functional or non-functional. The functional tumors manifest as Cushing syndrome. Rarely, they are associated with high levels of metanephrine due to pheochromocytoma. Here, we report an extremely rare case of adrenal adenoma associated with raised metanephrine, but no histopathological evidence of medullary changes. CASE PRESENTATION A 30-year female with diabetes, hypothyroidism, and hypertension was admitted for resistant hypertension, severe refractory hypokalemia, decreased sleep, fearfulness, anxiety, and palpitation. Facial puffiness, ecchymoses on upper and lower limbs, and bilateral pedal edema were present. Laboratory investigation revealed raised 24-hour-urine cortisol (52.5 μmol/dL) and metanephrine (56.00 μmol/24 h), very low ACTH (<5.0 pg/mL), and negative dexamethasone suppression test. MRI brain findings were normal. CT scan of the abdomen revealed a well-defined soft tissue lesion in the right adrenal gland and diffuse osteopenia vertebrae. Hence, diagnosis of Cushing Syndrome secondary to adrenal adenoma, and pheochromocytoma was made, and laparoscopic adrenalectomy was done under pheochromocytoma protocol. The patient improved dramatically, thereafter. Histopathological findings showed adrenocortical adenoma only; no evidence of pheochromocytoma was found. CLINICAL DISCUSSION We came across many articles reporting adrenal adenoma associated with high levels of metanephrine due to co-existing pheochromocytomas either in the ipsilateral or contralateral adrenal gland. But, in our case, the adrenal adenoma was associated with high metanephrine levels with no histopathologic features of pheochromocytoma. CONCLUSION Cushing syndrome due to Cortisol secreting Adrenal adenoma can be associated with biochemical and clinical features suggestive of Pheochromocytoma which could resolve after adrenalectomy.
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Affiliation(s)
- Amit Kumar Mishra
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Prahlad Gupta
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Radheshyam Yadav
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Naresh Parajuli
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Prego MT, Dias MJ, Mestrinho L, Englar R, Grinwis G, Galac S, Leal RO. Diagnosis, treatment and outcome of pheochromocytoma in a cat. J Small Anim Pract 2023; 64:415-420. [PMID: 36977649 DOI: 10.1111/jsap.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 03/30/2023]
Abstract
Pheochromocytoma in cats is a rare clinical condition characterised by the development of a secretory endocrine tumour that arises from the adrenal medulla. An 8-year-old castrated male, domestic shorthair cat was referred for further investigation of a 4-month history of progressive weight loss with normal appetite, polyuria/polydipsia, generalised weakness, and severe hypertension. Sonography and computed tomography of the abdomen disclosed a mass arising from the left adrenal gland. The contralateral adrenal gland was normal in size and shape. Results from a low dose dexamethasone suppression test and measurements of plasma aldosterone concentration and plasma renin activity ruled out a cortisol-secreting tumour and aldosteronoma. The clinical presentation made a sex-steroid secreting tumour unlikely. Increased plasma metanephrine and normetanephrine concentrations prioritised the differential diagnosis of pheochromocytoma. The cat underwent adrenalectomy of the left gland and histopathological diagnosis with immunohistochemical markers confirmed the diagnosis.
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Affiliation(s)
- M T Prego
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
| | - M J Dias
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - L Mestrinho
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - R Englar
- College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd, Oro Valley, Arizona, 85737, USA
| | - G Grinwis
- Veterinair Pathologisch Diagnostisch Centrum - Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R O Leal
- Veterinary Teaching Hospital/Faculty of Veterinary Medicine, University of de Lisbon, Lisbon, Portugal
- CIISA - Centre for Interdisciplinary Research in Animal Health - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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Oliveira J, Dias MJ, Fontes AP, Englar RE, Vicente G, Ferreira RL, Galac S, Leal RO. Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study. Vet Sci 2022; 9:vetsci9080420. [PMID: 36006335 PMCID: PMC9413254 DOI: 10.3390/vetsci9080420] [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] [Received: 07/17/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.
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Affiliation(s)
- João Oliveira
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Maria Joana Dias
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Ana Paula Fontes
- School of Healthcare, University of Algarve, 8005-139 Faro, Portugal
| | - Ryane E. Englar
- College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd., Oro Valley, AZ 85737, USA
| | - Gonçalo Vicente
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Rui Lemos Ferreira
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Sara Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 Utrecht, The Netherlands
| | - Rodolfo Oliveira Leal
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
- Correspondence:
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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Cirla A, Drigo M, Andreani V, Barsotti G. Ocular fundus abnormalities in cats affected by systemic hypertension: Prevalence, characterization, and outcome of treatment. Vet Ophthalmol 2021; 24:185-194. [PMID: 33512084 DOI: 10.1111/vop.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence of ocular fundus abnormalities in cats with a diagnosis of systemic hypertension, to characterize the abnormalities observed, and to evaluate ophthalmoscopic evolution during treatment with amlodipine besylate. ANIMALS STUDIED Cats diagnosed as affected by SHP in a 2-year period. PROCEDURES Systemic hypertension was assessed by oscillometric blood pressure measurement, and its etiology was also established. All the cats received an ophthalmic examination, and ocular lesions were classified with a score from 0 (no abnormalities) to 4 (severe abnormalities). All cats received amlodipine besylate by mouth, and those that showed fundus abnormalities were regularly rechecked from 7 to 365 days after diagnosis. Data were statistically analyzed to compare Psys and Pdia with all the variables and to correlate Psys and Pdia with the fundus score. RESULTS A total of 225 cats were enrolled in the study, and the prevalence of fundus abnormalities was 58.6% (21.2%: grade 1; 18.2%: grade 2; 36.4%: grade 3; and 24.2%: grade 4). Systemic hypertension was diagnosed concurrently with chronic renal failure (60.4%), hyperthyroidism (28.9%), both chronic renal failure and hyperthyroidism (7.6%), and hypertrophic myocardiopathy (3.1%). A significant effect of Psys values on the fundus score was detected. Amlodipine therapy improved fundus abnormalities in 50% of cases at the 21-day follow-up. CONCLUSIONS This study showed that fundus abnormalities are common in hypertensive cats at the time of the systemic diagnosis, and most of the abnormalities are moderate to severe. Treatment with amlodipine appeared to improve ophthalmic lesions over time.
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Affiliation(s)
- Alessandro Cirla
- Department of Ophthalmology, San Marco Veterinary Clinic and Laboratory, Veggiano, Italy
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | | | - Giovanni Barsotti
- Department of Veterinary Science, University of Pisa, S. Piero a Grado, Italy
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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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8
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Toleson LE, Tamulevicus A, Rahilly L. Diabetes mellitus and anterior uveitis secondary to the systemic effects of a functional adrenal tumour in a cat. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Lauren E Toleson
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
| | - Amy Tamulevicus
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
| | - Louisa Rahilly
- Emergency/Critical CareCape Cod Veterinary SpecialistsBuzzards BayMassachusettsUSA
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Leisering AL, Sola MF, Ambrosius LA, Monahan CF, Meyer BA, Deshuillers PL, Durkes AC, Knapp DW, Sledge DG, Thompson CA. Pathology in Practice. J Am Vet Med Assoc 2020; 255:433-436. [PMID: 31355720 DOI: 10.2460/javma.255.4.433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Correction: Vitamin D metabolism in canine and feline medicine. J Am Vet Med Assoc 2019; 255:436. [DOI: 10.2460/javma.255.4.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2018; 32:1803-1822. [PMID: 30353952 PMCID: PMC6271319 DOI: 10.1111/jvim.15331] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.
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Affiliation(s)
- Mark J Acierno
- Department of Medicine, College of Veterinary Medicine, Midwestern University, 5715 W. Utopia Rd, Glendale Arizona 85308
| | - Scott Brown
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Amanda E Coleman
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Mark Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Rebecca L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin
| | - Harriet M Syme
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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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 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [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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Abstract
CASE SUMMARY Herein a drug-resistant IgG-lambda-type multiple myeloma associated with probable phaeochromocytoma in a cat is described. A 12-year-old cat presented with weakness, weight loss, progressive blindness and open-mouth breathing, in addition to polyuria and polydipsia of 2 months' duration. Abdominal ultrasonography revealed a left adrenal mass. Phaeochromocytoma was suspected on the basis of cytology and was associated with systemic hypertension. Biochemistry showed hyperproteinaemia. Serum protein electrophoresis revealed a narrow spike in the gamma region, identified as IgG lambda type at immunoelectrophoresis. Bone marrow cytology revealed an infiltrate with numerous mature plasma cells. The cat was resistant to two different drugs for multiple myeloma and was euthanased 6 months later because of anorexia and persistent poor general condition. RELEVANCE AND NOVEL INFORMATION This is the first clinical description of multiple myeloma associated with a suspected phaeochromocytoma in a cat.
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14
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Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA. ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. J Feline Med Surg 2017; 19:288-303. [DOI: 10.1177/1098612x17693500] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Practical relevance: Feline hypertension is a common disease in older cats that is frequently diagnosed in association with other diseases such as chronic kidney disease and hyperthyroidism (so-called secondary hypertension), although some cases of apparent primary hypertension are also reported. The clinical consequences of hypertension can be severe, related to ‘target organ damage’ (eye, heart and vasculature, brain and kidneys), and early diagnosis followed by appropriate therapeutic management should help reduce the morbidity associated with this condition. Clinical challenges: Despite being a common disease, routine blood pressure (BP) monitoring is generally performed infrequently, probably leading to underdiagnosis of feline hypertension in clinical practice. There is a need to: (i) ensure BP is measured as accurately as possible with a reproducible technique; (ii) identify and monitor patients at risk of developing hypertension; (iii) establish appropriate criteria for therapeutic intervention; and (iv) establish appropriate therapeutic targets. Based on current data, amlodipine besylate is the treatment of choice to manage feline hypertension and is effective in the majority of cats, but the dose needed to successfully manage hypertension varies between individuals. Some cats require long-term adjuvant therapy and, occasionally, additional therapy is necessary for emergency management of hypertensive crises. Evidence base: These Guidelines from the International Society of Feline Medicine (ISFM) are based on a comprehensive review of the currently available literature, and are aimed at providing practical recommendations to address the challenges of feline hypertension for veterinarians. There are many areas where more data is required which, in the future, will serve to confirm or modify some of the recommendations in these Guidelines.
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Affiliation(s)
| | | | - Katherine Briscoe
- Animal Referral Hospital, 250 Parramatta Road, Homebush, Sydney, NSW 2140, Australia
| | - Jenny Carter
- PO Box 128209, Remuera, Auckland 1541, New Zealand
| | | | - Rosanne E Jepson
- Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | | | - Brian A Scansen
- Associate Professor, Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523, USA
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Junginger J, Hansmann F, Herder V, Lehmbecker A, Peters M, Beyerbach M, Wohlsein P, Baumgärtner W. Pathology in Captive Wild Felids at German Zoological Gardens. PLoS One 2015; 10:e0130573. [PMID: 26086731 PMCID: PMC4472349 DOI: 10.1371/journal.pone.0130573] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 05/22/2015] [Indexed: 12/30/2022] Open
Abstract
This retrospective study provides an overview on spontaneous diseases occurring in 38 captive wild felids submitted for necropsy by German zoological gardens between 2004 and 2013. Species included 18 tigers, 8 leopards, 7 lions, 3 cheetahs and 2 cougars with an age ranging from 0.5 to 22 years. Renal lesions, predominantly tubular alterations (intra-tubular concrements, tubular degeneration, necrosis, intra-tubular cellular debris, proteinaceous casts, dilated tubuli) followed by interstitial (lympho-plasmacytic inflammation, fibrosis, metastatic-suppurative inflammation, eosinophilic inflammation) and glomerular lesions (glomerulonephritis, glomerulosclerosis, amyloidosis) were detected in 33 out of 38 animals (87%). Tumors were found in 19 of 38 felids (50%) with 12 animals showing more than one neoplasm. The tumor prevalence increased with age. Neoplasms originated from endocrine (11), genital (8), lympho-hematopoietic (5) and alimentary organs (4) as well as the mesothelium (3). Most common neoplasms comprised uterine/ovarian leiomyomas (5/2), thyroid adenomas/adenocarcinoma (5/1), pleural mesotheliomas (3), hemangiosarcomas (2) and glossal papillomas (2). Inflammatory changes were frequently encountered in the intestine and the lung. Two young animals displayed metastatic mineralization suggestive of a vitamin D- or calcium intoxication. One tiger exhibited degenerative white matter changes consistent with an entity termed large felid leukoencephalomyelopathy. Various hyperplastic, degenerative and inflammatory changes with minor clinical significance were found in several organs. Summarized, renal lesions followed by neoplastic changes as well as inflammatory changes in lung and gastrointestinal tract represent the most frequent findings in captive wild felids living in German zoological gardens.
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Affiliation(s)
- Johannes Junginger
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
| | - Florian Hansmann
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
- Center for Systems Neuroscience, Hannover, Lower Saxony, Germany
| | - Vanessa Herder
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
- Center for Systems Neuroscience, Hannover, Lower Saxony, Germany
| | - Annika Lehmbecker
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
- Center for Systems Neuroscience, Hannover, Lower Saxony, Germany
| | - Martin Peters
- Chemisches und Veterinäruntersuchungsamt Westphalia, Arnsberg, North Rhine-Westphalia, Germany
| | - Martin Beyerbach
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine, Hannover, Lower Saxony, Germany
- Center for Systems Neuroscience, Hannover, Lower Saxony, Germany
- * E-mail:
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Daniel G, Mahony OM, Markovich JE, Appleman E, Monaghan KN, Lawrence YA, Fiocchi EH, Weaver K, Johnston A, Barton B. Clinical findings, diagnostics and outcome in 33 cats with adrenal neoplasia (2002–2013). J Feline Med Surg 2015; 18:77-84. [DOI: 10.1177/1098612x15572035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives The objective of this retrospective study was to describe the clinical signs and diagnostic findings in cats with histopathologically confirmed adrenal neoplasms, and to assess correlations with survival data. Methods Study data were acquired by reviewing medical records for all cats diagnosed with adrenal neoplasms at seven referral institutions between 2002 and 2013. Inclusion criteria required a histopathologic diagnosis of an adrenal neoplasm (ante-mortem or on necropsy). Results Thirty-three cats met the inclusion criteria for the study. The most common presenting complaints included weakness (n = 12), respiratory signs (n = 4), blindness (n = 4) or gastrointestinal signs (n = 3). Laboratory abnormalities included hypokalemia (n = 18), alkalemia (n = 12), elevated creatine kinase (>3000, n = 5) and azotemia (n = 4). In addition, hypertension was noted in 13 cats. Thirty cats were diagnosed with cortical tumors (17 carcinomas, 13 adenomas) and three cats were diagnosed with pheochromocytomas. Twenty-five cats underwent tests to evaluate the function of the adrenal tumors; 19/25 cats had functional tumors (hyperaldosteronism [n = 16], hypercortisolemia [n = 1], high estradiol [n = 1], and hypersecretion of aldosterone, estradiol and progesterone [n = 1]). Twenty-six cats underwent adrenalectomy, one cat was medically managed and six were euthanized without treatment. Long-term survival postoperatively ranged from 4–540 weeks, with 20 (77%) cats surviving the perioperative period of 2 weeks. The only variable that was found to be negatively associated with survival was female sex. The most common complications noted during the perioperative period were hemorrhage and progressive lethargy and anorexia. Conclusions and relevance Surgical treatment for feline adrenal tumors (regardless of tumor type) resulted in good long-term survival. Given that pre- and postoperative hypocortisolemia was identified in this study, and, in addition, hypersecretion of more than one adrenal hormone occurred in one cat, adrenal panels prior to surgery may be beneficial as part of the preoperative work-up.
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Affiliation(s)
- Gideon Daniel
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Orla M Mahony
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Jessica E Markovich
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Elizabeth Appleman
- Department of Internal Medicine, Animal Medical Center, USA; VCA Fifth Avenue Veterinary Specialists, USA
| | - Kelly N Monaghan
- Department of Medical Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri A Lawrence
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Kelli Weaver
- Tampa Bay Veterinary Specialists, Largo, FL, USA
| | - Andrea Johnston
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine Companion Animal Hospital, NY, USA
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts, Worcester, MA, USA
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Lo AJ, Holt DE, Brown DC, Schlicksup MD, Orsher RJ, Agnello KA. Treatment of aldosterone-secreting adrenocortical tumors in cats by unilateral adrenalectomy: 10 cases (2002-2012). J Vet Intern Med 2013; 28:137-43. [PMID: 24372771 PMCID: PMC4895543 DOI: 10.1111/jvim.12186] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/25/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022] Open
Abstract
Background Primary hyperaldosteronism (PHA) in cats occurs as a consequence of excessive hormone production by an adrenocortical tumor. Median survival time, association between tumor type and prognosis, and the likelihood that cats require continued medical therapy after surgery have not been systematically evaluated. Objectives To determine the median survival time of cats with PHA treated by unilateral adrenalectomy. To examine if tumor type, anesthesia time, or tumor location (left or right side) affect survival and if affected cats require continued postoperative treatment for persistent hypertension or hypokalemia. Animals Ten client‐owned cats. Methods Retrospective study. Cats were diagnosed with PHA based on clinical signs, increased plasma aldosterone concentration, and advanced imaging. Cats underwent unilateral adrenalectomy. Survival time (days alive after surgery) was determined for each cat. Factors affecting median survival time were investigated, including histopathology, anesthesia time, and location (side) of the tumor. Results Eight of 10 cats survived to discharge from the hospital post adrenalectomy. Overall median survival was 1,297 days (range 2–1,582 days). The only significant factor affecting median survival time was anesthesia time >4 hours. Tumor type and location (side) did not significantly affect median survival time. No cats required continued medical treatment for PHA. Conclusions and Clinical Importance Although PHA in cats is still considered an uncommon condition, it should be considered in middle to older aged cats with hypokalemic polymyopathy and systemic hypertension. Surgical correction by unilateral adrenalectomy is a viable approach to definitive treatment of PHA with no need for continued medical management.
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Affiliation(s)
- A J Lo
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Hypersomatotropism, Acromegaly, and Hyperadrenocorticism and Feline Diabetes Mellitus. Vet Clin North Am Small Anim Pract 2013; 43:319-50. [DOI: 10.1016/j.cvsm.2012.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Combes A, Pey P, Paepe D, Rosenberg D, Daminet S, Putcuyps I, Bedu AS, Duchateau L, de Fornel-Thibaud P, Benchekroun G, Saunders JH. Ultrasonographic appearance of adrenal glands in healthy and sick cats. J Feline Med Surg 2012; 15:445-57. [DOI: 10.1177/1098612x12469523] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The first part of the study aimed to describe prospectively the ultrasonographic features of the adrenal glands in 94 healthy cats and 51 chronically sick cats. It confirmed the feasibility of ultrasonography of adrenal glands in healthy and chronically sick cats, which were not statistically different. The typical hypoechoic appearance of the gland surrounded by hyperechoic fat made it recognisable. A sagittal plane of the gland, not in line with the aorta, may be necessary to obtain the largest adrenal measurements. The reference intervals of adrenal measurements were inferred from the values obtained in the healthy and chronically sick cats (mean ± 0.96 SD): adrenal length was 8.9–12.5 mm; cranial height was 3.0–4.8 mm; caudal height was 3.0–4.5 mm. The second part of the study consisted of a retrospective analysis of the ultrasonographic examination of the adrenal glands in cats with adrenal diseases (six had hyperaldosteronism and four had pituitary-dependent hyperadrenocorticism) and a descriptive comparison with the reference features obtained in the control groups from the prospective study. Cats with hyperaldosteronism presented with unilateral severely enlarged adrenal glands. However, a normal contralateral gland did not preclude a contralateral infiltration in benign or malignant adrenal neoplasms. The ultrasonographic appearance of the adrenal glands could not differentiate benign and malignant lesions. The ultrasonographic appearance of pituitary-dependent hyperadrenocorticism was mainly a symmetrical adrenal enlargement; however, a substantial number of cases were within the reference intervals of adrenal size.
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Affiliation(s)
- Anaïs Combes
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pascaline Pey
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dan Rosenberg
- Internal Medicine Unit, Paris-Est University, National Veterinary School of Alfort, Maisons-Alfort, France
| | - Sylvie Daminet
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ingrid Putcuyps
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Anne-Sophie Bedu
- Diagnostic Imaging Unit, National Veterinary School of Alfort, Maisons-Alfort, France
| | - Luc Duchateau
- Department of Comparative Physiology and Biometry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pauline de Fornel-Thibaud
- Internal Medicine Unit, Paris-Est University, National Veterinary School of Alfort, Maisons-Alfort, France
| | - Ghita Benchekroun
- Internal Medicine Unit, Paris-Est University, National Veterinary School of Alfort, Maisons-Alfort, France
| | - Jimmy H Saunders
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Cross E, Moreland R, Wallack S. Feline Pituitary-Dependent Hyperadrenocorticism and Insulin Resistance Due to a Plurihormonal Adenoma. Top Companion Anim Med 2012; 27:8-20. [DOI: 10.1053/j.tcam.2011.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 12/05/2011] [Indexed: 11/11/2022]
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Combes A, Vandermeulen E, Duchateau L, Peremans K, Daminet S, Saunders J. ULTRASONOGRAPHIC MEASUREMENTS OF ADRENAL GLANDS IN CATS WITH HYPERTHYROIDISM. Vet Radiol Ultrasound 2011; 53:210-6. [DOI: 10.1111/j.1740-8261.2011.01888.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anaïs Combes
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Eva Vandermeulen
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Luc Duchateau
- Department of Comparative Physiology and Biometry; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Kathelijne Peremans
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Sylvie Daminet
- Department of Small Animal Internal Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - Jimmy Saunders
- Faculty of Veterinary Medicine; Department of Medical Imaging; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
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Abstract
Practical relevance The increased availability of indirect blood pressure monitoring devices in clinical practice over the past decade has highlighted the significance of systemic hypertension in the feline population. Without routine monitoring and appropriate intervention, cats with undiagnosed systemic hypertension may first be presented with sudden-onset blindness as a consequence of either hyphaema or retinal detachment. Clinical challenges The primary aim in the early diagnosis and treatment of systemic hypertension is prevention of hypertensive target organ damage (with respect to the eye, kidney, cardiovascular and central nervous systems, in particular). A prerequisite is a knowledge of the pathophysiological mechanisms and disease conditions that may contribute to the development of hypertension. This allows the clinician to determine those cases in which blood pressure assessment and longitudinal monitoring is essential and can assist in determining appropriate therapeutic strategies for control of blood pressure. Recent studies have also begun to explore the relationship that systemic hypertension may have with proteinuria and the progression of kidney disease. Patient group The geriatric cat appears most susceptible to the development of systemic hypertension, and monitoring of systolic blood pressure is often advocated as part of a routine health screen in cats over 9–12 years old. Consideration must also be given to cats suspected of having an underlying disease such as chronic kidney disease or hyperthyroidism, or which are receiving therapeutic agents, irrespective of their age. Evidence base Much of our understanding of the pathogenesis of feline hypertension is extrapolated from studies performed in experimental animal models or in human patients, and interspecies differences are often poorly understood.
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