Canine Cushing's Case Files: The ins and outs of detection and treatment—Case file: Holly (Sponsored by Dechra Veterinary Products)
Case file: HOLLY
Patient history and initial referral findings
Follow-up referral evaluation
The results of a serum chemistry profile revealed increased alkaline phosphatase, alanine aminotransferase, asparagine aminotransferase, gamma-glutamyl transferase, and creatine kinase activities; hyperbilirubinemia; and hypercholesterolemia. The complete blood count results identified leukocytosis with a mature neutrophilia and monocytosis. Urinalysis showed a urine specific gravity of 1.027, bilirubinuria (1+; reference range = negative) and trace proteinuria (< 100 mg/dl; reference range = negative). All of these findings were deemed consistent with hyperadrenocorticism.
Confirmatory test results
The results of an adrenocorticotropic hormone (ACTH) stimulation test revealed a baseline cortisol concentration of 12.4 µg/dl (reference range = 2 to 6 µg/dl) and a one-hour post-ACTH cortisol concentration of 28.7 µg/dl (reference range =8 to 18 µg/dl). The abnormal ACTH stimulation test results in combination with Holly's history, clinical signs, and other abnormal laboratory test results confirmed hyperadrenocorticism.
The previous abdominal ultrasonographic examination and direct adrenal visualization at the time of exploratory laparotomy for cholecystectomy identified that both adrenal glands were normal size and shape, which is consistent with pituitary-dependent hyperadrenocorticism. Medical therapy options were discussed with the family, who elected treatment with VETORYL® Capsules (trilostane).
Treatment and follow-up
Treatment with VETORYL Capsules was begun at a dose of 3.6 mg/kg given orally once daily in the morning with food. The family was advised to keep a daily journal to document Holly's frequency of panting, water consumption, urination frequency, appetite voracity, and activity level. They were also asked to document any episodes of vomiting or diarrhea and to call with any questions or concerns. Holly's family was also advised to consult with her primary care veterinarian regarding prophylactic dental care.