Case file: HOLLY
8-year-old spayed female German shepherd weighing 33.3 kg (73.3 lb)
Patient history and initial referral findings
Holly's primary care veterinarian had diagnosed hyperadrenocorticism based on her history and clinical signs and the results
of routine laboratory tests and a low-dose dexamethasone suppression test. Holly was treated for hyperadrenocorticism with
trilostane (75 mg given orally once a day) obtained from a compounding pharmacy.
Dr. Christopher G. Byers
Six months later, Holly developed lethargy, vomiting, and abdominal distention and had markedly increased hepatic enzyme activities.
The trilostane was discontinued and Holly was referred to MidWest Veterinary Specialty Hospital for an abdominal ultrasonographic
examination. Peritoneal effusion secondary to a ruptured gallbladder mucocele was identified, and Holly was successfully managed
with cholecystectomy and appropriate supportive critical care.
Follow-up referral evaluation
About one month after recovery from the cholecystectomy, Holly was again presented to MidWest Veterinary Specialty Hospital
for evaluation of hair loss, increased panting, and polyuria and polydipsia. Holly's owners stated that she was otherwise
clinically normal at home. Abnormalities identified on physical examination were patchy dorsolateral truncal alopecia with
cutaneous hyperpigmentation, a pendulous abdomen, and moderate dental tartar with gingival inflammation (Figure 1).
Figure 1. When presented, 8-year-old Holly was experiencing increased panting, polyuria, and polydipsia. She had patchy dorsolateral
truncal alopecia and a pendulous abdomen.
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
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.