Dave & Princess
02-06-2010, 12:32 AM
Hi folks, thank you for this forum. I hope it will help Princess. She is a 14 yo spayed female, mixed breed, probably lab and greyhound(?). She had routine bloodwork done, Nov 2009, all normal. She started to show inappetance in Dec 09 – Jan 2010 so bloodwork was done again. The anomalies were ALT 168 (normal high 107), GGT 20 (normal high 14), and BUN 32 (normal high 27), all others within normal limits, urine specific gravity 1.025.
15 Jan 2010, I had an ultrasound done with chest x-rays:
“Findings: There is an ovoid, slightly irregular, diffusely hyperechoic mass adjacent to the cranial pole of the left kidney. It measures 4.2 cm in the dorsoventral dimension. The mass is adjacent to the caudal vena cava and no flow is seen in this vessel as it passes the mass. The aorta does not appear to be affected. There is a 2.2 cm nodule in the tail of the spleen which deforms the capsule, is primarily hypoechoic and contains a few foci of mineral. There are no abnormalities seen of the gallbladder, liver, kidneys, right adrenal gland, urinary bladder, medial iliac or mesenteric lymph nodes, pancreas or GI tract.”
“Opinion: Large left adrenal mass. The owner does not describe symptoms typical of pheochromocytoma (agitation, collapse). The lack of contralateral adrenal gland atrophy suggests that the mass in not producing cortisol. Therefore, nonfunctional tumor is most likely. The splenic nodule could represent a benign incidental finding, although metastasis cannot be excluded. Thoracic radiographs and additional biochemical/endocrine testing may be helpful prior to any planned surgery.”
I then had an ACTH test run 27 Jan 2010 (I couldn't get the data to line up):
Test Result (Baseline) Normal Range** Result (Post-ACTH) Normal Range**
Cortisol ng/ml 23.5 2.1-58.8 122.7 65.0-174.6
Androstenedione ng/ml 0.60* 0.05-0.57 3.91 0.27-3.97
Estradiol pg/ml 83.3* 30.8-69.9 73.0* 27.9-69.2
Progesterone ng/ml 0.12 0.03-0.49 1.33 0.10-1.50
17 OH Progesterone ng/ml 0.06 0.08-0.77 0.99 0.40-1.62
Aldosterone pg/ml*** 15.4 11-139.9 113.7 72.9-398.5
* Above or below reference range
**Mean normal range values for spayed female dogs (N=36). QNS= Insufficient sample.
***Normal range values for male and female dogs (N=72 baseline, N=23 post-ACTH)
“These results: [?] indicate presence of increased adrenal activity. (marginal)
[ ] indicate presence of adrenal hypofunction
[ ] are within normal limits
Comments: (History: L-adrenal mass at US) Values are increased as indicated. Androstenedione elevation is marginal, that of estradiol marginal-mild. Typically a functional mass is characterized by elevation of several steroid, this is not the case. Although estrogen may contribute to clinical signs it is not a good indicator of adrenal activity. Various treatment option considerations are attached Some veterinarians consider items 2-4 (melatonin, melatonin implants, lignin), for estradiol control, if symptomatic.”
Her EKG was normal and her BP was 220.
Dave’s notes on Princess: Princess is not on any meds besides supplements. She has been on the Dr. Pitcairn’s diet for many years (50% Pitcairn, 50% quality commercial food). Princess did have cluster seizures about 7 years ago and was treated with pheno-barb. This condition persisted for less than a year and she was weaned off the pheno-barb. She had one seizure about a year and a half ago. She has had focal (facial) seizures for two years usually caused by “crinkly” noises. She is much more critical of her food choices but has not lost weight. She does drink more water and urinate more but she is nowhere near incontinent. She has a good 25-45 minute walk every day and she shows no excessive lethargy compared to, say, a year ago. She does have some hind quarter weakness but this seems to have progressed with arthritis and age, ie no serious recent changes. She does have some excess panting. She has no other Cushing’s symptoms as described by Kate Connick. I am being told that this is probably a pheochromocytoma and not Cushing’s. I am in Massachusetts so if you have any internists/surgeon referrals with experience in this area, it would be greatly appreciated. We thank you!
15 Jan 2010, I had an ultrasound done with chest x-rays:
“Findings: There is an ovoid, slightly irregular, diffusely hyperechoic mass adjacent to the cranial pole of the left kidney. It measures 4.2 cm in the dorsoventral dimension. The mass is adjacent to the caudal vena cava and no flow is seen in this vessel as it passes the mass. The aorta does not appear to be affected. There is a 2.2 cm nodule in the tail of the spleen which deforms the capsule, is primarily hypoechoic and contains a few foci of mineral. There are no abnormalities seen of the gallbladder, liver, kidneys, right adrenal gland, urinary bladder, medial iliac or mesenteric lymph nodes, pancreas or GI tract.”
“Opinion: Large left adrenal mass. The owner does not describe symptoms typical of pheochromocytoma (agitation, collapse). The lack of contralateral adrenal gland atrophy suggests that the mass in not producing cortisol. Therefore, nonfunctional tumor is most likely. The splenic nodule could represent a benign incidental finding, although metastasis cannot be excluded. Thoracic radiographs and additional biochemical/endocrine testing may be helpful prior to any planned surgery.”
I then had an ACTH test run 27 Jan 2010 (I couldn't get the data to line up):
Test Result (Baseline) Normal Range** Result (Post-ACTH) Normal Range**
Cortisol ng/ml 23.5 2.1-58.8 122.7 65.0-174.6
Androstenedione ng/ml 0.60* 0.05-0.57 3.91 0.27-3.97
Estradiol pg/ml 83.3* 30.8-69.9 73.0* 27.9-69.2
Progesterone ng/ml 0.12 0.03-0.49 1.33 0.10-1.50
17 OH Progesterone ng/ml 0.06 0.08-0.77 0.99 0.40-1.62
Aldosterone pg/ml*** 15.4 11-139.9 113.7 72.9-398.5
* Above or below reference range
**Mean normal range values for spayed female dogs (N=36). QNS= Insufficient sample.
***Normal range values for male and female dogs (N=72 baseline, N=23 post-ACTH)
“These results: [?] indicate presence of increased adrenal activity. (marginal)
[ ] indicate presence of adrenal hypofunction
[ ] are within normal limits
Comments: (History: L-adrenal mass at US) Values are increased as indicated. Androstenedione elevation is marginal, that of estradiol marginal-mild. Typically a functional mass is characterized by elevation of several steroid, this is not the case. Although estrogen may contribute to clinical signs it is not a good indicator of adrenal activity. Various treatment option considerations are attached Some veterinarians consider items 2-4 (melatonin, melatonin implants, lignin), for estradiol control, if symptomatic.”
Her EKG was normal and her BP was 220.
Dave’s notes on Princess: Princess is not on any meds besides supplements. She has been on the Dr. Pitcairn’s diet for many years (50% Pitcairn, 50% quality commercial food). Princess did have cluster seizures about 7 years ago and was treated with pheno-barb. This condition persisted for less than a year and she was weaned off the pheno-barb. She had one seizure about a year and a half ago. She has had focal (facial) seizures for two years usually caused by “crinkly” noises. She is much more critical of her food choices but has not lost weight. She does drink more water and urinate more but she is nowhere near incontinent. She has a good 25-45 minute walk every day and she shows no excessive lethargy compared to, say, a year ago. She does have some hind quarter weakness but this seems to have progressed with arthritis and age, ie no serious recent changes. She does have some excess panting. She has no other Cushing’s symptoms as described by Kate Connick. I am being told that this is probably a pheochromocytoma and not Cushing’s. I am in Massachusetts so if you have any internists/surgeon referrals with experience in this area, it would be greatly appreciated. We thank you!