Peer-reviewed veterinary case report
Yorkshire terrier with hidden Cushing's treated with mitotane not
By Park, Su-Min et al.·Published in Veterinary medicine and science·2021·Department of Veterinary Clinical Science, South Korea·View original on PubMed →
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Original publication title: Successful treatment of occult hyperadrenocorticism with mitotane but not trilostane in a dog.
- Species:
- dog
Plain-English summary
An 11-year-old spayed female Yorkshire terrier was brought in for breathing problems, increased appetite, and excessive thirst, which suggested a condition called hyperadrenocorticism (HAC). Although initial tests showed normal cortisol levels, further testing revealed elevated levels of a hormone called 17-hydroxyprogesterone, leading to a diagnosis of occult HAC. The dog was first treated with trilostane, which initially helped but later caused a return of symptoms. Switching to mitotane provided better relief, and the dog's symptoms improved significantly after starting this treatment.
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Abstract
BACKGROUND: Occult (or atypical) hyperadrenocorticism (HAC) shows clinical signs and laboratory abnormalities similar to classic hyperadrenocorticism, but normal signs in routine screening tests such as the corticotropin (ACTH) stimulation test and low-dose dexamethasone suppression test (LDDST). Here, we describe a case of occult HAC in a Yorkshire terrier treated with mitotane. CASE: An 11-year-old spayed female presented to the Veterinary Teaching Hospital of Seoul National University because of respiratory distress symptoms, polyphagia, and polydipsia, suggestive of HAC. In abdominal sonography, enlargement of the caudal pole of the left adrenal gland was found, but the cortisol level of post-ACTH stimulation test was below the cut-off value, and LDDST was negative. To finalise the diagnosis of occult HAC, 17-hydroxyprogesterone (17-OHP) was examined. The concentrations of 17-OHP (pre- and post-ACTH stimulation) were found to be elevated. As occult HAC was highly suspected, we prescribed trilostane for trial therapy. At first, the clinical signs improved, but they later worsened. We changed medication as trilostane to mitotane, and the symptoms were relieved after mitotane administration. CONCLUSION: This is a unique case of occult HAC in which the response to mitotane was better than trilostane.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/33755348/