Title: Adrenalectomy in a Golden Retriever
Betty Lobanov
Seminar: Jan 29 th 2014
Advisors: Jay Harvey, Ariane Jay
Summary:
A 10 year old female spayed Golden Retriever was presented to Cornell University Soft Tissue Surgery
Service for surgical removal of the left adrenal gland. The patient had originally presented to the referring veterinarian for evaluation of polyphagia, polyuria, alopecia, hindlimb muscle atrophy and skin lesions. ACTH stim tests confirmed a diagnosis of hyperadrenocorticism. An abdominal ultrasound was performed 2 months prior to presentation to Cornell, and revealed a mass on the left adrenal gland.
Treatment with Trilostane was instituted, but did not ameliorate the patient’s clinical signs, so the owner elected left adrenalectomy.
On presentation to Cornell the patient was bright alert and responsive with vitals within normal range (T
101.8F, P 108bpm, R 32bpm). Physical exam revealed bilateral alopecia around the elbows, slight hindlimb muscle atrophy and a healing sebaceous cyst on the right hindlimb. Surgical options for adrenalectomy were discussed with the owner, and an open laparotomy was decided upon. Pre operative bloodwork was submitted for CBC and chemistry panel. The chemistry panel showed increased cholesterol (557mg/dL; ref: 138-332mg/dL) and triglycerides (314mg/dL; ref: 22-125mg/dL).
An abdominal ultrasound was repeated prior to surgery to confirm the appearance of the mass, assess vascular involvement and rule out metastases. Additionally, chest radiographs were done to rule out metastases. An exploratory laparotomy and left adrenalectomy were performed without complication.
IV dexamethasone was given intra-operatively to prevent an Addisonian crisis upon removal of the adrenal gland. Post operatively the patient was monitored in the Intensive Care Unit, and was maintained on intravenous fluids and a continuous rate infusion of Fentanyl for pain management. She received an additional dose IV Dexamethasone SP. and treatment with subcutaneous Fragmin was started to prevent thromboembolic events. An ACTH stimulation test performed 24 hours postoperatively revealed some response, though the value was well below reference range (pre 0.25ug/dL; ref 1.8-4ug/dL; post 3.74ug/dL; ref: 6-16ug/dL) Two days post-operatively fluids were discontinued and the patient was transitioned to oral prednisone and Omeprazole for gastroprotection. She was discharged the following day. Histopathology of the adrenal tumor revealed a locally extensive cortical adenoma.
Prednisone therapy was gradually weaned and an ACTH stimulation test was performed at the referring veterinarian 3 weeks after surgery, revealing a positive response (pre 3.6ug/dL; post 14.4ug/dL).
Clinically the patient continued to well, with improvement of all clinical signs.
This seminal will discuss differential diagnoses, clinical signs, diagnostics, surgical approaches, prognosis, and complications of adrenal neoplasia.
References:
Fossum, Theresa. Small Animal Surgery, 3 rd edition. St.Louis: Mosby Inc., 2007
Pelaez MJ, Bouvy BM, Dupre GP: Laparoscopic adrenalectomy for treatment of unilateral adrenocortical carcinomas: Techniques, complications and results in seven dogs. Vet Surg 2008;37:444-453