A Case Report of Feline Pituitary Carcinoma with Hypercortisolism

Kimitsuki, Kazunori; Boonsriroj, Hassadin; Kojima, Daisuke; Park, Chun-Ho

doi:10.1292/jvms.13-0373

Cited by 10 publications

(28 citation statements)

References 21 publications

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“…Bacterial or fungal infections, secondary to hypercortisolism-induced immunosuppression, are common -reported in 31% (37/121) of cases. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][23][24][25]27,28,[31][32][33][36][37][38][39]42,44 These include urinary tract, respiratory tract and oral cavity infections, subcutaneous abscesses and paronychia (painful, swollen nail beds, purulent exudate and loss of nails) ( Figure 5).…”

Section: Clinical Pathologymentioning

confidence: 99%

Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment

Boland

Barrs

2017

Journal of Feline Medicine and Surgery

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Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).

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Section: Clinical Pathologymentioning

confidence: 99%

Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment

Boland

Barrs

2017

Journal of Feline Medicine and Surgery

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“…10,32,40 Only 1 case of pituitary carcinoma was reported in a cat, with marked bone invasiveness but no metastases. 13 In the 2 cases of pituitary metastases of a salivary adenocarcinoma and nasal adenocarcinoma of the current study, the observed neurologic signs were mainly attributed to other coexisting intracranial metastases from the same primary neoplasm. Ante mortem clinical signs of pituitary dysfunction were not detected, similar to what is reported in humans, where only 7% of the metastases to the pituitary are symptomatic, with diabetes insipidus, visual field defects, headache/pain, and ophthalmoplegia being the most commonly reported symptoms.…”

Section: Neoplastic and Hyperplastic Lesionsmentioning

confidence: 55%

Pathological Findings in the Pituitary Glands of Dogs and Cats

et al. 2018

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With the exception of classic functional adenomas in dogs and horses, pituitary lesions are infrequently described in the veterinary literature. Approximately 10% of pituitary glands from asymptomatic humans contain abnormalities, but the equivalent proportion in small animals is unknown. Pituitary glands from 136 dogs and 65 cats collected during routine necropsies were examined to determine the prevalence of pituitary lesions and their histopathological diagnosis. Lesions were characterized in sections stained with hematoxylin and eosin, periodic acid-Schiff (PAS), Gordon and Sweet's and reticulin stains, and immunohistochemistry for adrenocorticotropic hormone (ACTH), growth hormone, melanocyte stimulating hormone-α, and prolactin. Pituitary abnormalities were identified in 36 of 136 (26.4%) dogs and 10 of 65 (15.3%) cats. Cystic changes were the most common lesion, occurring in 18 (13.2%) dogs and 8 (12.3%) cats. Pituitary neoplasia was detected in 14.1% (12/85) of middle-aged and old dogs; 1 (1.5%) cat had pituitary nodular hyperplasia. PAS and reticulin stains helped differentiate ACTH-immunoreactive adenomas from hyperplastic nodules: adenomas contained PAS-positive intracytoplasmic granules and loss of the normal reticulin network. One dog had a pituitary carcinoma with infiltration into the thalamus. Other pituitary abnormalities included secondary metastases (2 dogs) and hypophysitis (4 dogs, 1 cat). In most cases, the lesion appeared to be subclinical and could be considered incidental, whereas clinical manifestations were apparent in only 4 dogs (2.9%) and none of the cats with pituitary lesions. Pituitary abnormalities are common in dogs and cats, and their clinical relevance requires further investigation.

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“…Although reports on histopathologic findings in CIRCI patients are rare, severe adrenal hemorrhage secondary to bacterial infection (Waterhouse–Friderichsen syndrome), most commonly to meningococcal sepsis, is described in humans and has been associated with the development of CIRCI . In the case described herein, necropsy revealed bilateral diffuse adrenocortical hyperplasia and hypertrophy, which has previously been associated with chronic stress , pituitary hyperadrenocorticism , hyperaldosteronism , and congenital adrenal hyperplasia . Although ACTH‐stimulation testing is not considered useful during initial shock management, a convalescent ACTH‐stimulation test may, therefore, have been of benefit to investigate adrenal function in this case.…”

Section: Discussionmentioning

confidence: 87%

Hydrocortisone therapy in a cat with vasopressor‐refractory septic shock and suspected critical illness‐related corticosteroid insufficiency

Pisano

Howard

Posthaus

et al. 2017

Clinical Case Reports

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Key Clinical MessageA 27‐month‐old female cat was presented with septic peritonitis secondary to a ruptured pyometra and subsequent pyothorax. Vasopressor‐refractory septic shock led to a suspicion of critical illness‐related corticosteroid insufficiency, successfully treated with intravenous hydrocortisone. Previous megestrol acetate administration may have played a role in the development of adrenocortical dysfunction.

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A Case Report of Feline Pituitary Carcinoma with Hypercortisolism

Cited by 10 publications

References 21 publications

Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment

Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment

Pathological Findings in the Pituitary Glands of Dogs and Cats

Hydrocortisone therapy in a cat with vasopressor‐refractory septic shock and suspected critical illness‐related corticosteroid insufficiency

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