Adrenocortical Carcinoma in a Dog with Incomplete Excision Managed Long-term with Metastasectomy Alone

Abstract

A 10 yr old bichon frise presented with a 3 mo history of polyuria, polydipsia, and hind limb weakness. Serum biochemistry revealed persistent hypokalemia. A left adrenal gland mass with right adrenal atrophy was detected ultrasonographically. Basal serum cortisol concentration was at the low end of normal (30 nmol/L; reference range, 30-140 nmol/L) and adrenocorticotropic hormone (ACTH)-stimulated cortisol concentration was low (199 nmol/L; reference range, 220-470 nmol/L). Basal serum 17-α-OH progesterone concentration was also low (0.03 ng/mL; reference range, 0.06-0.30 ng/mL), but the aldosterone concentration 2 hr after the ACTH stimulation was elevated (> 3,000 pmol/L; reference range, 197-2,103 pmol/L). A left adrenalectomy and nephrectomy were performed. Histopathology revealed an adrenocortical zona glomerulosa carcinoma. Surgical excision was considered incomplete; however, clinical signs resolved. Two years later, basal and ACTH-stimulated aldosterone concentrations were elevated. Computed tomography demonstrated a mass effect in the liver. The left lateral and left medial hepatic lobes were removed. Histopathology confirmed metastatic endocrine carcinoma. The patient was stable 1,353 days postsurgically (when this report was prepared). This is the first case report of a metastatic adrenal carcinoma that was successfully managed surgically for > 3 yr.

Adrenal gland tumours. Different clinical presentations in three dogs: a case report

“…A diagnosis of hyperaldosteronism should ideally be made on the basis of high serum aldosterone concentrations in the presence of hypokalaemia and serum renin concentration within or under the reference range. However, due to laboratory limitations, there is a need to rule out all second-ary causes of hyperaldosteronism, which include cardiovascular and kidney failure and severe generalised hepatocellular dysfunction (Behrend et al 2005;Rijnberk and Kooistra 2010;Frankot et al 2012). None of the dogs in this report showed hypokalaemia.…”

“…Adrenocortical tumours traditionally have been assumed to secrete a single hormone. However, different reports have found adrenal gland tumours secreting more than one hormone (Behrend et al 2005;Machida et al 2008;Frankot et al 2012).…”

“…The excessive activation of mineralocorticoid receptors leads to the hypersecretion of aldosterone by the adrenocortical tumour. Hyperaldosteronism includes signs of polyuria, polydipsia, nicturia and episodic weakness (Behrend et al 2005;Rijnberk and Kooistra 2010;Frankot et al 2012). The most consistent laboratory abnormality detected includes hypokalaemia.…”

“…Adenoma and adenocarcinoma are the most common, followed by pheochromocytoma, myelolipoma, aldosteronoma, deoxycorticosterone-secreting and sex hormonesecreting adrenal tumours (Reine et al 1999;Lurye and Behrend 2001;Rijnberk et al 2001;Syme et al 2001;Tursi et al 2005;Frankot et al 2012).…”

Adrenalectomy in dogs: retrospective study of 13 cases performed in Universidade Anhembi Morumbi Veterinary Hospital (2012-2015)

“…The most commonly found primary adrenal tumors are adenomas and adenocarcinomas, followed by pheochromocytoma and others, which are the minority (FELDMAN, 2008;FRANKOT et al, 2012).…”