Comparison of two prepill cortisol concentrations in dogs with hypercortisolism treated with trilostane

Abstract

BackgroundThe ideal method for monitoring trilostane therapy in dogs with hypercortisolism is still open to debate. Recently, determination of the pre-trilostane (prepill) cortisol concentration has been proposed to be more repeatable than either post-trilostane or post-ACTH cortisol. The aim of this study was to compare two prepill cortisol concentrations in dogs with hypercortisolism during trilostane therapy. Sixteen client-owned dogs with naturally occurring hypercortisolism were prospectively included and cortisol concentrations were measured twice, 1 h apart, before the morning trilostane dose (prepill 1 and 2 cortisol).ResultsA total of 47 prepill cortisol measurement pairs were included. Compared to prepill 1, prepill 2 cortisol was higher in 15, equal in 8 and lower in 24 pairs. Group agreement between prepill 1 and 2 cortisol was 70% (moderate agreement - weighted kappa 0.55). In 30% of the pairs, group assignment was discrepant, implying a different therapeutic decision. In some dogs certain circumstances (e.g. excessive barking, difficulties during blood collection, excitement at arrival) were identified as potential factors explaining the discrepancy between prepill 1 and 2 cortisol measurements.ConclusionsIn a substantial number of dogs treated with trilostane, the two prepill cortisol concentrations differed. Part of this difference might be ascribable to stressful events during test performance. When using prepill cortisol measurements to monitor trilostane therapy, recording of any incident during handling that might affect cortisol release might be helpful to make a reliable decision about a trilostane dose adaptation.

Changes in systolic blood pressure in dogs with pituitary dependent hyperadrenocorticism during the first year of trilostane treatment

“…The relationship between serum cortisol concentrations and SBP during trilostane treatment in dogs with HAC has not been evaluated previously. Currently, no objective method is available to evaluate the response to trilostane treatment in dogs with HAC, and serum cortisol concentrations correlate poorly with clinical signs 41‐43,53 . However, the relationship between basal serum cortisol concentrations and SBP might indicate that the deleterious vascular effects of chronic hypercortisolism are more pronounced in dogs with higher basal serum cortisol concentrations, regardless of clinical control of the disease.…”

Increases in serum carbonylated protein levels of dogs with hypercortisolism

“…Our data suggest that protein carbonylation, which is one of the oxidative stress reactions, could be influenced by the medical control of HC. Although various methods have been considered for monitoring the health status after starting trilostane therapy, the gold standard has not yet been established for dogs with HC [19][20][21][22][23]. Additionally, the present results suggest that the carbonylation level of a 40-kDa protein could be a new factor used to monitor the medical condition of dogs with HC.…”

Ultrasonographic Changes of Adrenal Glands Size under Trilostane Therapy, Their Correlation with Clinical Signs and Endocrine Tests and Possibility of Introducing Ultrasound as Additional Monitoring Modality of Cushing’s Syndrome

“…If difficulties during blood sampling occurred (for example excessive movement, vocalizing, etc.) as suggested in recent studies [27] the stress factor was included in interpretation of test results. After every endocrine test ultrasound examination of both adrenal glands was done.…”