Concurrent metastatic islet cell carcinoma, ACTH‐producing pituitary carcinoma, adrenocortical necrosis and glucocorticoid‐deficient hypoadrenocorticism in a dog

Abstract

A 13-year-old female spayed boxer presented for severe hypoglycaemia. Electrolyte concentrations were within reference range, and adrenocorticotropic hormone (ACTH) stimulation test results were consistent with hypoadrenocorticism. Abdominal ultrasound revealed pancreatic and hepatic nodules. The left adrenal gland was of normal size, but the cranial pole of the right adrenal gland was enlarged. While the patient was severely hypoglycaemic, the insulin concentration was above reference range, consistent with insulinoma. The patient was hospitalised on dextrose supplementation and discharged on prednisone and directions to feed small, frequent meals. Surgery to remove the insulinoma was declined by the owner. When the hypoglycaemia became refractory to increasing doses of prednisone, diazoxide was added. Two months following initial presentation, the patient was euthanased due to refractory hypoglycaemia. Postmortem examination revealed a pancreatic islet cell carcinoma with metastatic lesions in the liver and pancreatic lymph nodes, a pituitary carcinoma that stained strongly positive with ACTH antibody, and adrenocortical necrosis.