Hyperadrenocorticism treated with metyrapone followed by bilateral adrenalectomy in a cat

Abstract

A 6-year-old spayed female cat was evaluated for uncontrolled diabetes mellitus and poor hair coat. Clinicopathologic abnormalities included high serum activity of liver enzymes, hyperglycemia, hypercholesterolemia, glucosuria, and an exaggerated response to ACTH stimulation. Abdominal ultrasonography revealed large adrenal glands. Hyperadrenocorticism was diagnosed. Treatment for a facial abscess was instituted along with administration of metyrapone for hyperadrenocorticism. After stabilization, bilateral adrenalectomy was performed. The cat recovered without complications and has remained clinically normal for 5 months with treatment of desoxycorticosterone pivalate and prednisone. Treatment with metyrapone appeared to stabilize the cat metabolically and clinically prior to surgery.

Hyperadrenocorticism in Cats

“…To aid in this discussion, information from the records of 56 cats diagnosed as having FCS at our hospital, including some reported in the literature (Duesberg et al, 1995) were added to the information from 31 cats described in the literature (Immink et al, 1992;Daley et al, 1993;Goossens et al, 1995;Schwedes, 1997;Watson and Herrtage, 1998;Moore et al, 2000a;Meij et al, 2001;Skelly et al, 2003;Neiger et al, 2004), for a total of 87 cats with naturally occurring FCS. This literature includes only those reports published since 1992, to have greater confidence that valid and currently available assays were used in the assessment of each cat and that current concepts in diagnosis and treatment were used.…”

PlasmaACTHPrecursors in Cats with Pituitary‐Dependent Hyperadrenocorticism

“…H yperadrenocorticism (HAC) in cats is a rare condition, with no more than 100 cases reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It is caused by a functional pituitary adenoma in 80% of cases. 1,16,17 About 50% of these pituitary tumors are microscopic, the others being large enough for visualization by computed tomography (CT) or magnetic resonance imaging (MRI).…”

Treatment of canine and feline hyperadrenocorticism: trilostane and the alternatives

“…Idiosyncratic ketoconazole-induced hepato-and other toxicity appear to be rare, but therapy is commonly associated with gastrointestinal upset (Lien and Huang, 2008;Mayer et al, 2008). Metyrapone inhibits the conversion of 11-deoxycortisol to cortisol, and successfully improved HAC clinical signs prior to bilateral adrenalectomy in two cats, but reports in dogs are lacking (Daley et al, 1993;Moore et al, 2000). In summary, trilostane is the medical management option of choice for the UK veterinarian, and mitotane is an appropriate second line therapy.…”