chasee parker

Chasee ParkerChasee Parker

SignalmentSignalment

Canine, Schipperke mixCanine, Schipperke mix Female, SpayedFemale, Spayed 12 years old12 years old

HistoryHistory

Significantly increased appetite over Significantly increased appetite over past yearpast year

PU/PDPU/PD

Physical ExamPhysical Exam

Abdomen: Hepatomegaly palpatedAbdomen: Hepatomegaly palpated PLN: Prominent axillary lymph nodesPLN: Prominent axillary lymph nodes Integument: Scaling noted Integument: Scaling noted All other parameters within normal All other parameters within normal

limitslimits

Diagnostic TestsDiagnostic Tests

CBC: plasma protein lipemic, no other CBC: plasma protein lipemic, no other abnormalities notedabnormalities noted

Biochemistry: hypercholesterolemia Biochemistry: hypercholesterolemia (397 MG/DL, rr=138-317), elevated (397 MG/DL, rr=138-317), elevated alkaline phosphatase (637 IU/L, rr=14-alkaline phosphatase (637 IU/L, rr=14-120), ALT (204 IU/L, rr=16-73), elevated 120), ALT (204 IU/L, rr=16-73), elevated creatine kinase (1314 IU/L, rr=48-380)creatine kinase (1314 IU/L, rr=48-380)

Urinalysis: 3+ protein, specific gravity Urinalysis: 3+ protein, specific gravity 1.022 (rr=1.015-1.045)1.022 (rr=1.015-1.045)

Diagnostics continuedDiagnostics continued

Elevated urine cortisol/creatinine Elevated urine cortisol/creatinine ratioratio

Urine cultureUrine culture Triglyceride level: mildly elevated Triglyceride level: mildly elevated

(218 MG/DL, rr=19-133)(218 MG/DL, rr=19-133) ACTH Stimulation Test: ACTH Stimulation Test: -base line=7.5 UG/DL, post=27.3 -base line=7.5 UG/DL, post=27.3

UG/DLUG/DL FNA of right axillary lymph nodeFNA of right axillary lymph node

RadiographsRadiographs

Spine-Lumbosacral: Spine-Lumbosacral: • bilateral hip dysplasia with secondary bilateral hip dysplasia with secondary

degenerative joint diseasedegenerative joint disease• L6-7 and L7-S1 spondylosis deformans L6-7 and L7-S1 spondylosis deformans

Hip DysplasiaHip Dysplasia

Spondylosis DeformansSpondylosis Deformans

RadiographsRadiographs

Thoracic:Thoracic:• spondylosis deformansspondylosis deformans• shoulder degenerative joint diseaseshoulder degenerative joint disease• no evidence of pulmonary metastatic no evidence of pulmonary metastatic

diseasedisease

Lateral ThoraxLateral Thorax

Ventral-Dorsal ThoraxVentral-Dorsal Thorax

Abdominal UltrasoundAbdominal Ultrasound

Hepatic hyperechogenicity, as with Hepatic hyperechogenicity, as with pronounced vacuolar changespronounced vacuolar changes

Hyperechoic nodule in midregion of Hyperechoic nodule in midregion of spleenspleen

Bilateral adrenomegalyBilateral adrenomegaly Small splenic nodules, likely benignSmall splenic nodules, likely benign Gallbladder sediment Gallbladder sediment

Left Adrenal GlandLeft Adrenal Gland

Left Adrenal GlandLeft Adrenal Gland

Left Adrenal GlandLeft Adrenal Gland

SpleenSpleen

LiverLiver

Right LiverRight Liver

GallbladderGallbladder

GallbladderGallbladder

Right Adrenal GlandRight Adrenal Gland

Right Adrenal GlandRight Adrenal Gland

MeasurementsMeasurements

DiagnosesDiagnoses

PolyphasiaPolyphasia Possible hyperadrenocorticism -Possible hyperadrenocorticism -

elevated ALT, ALKP and elevated ALT, ALKP and hypercholesteraolemiahypercholesteraolemia

Lipemia despite fasting –elevated Lipemia despite fasting –elevated triglycerides and cholesteroltriglycerides and cholesterol

ProteinuriaProteinuria Abdominal/thoracic Abdominal/thoracic

masses/prominent lymph nodesmasses/prominent lymph nodes

AssessmentAssessment

Clinical signs of polyphagia and Clinical signs of polyphagia and polyuria in conjunction with elevated polyuria in conjunction with elevated liver enzymes (ALT and ALKP), liver enzymes (ALT and ALKP), hypercholesterolemia, ACTH stim. hypercholesterolemia, ACTH stim. test and the ultrasound findings are test and the ultrasound findings are suggestive of hyperadrenaocorticismsuggestive of hyperadrenaocorticism• Leads to hyperactivity of adrenal glandLeads to hyperactivity of adrenal gland• Benign tumor of pituitary or tumor of Benign tumor of pituitary or tumor of

adrenal glandadrenal gland

Assessment continuedAssessment continued

Persistant proteinuria and lipemic Persistant proteinuria and lipemic plasma protein causing an elevated plasma protein causing an elevated triglyceride level is also consistant triglyceride level is also consistant with hyperadrenocorticism with hyperadrenocorticism

Elevated urine cortisol/creatinine Elevated urine cortisol/creatinine ratio also supportive of ratio also supportive of hyperadrenocorticism, but also hyperadrenocorticism, but also consistant with neoplasia, consistant with neoplasia, hyperthyroidism and stress hyperthyroidism and stress

Assessment continuedAssessment continued

Abdominal ultrasound is supportive of Abdominal ultrasound is supportive of hyperadrenocorticism as the primary hyperadrenocorticism as the primary ruleoutruleout

No evidence of neoplasia or metastatic No evidence of neoplasia or metastatic disease on either the ultrasound or disease on either the ultrasound or radiographsradiographs

Thoracic and abdominal radiographs Thoracic and abdominal radiographs revealed orthopedic disease including revealed orthopedic disease including spondylosis and DJD of shoulders and spondylosis and DJD of shoulders and hip dysplasia with secondary DJDhip dysplasia with secondary DJD