Download - 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