Ch 120 - Adrenal dependant cushings Flashcards
What percentage of pituitary dependent cushinoid dogs will also fail to suppress on LDDST?
40% - Therefore if suppression occurs, can confirm it is pituitary dependent, however, if no suppression, cannot differentiate
What percentage of Cushinoid dogs have adrenal dependant cushing?
15-20%
What size is the contralateral adrenal gland in adrenal dependant cushings?
<3mm
List the layers of the adrenal cortex
zona glomerulosa, zona fasicularis, zona reticularis
Bilateral adrenalectomies require what medications indefinitely?
Prednisone and DOCP (desoxycorticosterone pivalate)
What is the peri-operative mortality of adrenocortical tumours?
13-60% (4-22% with recent improved peri-op management)
What is the MST of adrenocortical tumour treated with trilostane alone?
MST 15.4m
List perioperative management strategies which can reduce perioperative mortality
- Pre-op treatment with trilostane for 2-3 weeks (goal is post-ACTH cortisol of 2-5mcg/dL and reduction of clinical signs)
- Frequent short walks within 4 hours after surgery
- Keeping anaesthesia as short as possible
- Minimally invasiv techniques may help to decrease tissue trauma and have a faster return to ambulation
List some potential complications after adrenalectomy for a cortisol-secreting tumour
- PTE
- Hypoadrenocorticism (glucocorticoid +/- mineralocorticoid)
What might be expected on a blood-gas analysis of a patient with a PTE?
- Hypoxaemia
- Hypocapnia
- Increased Aa gradient on room air
What treatments can be instituted to treat PTE?
- Oxygen
- Mechanical ventilaton may be needed
- Unfractionated heparin
- Judicious IVFT
- Theophylline (bronchodilation, pulm vasodilation, increased diaphragmatic contractility)
- Sildenafil - In documented pulm hypertension
