HAC in cats

Question 1

Why do cats show less steroid related signs than dogs?

Answer 1

Fewer cortisol receptors

Question 2

What is atypical HAC?

Answer 2

Signs of excess glucocorticoids d/t presence of hormones other than cortisol - mainly 17-OH-progesterone

Question 3

What is the typical signalment in cats?

Answer 3

Normally middle aged to older
F>M
DSL/DSH more than breeds

Question 4

What are the clinical signs in cats?

Answer 4

PUPD, normally to do with DM
PP
Weight gain or loss
Dermatological dz - hair loss/ chronic skin infections/ skin fragility syndrome
Poorly regulated DM
Lethargy
Poor wound healing
Muscle wastage

Question 5

What are common co-morbidities?

Answer 5

DM
Heart murmur grade 1-4
Skin fragility syndrome
Acute pancreatitis
DKA
GI dz

Question 6

What is often seen on clin path

Answer 6

Haem - unremarkable, shouldn't really see leukopaenia
Biochem - high BG
High cholesterol
High TG
High ALT and LOW ALP
High BUN sometimes

Question 7

Outline the low ALP seen with cats

Answer 7

D/t short half life and lack of enzymes
If see high ALP there is a cholestatic disorder, incl hepatic lipidosis or severe swelling of hepatocytes dt steroid hepatopathy

Question 8

What would you see on UA?

Answer 8

High SG inspite of PUPD
If SG low susp CKD
Mild proteinuria
UTIs rare
Glucosuria

Question 9

What would you want to image?

Answer 9

Thoracic rads to r/o cardiomegaly (acromegaly, high T4, other)
Abdo U/s
MRI/CT for pituitary tumours

Question 10

What is a good screening test for HAC?

Answer 10

UCCR
easy to perform
single sample needed
V sensitive, unknown specificity

Question 11

How useful is the ACTH stim?

Answer 11

NOT
Poor sensitivity
Unknown specificity

Question 12

How do you definitively dx

Answer 12

C/S
Imaging
LDDST

Question 13

How do you differential PDH and ADH

Answer 13

Imaging
HDDST
Endogenous ACTH (best)

Question 14

What are treatment option

Answer 14

Really only trilostane or Sx
Mitotane ineffective
Ketokonazole has promise for the future
Radiation or pituitary tumours possible

Question 15

How do you assess response to trilostane?

Answer 15

ACTH stim 10-14d, 30d, 90d post starting
Assess kidney values as may unmask dz
Do not use trilostane if kidney or liver dz present

Question 16

What are possible complications with Sx?

Answer 16

Pancreatitis
Low BG
electrolyte issues
Stabilise prior
Do not do if skin fragile/ muscle wastage

Question 17

What is the prognosis in cats?

Answer 17

Medical - MST 617d
Sx - reported more than 30
Radiation - 522d

Question 18

How is iatrogenic HAC different?

Answer 18

Get skin hyperpigmentation
medially curled pinna
bruising