STS Journals - Endocrine Flashcards
Magno JFMS 2023 - Surgical findings and outcomes after unilateral adrenalectomy for primary hyperaldosteronism in cats: a multi-institutional retrospective study
What were the most common presenting clinical signs?
What was the mean adrenal mass size?
What was the most frequent histopath diagnosis?
What was the survival to discharge?
What was the MST?
What long term tx was necessary?
HypoK, Hypertension, lethargy and neck ventroflexion
1.5x2.0cm
Cortical carcinoma 69%
97%
1082d (3yr)
No long term tx required - hypoK and hypertension resolved in almost all
Kang JSAP 2024 - Adrenalectomy for the treatment of hypotension in a cat with phaeochromocytoma associated with caudal vena cava syndrome
Fontes JAVMA 2024 - Outcome in dogs with invasive adrenal gland tumors that did not pursue adrenalectomy
What was the most common cause of ‘death’?
MST?
Haemoabdomen
50d
Farrell JAVMA 2023 - Bilateral, single-session, laparoscopic adrenalectomy was associated with favorable outcomes in a cohort of dogs
Describe positioning and portal placement
What was the conversion rate?
What was the median tumour size?
Laparoscopic adrenalectomy with the dog positioned in an oblique lateral recumbent position. A paramedian endoscopic portal was established lateral and caudal to the umbilicus. Depending on surgeon preference, 2 or 3 instrument portals were established in a triangulating pattern around the affected adrenal gland
1/6 (17.5%)
Median maximal tumor diameter was 2.6 and 2.3 cm for the right and left-sided tumors.
Mayhew JAVMA 2023 - Laparoscopic adrenalectomy for resection of unilateral noninvasive adrenal masses in dogs is associated with excellent outcomes in experienced centers
What was the rate of conversion? What variables were associated with an increased rate of conversion?
What were the most common complications?
What % survived to discharge? What factors were associated with an increased mortality?
What was associated with an increased risk of recurrence?
9.4% - increasing BCS and lesion size, more experienced surgeon
Capsular penetration (19%) and major haemorrhage (5%)
95% - increasing lesion size and lack of surgeon experience
Capsular penetration
Enright VS 2022 - Short- and long-term survival after adrenalectomy in 53 dogs with pheochromocytomas with or without alpha-blocker therapy
What 2 alpha-blockers are often utilised and for what reason are they used? (and were used in this study)
What impact did the use of alpha-blockers have on survival and intra-op findings?
What was the survival to discharge rate?
MST for dogs discharged?
Phenoybenzamine, prazosin - to manage hypertension
NONE - Preoperative alpha blockers not associated with increased survival, also did not appear to prevent hypertension/arrhythmias intra-op. NB lower doses & shorter duration (median 14d c.f. 20d in prev. study) than previously reported + only 14/53 dogs were not pre-treated.
83% 44/53
1169d
Mitsui JAVMA 2024 - Hypercoagulability based on thromboelastography is common in dogs undergoing adrenalectomy
What % of dogs were ‘hypercoagulable’ on TEG?
What % were hypocoagulable?
Which of the two TEGs is hypercoagulable?
53%
0%
Bottom (see pic)
Young VS 2022 - Balloon catheter as an extraction device for caudal vena cava adrenal tumor thrombectomy in a dog: A case report
Chiti VS 2021 - Renal venotomy for thrombectomy and kidney preservation in dogs with adrenal tumors and renal vein invasion
What % had successful renal preservation?
Which renal vein was more likely to be affected?
100% (5/5)
All were left (adrenal vein drains into left renal vein)
Knight VS 2019 - Variations in surgical technique for adrenalectomy with caudal vena cava venotomy in 19 dogs
How does a left vs right sided CVC venotomy differ?
What was the recommended upper limit of CVC which can be tolerated?
What was the rate of intra-op and post-op complications?
Peri-op mortality rate?
R side usually 2 tourniquets, L needs additional renal vein tourniquets due to proximity of renal vein & phrenicoabdominal on L side. L ureteronephrectomy required in some cases of L adrenal masses
8 minutes (median of 6.5mins achieved in this study) - although all 4 that had occlusion for longer (up to 25 mins) survived
74% intra-op (hypotension m.common), post-op 68%
21%
Mayhew VS 2019 - Perioperative morbidity and mortality in dogs with invasive adrenal neoplasms treated by adrenalectomy and cavotomy
What was the prei-op mortality rate?
MST?
Most common histopath diagnosis?
What factor was associated with a greater risk of death?
24%
547d (1.5yr)
Pheo
Postdiaphragmatic (rather than prediaphragmatic)thrombus termination was associated with a greater risk of death
Traverson JAVMA 2023 - Adrenal tumors treated by adrenalectomy following spontaneous rupture carry an overall favorable prognosis: retrospective evaluation of outcomes in 59 dogs and 3 cats (2000–2021)
Mortality rate?
Short term complication rate?
Negative prognostic factors for survival?
Overall MST?
21%
42%
Emergent sx, intraop hypotension and additional surgical procedures
MST 574d
Prego JSAP 2023 - Diagnosis, treatment and outcome of pheochromocytoma in a cat
How did this case present?
How was this case diagnosed following identification at imaging?
What is performed to confirm diagnosis?
Weight loss, PU/PD, weakness, and severe hypertension
LDDST, plasma aldosterone/renin activity –> to rule out cortical tumours
Plasma metanephrine and normetanephrine concentrations
Histopath and IHC - chromogranin A and synaptophysin (medullary markers)
Burkhardt VS 2021 - Ambidirectional cohort study on the agreement of ultrasonography and surgery in the identification of parathyroid pathology, and predictors of postoperative hypocalcemia in 47 dogs undergoing parathyroidectomy due to primary hyperparathyroidism
What US size cutoff was suggested to distinguish malignant from benign PT masses?
What pre-op factor was associated with a greater risk of becoming hypoCa post-op?
> 0.8mm more likely to be malignant
Agreement of ultrasound and surgery for number (66%) and side of affected glands (72%)
Pre-op iCa >1.75mEq/L
Erickson JAVMA 2021 - Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010–2019)
What number of nodules was most common?
What % of dogs became hypoCa post-op?
1, 2 and 3yr survival rates?
Single nodule in 70%, 2 in 25% & >3 in 4%
US identified PT nodule in 100% of cases
34%
Preop hyperCa resolved in 93% within 7d
1y - 84%
2y - 65%
3y - 51%
Young VS 2022 - Surgical description and outcome of US guided minimally invaisve parathyroidectomy in 50 dogs with primary hyperparathyroidism
Describe the approach
What was the rate of favourable outcomes?
US mini lateral approach between SH and ST muscles to expose thyroid gland and enlarged PT gland.
44/45 (98%)
Skinner VS 2021 - Metastasis to ipsilateral medial retropharyngeal and deep cervical lymph nodes in 22 dogs with thyroid carcinoma
What was the rate of mets?
45%
Scharf JSAP 2020 - Clinical features and outcome of functional thyroid tumours in 70 dogs
What was the MST reported? For sx and for medical tx?
What was the reported met rate?
What was the most common long term post-op complication?
35m (~3y), 72m for sx (6y) and 16m for medical
3% (c.f. skinner et al. 45%)
Hypothyroidism (64%)
Frederick JAVMA 2020 - Outcomes for dogs with functional thyroid tumours treated by surgical excision alone
What were the most common presenting clinical signs?
What breeds were predisposed?
Met rate?
MST w. sx only?
PU/PD, w.loss
Golden Retriever, Labrador Retriever (labs not mentioned in book)
~3%
MST 1072d (3yr)
Reagan JAVMA 2019 - Complications and outcomes associated with unilateral thyroidectomy in dogs with naturally occurring thyroid tumors: 156 cases (2003–2015)
What was the complication rate? What were the most common intra and post-op complications?
What was the peri-op mortality?
Survival to discharge rate and MST?
20% (haemorrhage intra op, a.pneumonia post-op)
2%
98%, MST 911d (30m)
Lyssens JSAP 2020 - I131 tx in dogs with hyperthyroidims caused by a non-resectable ectopic thyroid tumour: 5 cases (2008-2019)
What effects did the I131 have?
What complication was observed?
Tumour size reduction and total T4 reduced to ref range
Myelosuppression in 1 dog
