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Canine hyperadrenocorticism

image of Canine hyperadrenocorticism
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Abstract

Canine hyperadrenocorticism describes the excessive production or administration of glucocorticoids and is one of the most commonly diagnosed endocrinopathies in the dog. The chapter focuses on the physiology of the adrenal gland, causes of hyperadrenocorticism, clinical features, routine clinicopathological features, diagnostic imaging, diagnostic endocrine tests, tests to differentiate the cause of hyperadrenocorticism and treatment.

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Figures

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16.1 Regulation of glucocorticoid release. ACTH adrenocorticotropic hormone. CRH = corticotropin-releasing hormone.
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16.3 The pituitary-adrenal axis in pituitary-dependent hyperadrenocorticism. The pituitary-adrenal axis in adrenal-dependent hyperadrenocorticism. ACTH = adrenocorticotropic hormone; CRH = corticotropin-releasing hormone.
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16.4 Pituitary macroadenoma found on post-mortem examination of a 13-year-old Golden Retriever that had been successfully treated with mitotane for hyperadrenocorticism for 5 years. There were no neurological signs associated with this tumour.
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16.5 An adrenocortical carcinoma of the right adrenal gland invading the phrenicoabdominal vein. The caudal vena cava can be seen at the top of the photograph.
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16.6 The cut surface of both adrenal glands from thesame case as Figure 16.4 . Note the severe cortical atrophy (pale rim) in the contralateral adrenalgland.
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16.8 A 6-year-old Poodle bitch with pituitary-dependent hyperadrenocorticism. Note the abdominal distension, muscle wasting, alopecia and thin skin.
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16.9 The skin on the ventral abdomen can be tented to assess elasticity.
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16.10 In hyperadrenocorticism, the skin is thin and inelastic and remains tented. The abdominal veins are visible through the skin.
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16.11 Comedones around a nipple. The skin is thin and abdominal veins are visible.
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16.12 Extensivebruising on the neck of aPomeranian with hyperadrenocorticism. This resultedfrom a single needleinsertion with minimalrestraint and pressurebeing applied for aminute or soafterwards.
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16.13 Partial breakdown of an abdominal incision in a Boxer with hyperadrenocorticism.
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16.14 Skin in the inguinal area of a poodle. Focal areas of calcinosis cutis can be seen eroding through the epidermis. Comedones are also present.
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16.17 Abdominal radiograph of a Cairn Terrier with pituitary-dependent hyperadrenocorticism. The radiographic signs include hepatomegaly, abdominal distension, calcinosis cutis, dystrophic calcification in the soft tissues along the spine, an enlarged bladder and osteopenia.
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16.18 Abdominal radiograph of a Yorkshire Terrier with an adrenal tumour. The calcified mass can be seen in the dorsocranial area of the abdomen (open arrow). In addition, cystic (blue arrow) and urethral (yellow arrows) calculi are present. Despite this extensive urolithiasis, the dog was able to urinate normally. The anti-inflammatory effects of the excessive glucocorticoids may have contributed to this
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16.19 Ultrasonography of the canine adrenal gland. Ultrasonograph of the right adrenal of an 8-year-old crossbreed dog with pituitary-dependent hyperadrenocorticism showing the thickened hypoechoic cortex surrounding a normal echogenic medulla. Ultrasonograph of the right adrenal of an 8-year-old German Shepherd bitch with adrenal-dependent hyperadrenocorticism. The adrenal tumour is the large mixed echogenic mass in the centre of the scan that has completely replaced the normal architecture of the adrenal gland. Ultrasonography of the canine adrenal gland. Ultrasonograph of the cranial abdomen of a 10-year-old Labrador Retriever bitch with an adrenocortical carcinoma which has invaded the caudal vena cava (CVC).
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16.20 MRI: T2-weighted midline sagittal image, and T2-weighted transverse image showing a pituitary macroadenoma in a 10-year-old Bulldog with pituitary-dependent hyperadrenocorticism and central diabetes insipidus.
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16.21 A summary flow chart of the key stages in diagnosing canine hyperadrenocorticism. ADH = adrenal-dependent hyperadrenocorticism; PDH = pituitary-dependent hyperadrenocorticism.
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16.23 Interpretation of measurements of plasma cortisol concentrations before and after the administration of synthetic ACTH. ACTH = adrenocorticotropic hormone
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16.24 Interpretation of measurements of plasma cortisol concentrations before and after the administration of a low dose of dexamethasone (DXM). ?PDH/ADH represents the type of response seen in cases of pituitary-dependent or adrenal-dependent hyperadrenocorticism. PDH represents the response in pituitary-dependent cases where suppression occurs.
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16.26 A 10-year-old crossbred dog with pituitary-dependent hyperadrenocorticism. Before treatment; after commencing treatment with mitotane; 6 months later.

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